Computerized Screening in Adolescents with Substance or Psychiatric Disorders

描述(由申请人提供)：精神共病是有药物使用或精神障碍的青少年的主要担忧。在接受药物使用障碍治疗的青少年中，85%有额外的精神共病。同样，精神障碍在物质使用障碍的病因和易感性方面也发挥着重要作用。同时患有精神和物质障碍的青少年比单纯障碍的患者更顽固、更严重、更抗拒治疗，有更多的行为和医疗问题，以及更高的自杀风险。虽然对患有共病物质和精神障碍的青少年有有效的治疗方法，但临床医生在65%的时间内无法识别并存的精神疾病(诊断率低至服务系统费用的5%)。SAMHSA的“行动蓝图”呼吁增加对合并疾病的筛查，这是国家的优先事项。目前的研究将开发一种在线、计算机化的筛查工具，以识别青少年中有药物使用或精神障碍的共病精神障碍。该工具基于KSADS，还将包含嵌入式严重程度量表，以监控随时间的变化。计算机化促进了可获得性，使更广泛的传播成为可能，特别是在无法联系到临床医生诊断人员的情况下。50名青少年和他们的父母将按平衡顺序接受计算机版和临床医生版的访谈；辅助量表将评估结构效度。这项研究将产生关于可靠性、有效性、可行性、临床实用性、用户满意度以及与临床医生管理的诊断等价性的数据。 公共卫生相关性：青少年中的共病药物滥用和精神障碍已被确定为一个主要的公共卫生问题。未能识别共病是很常见的，并导致患者的治疗结果显著恶化，给社会带来更大的负担。基于网络的筛查设备将有助于促进共病的检测和治疗，从而为患者带来更有效的治疗结果，并减少社会负担。

DESCRIPTION (provided by applicant): Psychiatric comorbidity is a major concern for adolescents with substance use or psychiatric disorders. Eighty-five percent of adolescents in treatment for a substance use disorder have an additional psychiatric comorbidity. Similarly, psychiatric disorders have an important role in the etiology of and vulnerability to substance use disorders. Adolescents with both mental and substance disorders are more persistent, severe, and treatment resistant than patients with pure disorders, have more behavioral and medical problems, and higher suicide risk. While effective treatments exist for adolescents with comorbid substance and psychiatric disorders, clinicians fail to identify the comorbid psychiatric condition 65% of the time (the detection rate was as low as 5% in fee for service systems). SAMHSA's "Blueprint for Action" calls increased screening of comorbidity a national priority. The current study will develop an on-line, computerized screening tool to identify comorbid psychiatric disorders in adolescents with substance use or psychiatric disorders. The tool, based on the KSADS, will also contain embedded severity scales to monitor change over time. Computerization facilitates accessibility, enabling wider dissemination, especially when clinician-diagnosticians are unavailable. Fifty adolescents and their parents will take computer and clinician versions of the interview in counterbalanced order; ancillary scales will evaluate construct validity. The study will generate data on reliability, validity, feasibility, clinical utility, user satisfaction, and equivalence to clinician administered diagnosis. PUBLIC HEALTH RELEVANCE: Comorbid substance abuse and psychiatric disorders in adolescents has been identified as a major public health issue. Failure to identify the comorbidity is common, and results in significantly worse treatment outcomes for patients and greater burden on society. A web-based screening device will help facilitate detection and treatment of comorbidity, resulting in more effective treatment outcomes for patients and decreased societal burden.