Comorbid anxiety and affective disorder in alcohol-dependent patients seeking treatment: the first Multicentre Study in Germany

U. SCHNEIDER 10 11 A. ALTMANN 10 11 18 M. BAUMANN 10 11 16 J. BERNZEN 10 11 15 B. BERTZ 10 11 22 U. BIMBER 10 11 21 T. BROESE 10 11 20 A. BROOCKS 10 11 15 W. BURTSCHEIDT 10 11 19 K. F. CIMANDER 10 11 24 P. DEGKWITZ 10 11 23 M. DRIESSEN 10 11 15 H. EHRENREICH 10 11 18 E. FISCHBACH 10 11 17 H. FOLKERTS 7 10 11 H. FRANK 7 10 11 D. GURTH 8 10 11 U. HAVEMANN-REINECKE 10 11 18 W. HEBER 5 10 11 J. HEUER 10 11 17 A. HINGSAMMER 6 10 11 S. JACOBS 10 11 18 H. KRAMPE 10 11 18 W. LANGE 10 11 17 T. LAY 10 11 20 M. LEIMBACH 7 10 11 M. R. LEMKE 3 10 11 M. LEWEKE 10 11 19 A. MANGHOLZ 10 11 18 W. MASSING 4 10 11 R. MEYENBERG 6 10 11 J. PORZIG 10 11 18 T. QUATTERT 1 10 11 C. REDNER 10 11 19 G. RITZEL 1 10 11 J. D. ROLLNIK 10 11 R. SAUVAGEOLL 10 11 21 D. SCHLFKE 10 11 20 G. SCHMID 10 11 20 H. SCHRDER 2 10 11 U. SCHWICHTENBERG 0 10 11 D. SCHWOON 10 11 23 J. SEIFERT 10 11 I. SICKELMANN 10 11 C. F. SIEVEKING 9 10 11 C. SPIESS 10 11 H. H. STIEGEMANN 1 10 11 R. STRACKE 8 10 11 H. D. STRAETGEN 10 11 12 P. SUBKOWSKI 10 11 13 R. THOMASIUS 10 11 23 H. TRETZEL 10 11 22 L. J. VERNER 10 11 J. VITENS 10 11 14 T. WAGNER 10 11 18 S. WEIRICH 10 11 20 I. WEISS 6 10 11 T. WENDORFF 3 10 11 T. WETTERLING 10 11 16 B. WIESE 10 11 J. WITTFOOT 10 11 17 0 Nds. Landeskrankenhaus, Osnabrck 1 Nds. Landeskrankenhaus, Hildesheim 2 Klinik fr Psychiatrie und Psychotherapie, Langenhagen 3 Christian-Albrechts Universitt , Kiel 4 Tagesklinik Knigstrae, Hannover 5 Nds. Landeskrankenhaus, Gttingen 6 Klinik fr Psychiatrie und Psychotherapie III des Zentralkrankenhauses Bremen Ost/Universitt Oldenburg 7 Reinhard-Nieter Krankenhaus, Wilhelmshaven 8 Klinikum Nord, Hamburg 9 Paracelsus-Wiehengebirgsklink, Bad Essen 10 Hannover, Department of Clinical Psychiatry and Psychotherapy , OE 7110, 30625 Hannover, Germany 11 Medizinische Hochschule Hannover 12 Fachklinik Holstein, Lbeck 13 Paracelsus Berghof-klinik, Bad Essen 14 Nds. Landeskrankenhaus Wehnen, Bad Zwischenahn, Germany 15 Medizinische Universitt , Lbeck 16 Johann-Wolfgang-Goethe Universitt , Frankfurt 17 Gilead, Psychiatrische Klinik, Bielefeld 18 Georg-August Universitt , Gttingen 19 Psychiatrische Klinik der Heinrich Heine Universitt , Dsseldorf 20 Klinik fr Psychiatrie und Psychotherapie der Universitt Rostock 21 Zentrum fr Soziale Psychiatrie, Bad Emstal 22 Klinikum der Hansestadt Stralsund 23 Universittskrankenhaus , Hamburg 24 Zentrum fr Drogenkranke, Hannover The goals of this study were to describe demographic variables, drinking history, and the 6-month prevalence of Axis I comorbidity among alcohol-dependent subjects in Germany. The variables: amount of alcohol consumption, age at onset of the first alcohol consumed, age at onset of daily alcohol consumption, age at onset of withdrawal symptoms and number of detoxifications were related to the different comorbid disorders and gender. In this study, 556 patients from 25 alcohol treatment centres were enrolled between 1 January 1999 and 30 April 1999. After a minimum of 10 days of sobriety patients who fulfilled ICD-10 and DSM-IV criteria of alcohol dependence were interviewed for data collection using the Mini-DIPS (German version of the Anxiety Disorders Interview Schedule) and a standardized psychosocial interview. The 6-month prevalence of comorbid Axis I disorders was 53.1%. Among the patients with comorbidity, affective and anxiety disorders were most frequent. Comorbid stress disorder was associated with an early start of drinking, an early beginning of withdrawal symptoms, highest number of detoxifications, and the highest amount of alcohol consumed. Female patients with anxiety disorder consumed more alcohol and started earlier than females without this comorbid disorder. The data do not answer the question of the pathogenesis of comorbid disorders and alcoholism, but indicate that stress disorders in alcoholic patients and anxiety disorders in female alcoholics influence the course and severity of alcoholism. INTRODUCTION While many alcohol treatment units exclusively focus on alcohol problems, psychiatric comorbidity may be underestimated both diagnostically and therapeutically. Although the impact of co-occurring disorders remains controversial (Schuckit, 1985; Bean-Bayog, 1988) it is reasonably clear that alcohol-dependent individuals who meet diagnostic criteria for one or more comorbid psychiatric disorders differ from those without comorbidity in many clinically relevant ways. Among alcohol-abusing and alcohol-dependent patients, prevalence rates for psychiatric comorbidity of between 57% and 84% have been reported (Powell et al., 1987; Regier et al., 1990; Wittchen et al., 1992). Depressive disorders as well as anxiety disorders were found very frequently (Arolt and Driessen, 1996; Schuckit et al., 1997; Berglund and Ojehagen, 1998; Swendsen et al., 1998; Tondo et al., 1999). The amount of pure alcohol consumed is higher in Germany than in most other European countries. However, there is a paucity of data concerning psychiatric comorbidity in alcohol-dependent patients (Driessen et al., 1998). This multicentre study, which is the largest in sample size yet undertaken in Germany, aimed to close that gap. The CART (Classification and Regression Trees) procedure was used for data analysis. Two main issues were addressed by the study: (1) to investigate the current (6 months) prevalence of psychiatric comorbidity in alcohol-dependent patients in 25 treatment centres; (2) to analyse the relation of comorbid disorders and gender on alcohol-related variables. SUBJECTS AND METHODS The Multicentre Study of Psychiatric Comorbidity in Alcoholics (MUPCA) is a retrospective study that enrolled 556 patients from 25 centres between 1 January 1999 and 30 April 1999. These 25 centres cover a population of 7 250 000 inhabitants, representing ~10% of the population of Germany, and they treat anually about 15 285 patients with alcoholrelated disorders. Only those patients who fulfilled ICD-10 (World Health Organization, 1992) and DSM-IV (American Psychiatric Association, 1994) criteria of alcohol dependence were included in this study. Patients with additional substance misuse or dependence were excluded. The patients were interviewed face to face after a minimum of 10 days and a maximum of 28 days of sobriety and when withdrawal symptoms could no longer be observed by clinical means. The patients were selected consecutively. The MiniDIPS (Markgraf, 1994) and a standardized psychosocial interview were applied. The DIPS represents the German version of the Anxiety Disorders Interview Schedule (Di Nardo and Barlow, 1988). The Mini-DIPS is the short form of this structured interview according to DSM-IV and ICD-10 criteria for current (6 months) comorbidity and covers the following disorders: anxiety, affective, somatization, obsessivecompulsive, post-traumatic stress, acute stress, dissociative, and eating disorders (F30F50). Furthermore, it allows the exclusion of patients with schizophrenic psychoses. The Mini (...truncated)