Hospital del Mar Research Institute Hospital del Mar Research Institute

Addiction Marta Torrens


Dual pathology, psychiatric comorbidity in addictive disorders

At present, we have validated a dual diagnosis screening survey (ECDD). ECDD has a set of 66 questions grouped into five diagnostic sections and one section on observations structured as follows:

  • Section A (Anxiety) is divided into anxiety/panic attacks (three questions), General Anxiety (three questions), Simple Phobia (seven questions), Social Phobia (two questions), and Agoraphobia (two questions).
  • Section B is divided into Depression (seven questions), dysthymia (two questions), and Mania (five questions).
  • Section C (Psychosis) is the longest section, with 24 questions.
  • Section D (ADHD) has six questions and, finally,
  • Section E (post-trauma) has two more questions.

Once the survey is over, the interviewer is asked to answer three questions on the respondent’s state and level of cooperation during the interview. The interviewer may also add comments on how the interview developed, on the respondent’s attitude or anything else considered worth noting in a specific Section on observations created for this purpose.

PRISM-IV is a structured interview based on the DSM-IV diagnosis criteria that has been designed specifically to differentiate primary mental disorders from substance-induced disorders, the expected effects of intoxication and abstinence in people with a high consumption of alcohol and other substances.

The main features that make PRISM a specific tool to study comorbidity in drug-dependent people are:

  • It adds specific assessment/classification guidelines during the interview, such as establishing the frequency and duration of symptoms, explicit exclusion criteria and guidelines to solve any doubts;
  • Sections on alcohol and other drugs are positioned nearly at the beginning of the interview, before sections on mental disorders and
  • Using a more structured anamnesis on alcohol and other drugs, it provides a better context to monitor psychiatric comorbidity.

PRISM assesses 20 Axis I Disorders and 2 Axis II Disorders according to DSM-IV, which are:

  • Substance Use Disorder, including abuse and dependence for each of the substances (alcohol, cannabis, hallucinogenic drugs, opiates and stimulants);
  • Primary affective disorder (Major Disorder, Maniac Episode, Bipolar Disorder I, Affective Disorder with Psychotic symptoms, Episodes of Hypomania, Bipolar Disorder II, Dysthymia and Cyclothymic Disorder);
  • Primary Anxiety Disorder (Panic Disorder, Simple Phobia, Social Phobia, Agoraphobia, Obsessive-Compulsive Disorder, General Anxiety Disorder and Post Trauma Stress Disorder);
  • Primary Psychotic Disorder (Schizophrenia, Schizophreniform Disorder, Delusional Disorder, brief Psychotic Disorder and unspecified Psychotic Disorder);
  • Food Disorders (Anorexia, Bulimia and binge eating Disorder);
  • Personality Disorders (Anti-social Disorder and Borderline Personality Disorder)
  • Substance Induced Disorders (Major Depression, Mania, Dysthymia, Psychosis, Panic Disorder and General Anxiety Disorder).

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