Validation of a self-administered modified CAGE test (CAGE-C) in a somatic hospital ward: comparison with biochemical markers.

OBJECTIVE: The time frame for the original CAGE questionnaire is lifetime and it does not quantify drinking frequency and may be less suitable in a population with very few teetotalers. The purpose of this study was to validate a variant of the CAGE questionnaire and compare it with the outcome of a thorough interview according to DSM-III and ICD-10 criteria and to the outcome of biochemical markers in inpatients in a somatic hospital setting. MATERIAL AND METHODS: The questionnaire and biochemical markers were tested on a random sample of 130 patients admitted to a department of orthopedic surgery. The result of a diagnostic interview with a trained staff member from the local alcohol treatment unit was used as the gold standard. Data were analyzed by means of receiver operating characteristic (ROC) curves. RESULTS: In this population 25 % had an alcohol problem and the questionnaire proved to be valid, with a sensitivity and specificity of 0.94 and 0.88, respectively, while the positive predictive value (PVpos) was 0.73 and the negative predictive value (PVneg) was 0.98. Carbohydrate-deficient transferrin (CDT) had a sensitivity and a specificity of 0.47 and 0.96, and PVpos and PVneg of 0.80 and 0.85, respectively. CONCLUSIONS: This new diagnostic questionnaire is simple, easy to administer and suitable for screening purposes in populations with a high prevalence of at-risk drinkers.

[Alcohol consumption among patients aged 65 and over in an emergency medical department. A comparison between medical records and interviews]. / Alkoholforbrug hos patienter over 65 år på en medicinsk modtageafdeling. En sammenligning mellem journaloplysninger og interview.

METHODS: Two hundred and seven randomly selected patients more than 65 years of age were interviewed about their alcohol habits in a max. 15 minutes interview. The consumption was classified as "borderline consumption" (BC): 14/21 drinks per week female/male, "heavy users" (HU): more than 14/21 drinks per week female/male and "control group" (CG): less than 14/21 drinks per week female/male. RESULTS: Twenty-five percent of the patients were BC or HU. Thirty-one percent of the HU had unspecified vertigo/falling tendency compared to 2% in the CG. Sixty-three percent of the HU and 77.7% of the BC were registered in their medical notes as having "no alcohol consumption" or a much lower (50%) consumption than that found by interview. DISCUSSION: It is concluded, that you get a better estimate of alcohol consumption by asking: "How/when do you use alcohol?" and thereafter calculating the intake.

[Reactive psychosis in connection with an executive replacement program]. / Reaktiv psykose i forbindelse med "gyldent håndtryk".

A case of reactive psychosis, after an "executive replacement" programme, is described and the importance of a proper evaluation of the patient's crisis before entering such a programme is emphasized.

Integration of DSM-III and ICD-8 to be used in a consultation-liaison psychiatric service. Preliminary experiences.

In 1983 a total of 405 patients received psychiatric supervision in somatic departments in the general hospital. At this supervision, these patients were registered by means of a five-axial diagnostic coding according to the DMS III principle, and this was combined with a quantitative global assessment of the severity of the condition. Reliability testing was undertaken by five supervising physicians with a total of 15 patients. The total number of supervisions constituted one supervision per somatic bed per annum. Women were overrepresented, and medical departments made the greatest use of psychiatric supervision. Reactive conditions dominated parallel with a high relative incidence of alcohol-related conditions. In patients with diagnoses of psychoses, only slight to moderate psychiatric symptoms were encountered. This held true also for personality deviations. 50% of the patients had experienced significant psychosocial stress, but 10% of these were diagnosed as having non-reactive psychoses, 52% of the patients had moderate to pronounced disturbances of social function. Half of the patients supervised in this manner could be investigated or treated in the referring departments. Approximately half of the patients in whom referral to private psychiatric specialists was made did not keep these appointments. Reliability testing in the material shows the employability of the diagnostic armamentarium. All in all, the investigation suggests that extension of the liaison psychiatric service in somatic departments would result in a relative increase in the number of patients who could be treated in the referring department and an increase in the number of psychiatric conditions diagnosed. Establishment of a psychiatric outpatient clinic in the somatic environment appears to be indicated.