Assessment And Prognosis of Alcohol-Related Disorders

Assessment Of Alcohol-related disease

The evaluation consists of the following assessments-

• CAGE Questionnaire: It comprises of four questions abbreviated as CAGE-
  • C:  Has the patient felt to(Need to) cut down on drinking
  • A:  Have people annoyed the patient by criticizing his/her drinking?
  • G: Is the patient guilty about his/her drinking?
  • E: (Eye opener) Has the patient ever had a drink first thing in the morning to steady nerves or get rid of a hangover?

If the patient responds yes to two or more questions, then it is suggestive of Alcohol Use Disorder (AUD).

• AUDIT: It stands for Alcohol Use Disorder Identification Test. It consists of 10 items that review problems related to alcohol using a five-point scale.
  • Q1-3: This addresses the quantity of alcohol.
  • Q4-6: These pertain to signs and symptoms of dependence.
  • Q7-10: These address behavior and symptoms associated with harmful use.

A score of 8 or higher indicates potential harm from alcohol use, impacting the individual's physical and mental well-being. This necessitates a closer examination for potential Alcohol Use Disorder.

• MAST: It stands for the Michigan Alcoholism Screening test.

Other Tests

These tests help to assess the severity of alcoholism. Examples are-

• SADQ: It stands for Severity of Alcohol Dependence Questionnaire. It is a detailed questionnaire comprising twenty items with scores of 0-3. The maximum score is 60.  The interferential criteria are-
  • Mild dependence: 15 or less

• Moderate dependence: 15 to 30
• Severe dependence: More than 30

Laboratory Tests for Alcohol-related disease

It's crucial to understand the State Markers of Heavy Drinking initially. These indicators help assess whether the individual has recently consumed significant amounts of alcohol. They reflect physiological alterations, such as the likelihood of ingestion of five or more drinks per day for several weeks.

1. GAMMA-GLUTAMYL TRANSFERASE (GGT): It is the most widely employed marker for heavy drinking. GGT levels increase with heavy drinking. Levels of at least 35 units per liter have a sensitivity and specificity of 60%. GGT levels return to normal after 2-4 weeks of abstinence. If a 20% rise in GGT levels is detected, it is indicative of drinking relapse. A combination of CDT and GGT is better than either of these tests alone for identifying heavy drinking and monitoring abstinence.
2. MEAN CORPUSCULAR VOLUME (MCV): There is an increase in MCV in alcohol abusers due to folate deficiency. If MCV is more than 91 um3, it has a sensitivity of 50% to identify heavy drinking. MCV increase is more prominent in the alcoholics who smoke as well. This marker is not used for assessing abstinence, as the RBC life span is 120 days, which renders it a less useful indicator of drinking relapse.
3. URIC ACID: Uric acid is increased in patients who consume heavy alcohol. In males, the value of more than 6.4 mg/dL, and in females, the value of more than 5mg/dL is suggestive of alcoholism.
4. ASPARTATE AMINOTRANSFERASE (AST) AND ALANINEAMINOTRANSFERASE (ALT): AST  and ALT of more than 45IU/L are indicative of heavy drinking. Also, the AST: ALT ratio of more than 2 is correlated with alcoholic liver disease.
5. OTHER TESTS
   1. Alkaline Phosphate (ALP): It can be elevated due to liver injury by heavy alcohol consumption.
   2. Bilirubin
   3. Prothrombin time (PT)
   4. Particle thromboplastin time (PTT)
   5. Alcohol breath tests and blood alcohol levels (BAL) can be performed to confirm intoxication.
   6. Urine toxicology screens can also reveal information about alcohol ingestion.

Course of Alcohol-related Disease

• Women are likely to begin drinking a few years later than men. They may have a faster escalation of AUD symptoms.
• In the early course, patients with ASPD, who have developed AUD are more likely to have early onset of drinking.
• These patients also have severe alcohol-related difficulties occurring in their early 20s to mid-30s.
• In the later course, the AUD patients may temporarily cessate (days to months) leading to temporary controlled drinking and finally, there is increased alcohol intake.
• In general, persons with AUD and preexisting independent major psychiatric disorders like ASPD, schizophrenia, and bipolar disorder, are likely to run the course of independent psychiatric disorder.

Spontaneous Remission in Alcohol-related disease

• Around 20% of patients show spontaneous remission.
• If the patient continues to drink, it can decrease the life span by 10 years.

Prognosis of  Alcohol-related disease

• Less than 50% of patients with AUDs ever receive a treatment.
• Good prognostic factors include-
  • Without ASPD
  • Good psychosocial functioning
  • Stable job
  • Stable family
  • No legacy problems
  • Adherence to treatment

These predict 60% chances for more than one year of abstinence.

Frequently Asked Question

Question: What does the CAGE questionnaire assess in patients?

A. Cognition

B. Alcohol Use Disorder (AUD)

C. Anxiety

D. Depression

Answer: B. Alcohol Use Disorder (AUD)

Question: What does AUDIT stand for, and how many items does it consist of?

A. Alcohol Undergoing Diagnosis and Identification Test; 5 items

B. Alcohol Use Disorder Identification Test; 8 items

C. Alcohol-Related Disorders Unified Identification Test; 10 items

D. Alcohol Use Dependency Investigation Tool; 15 items

Answer: C. Alcohol-Related Disorders Unified Identification Test; 10 items

Question: What does MAST stand for, and what is its maximum score?

A. Mental and Alcohol Screening Test; maximum score of 50

B. Michigan Alcoholism Screening Test; maximum score of 60

C. Moderate Alcohol Severity Test; maximum score of 30

D. Minimal Assessment of Substance Tolerance; maximum score of 40

Answer: B. Michigan Alcoholism Screening Test; maximum score of 60

Question: What does SADQ stand for, and how is it categorized based on scores?

A. Substance Abuse Diagnosis Questionnaire: Mild, Moderate, Severe dependence

B. Severity of Alcohol Dependence Questionnaire: Low, Moderate, High dependence

C. Substance Addiction Detection Quiz; Minor, Major, Extreme dependence

D. Severity Assessment for Drug Quotient: Low, Moderate, Severe dependence

Answer: B. Severity of Alcohol Dependence Questionnaire; Low, Moderate, High dependence

Question: What does Carbohydrate Deficient Transferrin (CDT) indicate in heavy drinkers?

A. Elevated serotonin levels

B. Decreased liver function

C. Recent significant alcohol consumption

D. Impaired cognitive function

Answer: C. Recent significant alcohol consumption

Question: What AST: ALT ratio is correlated with alcoholic liver disease?

A. Less than 1

B. 1:1

C. More than 2

D. Equal to 2

Answer: C. More than 2

Question: How many affirmative responses in the CAGE questionnaire are suggestive of Alcohol Use Disorder (AUD)?

A. One or more

B. Two or more

C. Three or more

D. All four

Answer: B. Two or more

Question: Why is the combination of CDT and GGT considered better than either test alone for identifying heavy drinking?

A. Increased sensitivity

B. Decreased specificity

C. Improved taste sensitivity

D. Quicker results

Answer: A. Increased sensitivity

Question: Besides indicating heavy drinking, what does an AST: ALT ratio of more than 2 correlate with?

A. Kidney dysfunction

B. Alcoholic liver disease

C. Cardiovascular disorders

D. Iron deficiency

Answer: B. Alcoholic liver disease

Question: What percentage of patients with alcohol-related problems meet the diagnostic criteria for Major Depressive Disorder (MDD)?

A. 10-20%

B. 30-40%

C. 50-60%

D. 70-80%

Answer: B. 30-40%

Also Read: Management Of Alcohol Use Disorder

Hope you found this blog helpful for your Psychiatric Theory and Specialities Preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.