The clinical nature and detection of psychiatric disorders in patients with alcoholic liver disease.

To determine the clinical nature of psychiatric disorders and their detection in patients with alcoholic liver disease we interviewed 71 randomly sampled subjects using two well-validated techniques: (i) the Schedule for Affective Disorders and Schizophrenia (SADS-L) and (ii) the General Health Questionnaire (GHQ), a self-administered screening questionnaire. We also interviewed a similar number of controlled subjects with non-alcoholic liver disease of comparable severity. Forty-seven (66%) of those with alcoholic liver disease had psychiatric disorder compared with 23 (32%) of the control group (P less than 0.001). The commonest problems encountered in both groups were affective disorders, neuroses and anti-social personality, the latter was commoner in male alcoholics (33%) than in non-alcoholics (13%; P less than 0.02). In nearly half of the alcoholic group, psychiatric disorder antedated the onset of heavy drinking; nearly half of them had psychiatric disorders at the time of interview. Thirty-five (74%) of the alcoholics with positive psychopathology assessed by SADS-L were identified as psychiatric cases by the GHQ (score greater than 5), and the mean GHQ score was significantly higher in the alcoholics than in the controls (13.2 +/- 2.1 and 6.2 +/- 1.3, P less than 0.01). These results demonstrate the high frequency of psychiatric disorders in patients with alcoholic liver disease and suggest that psychiatric intervention is needed in many patients to improve their likelihood of remaining abstinent from alcohol.