Independent versus substance-induced major depressive disorder in substance-dependent patients: observational study of course during follow-up.

OBJECTIVE: Clinicians frequently encounter patients presenting with both depression and substance abuse, and their diagnosis has been a source of controversy. The authors examined whether baseline and past diagnoses of DSM-IV primary (independent) or substance-induced depression or other psychiatric syndromes predict 1-year course of depression in substance-dependent patients. METHOD: Inpatients with current DSM-IV major depressive disorder (MDD) and DSM-IV alcohol, cocaine, or opiate dependence (N = 110) were evaluated with the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) and followed for 12 months after discharge. Logistic regression for repeated measures modeled the odds of MDD and depressed mood over time as a function of baseline diagnoses and past independent depression, controlling for demographics, substance use, and antidepressant treatment during the follow-up. Subject recruitment was conducted from July 25, 1995 to May 14, 1997. RESULTS: Over the 12 months, 88% of the patients experienced depressed mood for at least 1 week, and 57% experienced MDD. Depression during follow-up was equally likely among patients with current (baseline) DSM-IV independent or substance-induced MDD; in the latter group, past independent MDD increased the likelihood of MDD during the follow-up. Panic attacks, posttraumatic stress disorder (trend), borderline personality, and antisocial personality also significantly predicted depression during the follow-up. CONCLUSIONS: In substance-dependent patients, both DSM-IV primary and substance-induced MDD predict future depression, warranting consideration for specific treatment. The data suggest the importance of a careful psychiatric history that includes attention to past episodes of independent depression as well as anxiety and cluster B personality syndromes.

Diagnosis of comorbid psychiatric disorders in substance users assessed with the Psychiatric Research Interview for Substance and Mental Disorders for DSM-IV.

OBJECTIVE: The authors used the Psychiatric Research Interview for Substance and Mental Disorders for DSM-IV (PRISM-IV) to test the reliability of DSM-IV-defined disorders, including primary and substance-induced disorders, in substance-abusing subjects. METHOD: Substance-abusing patients (N=285) from substance abuse/dual-diagnosis treatment settings and mental health treatment settings participated in test and blind retest interviews with the PRISM-IV, which includes specific guidelines for assessment of substance abusers. RESULTS: Kappas for primary and substance-induced major depressive disorder ranged from 0.66 to 0.75. Reliability for psychotic disorders, eating disorders, antisocial personality disorder, and borderline personality disorder was in the same range. Reliability for most anxiety disorders was lower. Reliability was good to excellent (kappas >/=0.65) for most substance dependence disorders. Continuous measures (severity, age at onset) had intraclass correlation coefficients >0.70 with few exceptions. Reliability was better for primary than for substance-induced disorders, although not greatly so. CONCLUSION: Most DSM-IV psychiatric disorders can be assessed in substance-abusing subjects with acceptable to excellent reliability by using specifically designed procedures. Good reliability improves the likelihood of significant study results.

Alcohol dependence symptoms and alcohol dehydrogenase 2 polymorphism: Israeli Ashkenazis, Sephardics, and recent Russian immigrants.

BACKGROUND: Jews have lower rates of alcohol-related problems than other Caucasians. The ADH2*2 allele of the alcohol dehydrogenase 2 (ADH2 ) gene protects against alcoholism in Asians and is found in approximately 20% of Jews. We studied the relationship of ADH2*2 to DSM-IV dependence severity in a random community sample of Israeli Ashkenazis, recent Russian immigrants (also Ashkenazis), and Sephardics. METHODS: Subjects participated in a structured interview that included highly reliable questions on DSM-IV alcohol dependence symptoms. ADH2 genotype was determined for 68 subjects. RESULTS: Recent Russian immigrants had more past and lifetime DSM-IV dependence symptoms. Sephardics had a higher prevalence of ADH2*2 than Ashkenazis. Controlling for group and other potentially confounding factors, ADH2*2 was associated with a lower lifetime DSM-IV alcohol dependence severity, although this differed somewhat within groups. CONCLUSIONS: ADH2*2 protects against dependence severity in Jewish samples. Future work in larger samples should address genetic and environmental factors that affect the relationship of ADH2*2 to alcohol consumption and dependence.

Alcohol and ADH2 in Israel: Ashkenazis, Sephardics, and recent Russian immigrants.

OBJECTIVE: Jews drink less than other Caucasians and have a higher prevalence of ADH2*2, an allele of an alcohol dehydrogenase gene that protects against heavy drinking. The relationship of ADH2 polymorphisms to lifetime maximum number of drinks per occasion was investigated in recent Russian immigrants to Israel (exposed to heavier drinking in their country of origin), other Israeli Ashkenazis, and Sephardics. METHOD: Seventy-five randomly sampled Israelis participated in a structured interview. ADH2 was genotyped for 68 subjects. RESULTS: ADH2*2 predicted less drinking; however, associations between ADH2 and drinking appeared to differ across the groups, consistent with differences in environmental exposure to heavy drinking. CONCLUSIONS: The findings support a protective effect for ADH2*2 against heavy drinking in Jewish samples but also suggest the importance of environment. Future work should investigate interactions between genes and the environment in larger samples.