Substance abuse and dependence in physicians: the Missouri Physicians' Health Program.

Substance abuse and dependence (alcohol and drugs) are behavioral disorders and treatable medical diseases. There is growing concern in the medical community for physicians impaired by these diseases. The Missouri Physicians' Health Program has been established to help impaired physicians return to healthy personal and professional lives. This confidential voluntary program of early referral, intervention, treatment, monitoring, and advocacy has been highly successful. The average recovery rate in this study of 146 participants was 94%.

The impaired physician, Part II: Missouri State Physicians Health Program.

Missouri Physicians Health Program (MPHP) was established to help impaired physicians return to healthy personal and professional lives. One percent of Missouri physicians will suffer some sort of impairment; ie: substance abuse, or dependency of drugs or alcohol within a year. This is a confidential voluntary program. This program of early referral, intervention, treatment and monitoring advocacy has been highly successful. The average recovery rate in this study of 75 participants was 92%.

Substance abuse and dependence in physicians: an overview of the effects of alcohol and drug abuse.

Substance abuse and dependence (alcohol and drugs) are behavioral disorders and treatable medical diseases. Early intervention followed by appropriate treatment can often help return physicians to healthy personal and professional lives. Current scientific evidence suggests the prevalence of substance abuse or dependence among the medical profession over a lifetime is approximately 10-15%, slightly in excess of the general population. The initiation of intervention is critical and ultimately may be lifesaving.

Response to treatment with antidepressants of patients with severe or moderate nonpsychotic depression and of patients with psychotic depression.

Hospitalized patients were divided into nonpsychotic severely depressed (N = 53), nonpsychotic moderately depressed (N = 54), and psychotic depressed (N = 25) groups and treated with either imipramine or amitriptyline, up to 250 mg/day, for 4 weeks. Good response occurred in 39% of the 38 severely depressed, 67% of the 49 moderately depressed, and 32% of the 19 psychotic depressed patients who completed treatment. The response of the patients with nonpsychotic severe depression did not differ significantly from the response of those with psychotic depression, and both groups fared worse than the group with nonpsychotic moderate depression.

Sociodemographic and prior clinical course characteristics associated with treatment response in depressed patients.

A sociodemographic and clinical picture is presented of 82 depressed subjects who had an unequivocal response or lack of response to treatment with amitriptyline or imipramine. Patients with less severe depressive illness were found more likely to respond to treatment, while those with psychotic features were more likely to be treatment resistant. Sociodemographic and other prior and current clinical course variables were not predictive of treatment response in depressed patients.

Association of alcoholism and antisocial personality in a narcotic-dependent population: the Lexington addicts.

Men with antisocial personality have a higher prevalence of alcoholism than men without. This relationship was examined in a narcotic-dependent sample, and it was found that narcotic-dependent men with antisocial personality had a rate of alcoholism comparable to that of narcotic-dependent men without antisocial personality. The methodological and clinical explanations for this finding are discussed along with the neurophysiological implications.

Psychiatric diagnosis and prediction of drug and alcohol dependence.

Some sociodemographic variables that have distinguished the future addict from the general population have not been found to predict outcome in those already dependent. This study demonstrates that a past history of specific psychiatric disorders is predictive of outcome in narcotic addicts. Future research should focus on interactions among past histories, past and present personality and motivation, and situational variables in the search for reliable clinical prognostic factors.

Psychiatric illness in male and female narcotic addicts.

This report describes the results of initial psychiatric interviews on 100 male and 100 female narcotic addicts who were matched by age, race, and geographic origin. The majority met criteria for antisocial personality whereas about one in four males and one in seven females met criteria for alcoholism. Between one-third and one-half of the subjects met criteria for secondary depression. Bipolar affective disorder and schizophrenia rates were not elevated. Males significantly more often were diagnosed as having antisocial personality and alcoholism whereas females significantly more often were diagnosed as having a non-drug depression. Treatment implications of the observed differences between males and females are discussed.

Diagnostic concordance between DSM-III, Feighner, and RDC.

The NIMH Diagnostic Interview Schedule was administered by psychiatrists to 216 individuals. The DSM-III, Feighner, and RDC diagnoses derived from the computerized interview results were then compared for eight psychiatric disorders. Rates of diagnostic concordance among the systems are given, and the causes of diagnostic discrepancies are discussed. Diagnostic concordance was highest for mania and alcoholism and lowest for schizophrenia and antisocial personality disorder. Implications of these findings and future research directions are discussed.

Renard diagnostic interview. Its reliability and procedural validity with physicians and lay interviewers.

A psychiatric diagnostic interview that can be reliably and validly administered by nonpsychiatric physicians and lay interviewers has both research and clinical applications. We examined the interrater reliability and procedural validity of the Renard Diagnostic Interview (RDI), an instrument designed for these purposes. Randomly selected psychiatric inpatients were interviewed once by a psychiatrist using our standard departmental research interview and were then given RDIs by two psychiatrists, two lay interviewers, or one of each. The reliability of the RDI is estimated by examining diagnostic concordance for the two RDI interviews. Procedural validity is estimated by examining diagnostic concordance between the RDI and the traditional departmental interview. Both reliability and procedural validity were found to be high, and the study demonstrates that lay interviewers using the RDI after a brief period of training can obtain accurate diagnostic information.

Alcoholism and alcohol dependence in narcotic addicts: a prospective study with a five-year follow-up.

In this paper we report on the prediction of mortality, alcohol dependence, and the rate of previously undiagnosed alcoholism in male and female narcotic addicts. These subjects (N = 200) were initially interviewed upon admission to the Clinical Research Center, National Institute of Mental Health, Lexington, Kentucky, and prospectively followed-up and reinterviewed 5 years later (N = 187). The results indicate that alcoholism and alcohol dependence are very prevalent in this sample of addicts. A history of diagnosable alcoholism obtained at admission was a significant predictor of mortality during the follow-up period whereas a history of heavy drinking was associated with increased mortality but not significantly. About one-half of the males and one-quarter of the females met criteria for alcohol dependence during the follow-up period. Both a prior diagnosis of alcoholism and a history of heavy drinking were significant predictors of episodes of alcohol dependence during the follow-up period. In addition, the proportion of subjects positive for alcoholism increased between two- and threefold during the 5-year period. Finally, a history of heavy drinking at any time within the 4 years immediately prior to admission significantly predicted subsequent episodes during the follow-up period.

The management of patients with undiagnosed psychiatric illness.

The results of using formal diagnostic criteria on a series of newly admitted inpatients are presented. Several strategies were employed in the management of the undiagnosed patients. The percent of undiagnosed patients significantly decreased with time during the course of hospitalization.