Psychiatric comorbidity in long-term abstinent alcoholic individuals
Psychiatric comorbidity in long-term abstinent alcoholic individuals
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DOI：
10.1111/j.1530-0277.2007.00361.x
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发表时间：
2007-05-01
影响因子：
3.2
通讯作者：
Fein, George
中科院分区：
文献类型：
--
作者：
Di Sclafani, Victoria;Finn, Peter;Fein, George
背景：在社区和治疗样本中，酒精使用障碍个体中共病性精神障碍的患病率较高，治疗样本中共病性精神障碍的发生率较高。在这项研究中，我们检查了长期戒酒的酒精个体（LTAA，平均戒酒6.3年，n=52）与年龄和性别可比较的非酒精对照组（NC, n=48）的终生和当前精神病学诊断。我们提出了以下问题：(1)要实现长期禁欲，个体必须在精神上相对健康（即与NC相当）；(2)面对当前的精神疾病，是否可以保持持续的禁欲？方法：使用计算机化诊断访谈表（c-DIS）评估终生和当前（过去12个月）的精神病学诊断，包括情绪、焦虑和外化障碍领域。结果：超过85%的LTAA患者有终生精神病诊断，而NC患者为50%。长期戒酒的酗酒者在终身情绪、焦虑和外化障碍诊断方面的患病率高于非酗酒者。长期戒酒的酗酒者在当前情绪和焦虑诊断方面的患病率也高于非酗酒者。尽管LTAA的反社会人格障碍（ASPD）终生患病率高于NC，但目前没有LTAA或NC被诊断为ASPD。最后，禁欲的持续时间与终生或当前的精神病学诊断没有关联，这与精神病学诊断对复发的影响很小一致。结论：我们的研究结果表明：(1)终身精神病诊断并不妨碍实现长期戒断；(2)在存在当前情绪或焦虑障碍的情况下，戒断可以维持；(3)当前的反社会人格障碍诊断可能与长期戒断不相容。与禁欲前相比，反社会行为的水平相对较低（没有LTAA符合目前的反社会障碍标准），这引发了一个问题，即在禁欲中，反社会行为的神经生物学基础是否发生了变化，还是受到了更强的执行控制，或者两者兼而有之。
Background: A high prevalence of comorbid psychiatric disorders has been demonstrated in individuals with an alcohol use disorder in both community and treatment samples, with higher comorbidity in treatment samples. In this study, we examined lifetime and current psychiatric diagnoses in long-term abstinent alcoholic individuals (LTAA; mean abstinence=6.3 years; n=52) compared with age and gender-comparable non-alcoholic controls (NC; n=48). We asked the following questions: (1) to achieve long-term abstinence, must an individual be relatively psychiatrically healthy (i.e., comparable with NC) and (2) can ongoing abstinence be maintained in the face of a current psychiatric disorder?Methods: Lifetime and current (prior 12 months) psychiatric diagnoses were assessed in the mood, anxiety, and externalizing disorder domains using the computerized Diagnostic Interview Schedule (c-DIS).Results: Over 85% of LTAA had a lifetime psychiatric diagnosis, compared with 50% of NC. Long-term abstinent alcoholic individuals had a higher prevalence than NC of lifetime mood, anxiety, and externalizing disorder diagnoses. Long-term abstinent alcoholic individuals also had a greater prevalence than NC of current mood and anxiety diagnoses. Although LTAA had a greater lifetime prevalence of an antisocial personality disorder (ASPD) than NC, no LTAA or NC had a current ASPD diagnosis. Finally, there was no association of duration of abstinence with lifetime or current psychiatric diagnoses, consistent with psychiatric diagnoses having little effect on relapse.Conclusions: Our results suggest that: (1) the presence of a lifetime psychiatric diagnosis does not militate against achieving long-term abstinence, (2) abstinence can be maintained in the presence of a current mood or anxiety disorder, and (3) a current diagnosis of ASPD may not be compatible with long-term abstinence. The relatively low levels of antisocial behavior compared with preabstinence (as indicated by no LTAA meeting current criteria for ASPD) raises the question of whether the neurobiology underlying antisocial behavior is changed in abstinence, or brought under increased executive control, or both.