Underdiagnosis of bipolar disorder in men with substance use disorder.
Underdiagnosis of bipolar disorder in men with substance use disorder.
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DOI：
10.1097/00131746-200603000-00010
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发表时间：
2006-03-01
影响因子：
1.9
通讯作者：
Ghaemi, S Nassir
中科院分区：
文献类型：
--
作者：
Albanese, Mark J;Clodfelter, Reynolds C Jr;Ghaemi, S Nassir
目的：最近的报告表明，双相情感障碍在临床人群中经常被诊断不足，导致抗抑郁药的过度使用和情绪稳定剂的使用不足。本研究评估了双相情感障碍的诊断率在一个物质滥用population.METHOD：这项研究涉及一个回顾性的图表审查的数据，从295例患者入院的住院药物滥用计划的男子。然后分析样本中85名患者的数据，这些患者在进入该项目时被诊断为符合DSM-IV双相情感障碍标准。审查图表中的相关临床和人口统计学数据。主要结果测量是以前误诊率。结果：在85例诊断为双相情感障碍的患者中，42例（49%）以前没有被诊断为双相情感障碍;在这42名患者中，6名（14%）患者以前没有接受过评估，而36名（86%）患者以前接受过评估，并接受过许多其他精神病诊断，包括重度抑郁症（77%）、注意力缺陷/多动障碍（20%）和惊恐障碍（3%）。在这些患者的共病物质使用障碍中，酒精依赖是最常见的（62%），其次是可卡因（38%），阿片类药物（26%），多种物质（12%）和镇静催眠药（2%）依赖。其他共病的轴I障碍包括创伤后应激障碍（14%）、注意力缺陷/多动障碍（10%）、惊恐障碍（2%）和广泛性焦虑障碍（2%）。这项研究发现，在大约50%的患者中，在一个物质滥用人群中的白人男性样本中，他们在入院时被诊断为双相情感障碍，进入一个住院的物质滥用项目。
OBJECTIVE: Recent reports indicate that bipolar disorder is frequently underdiagnosed in the clinical population, leading to overuse of antidepressants and underuse of mood stabilizers. This study assessed rates of diagnosis of bipolar disorder in a substance abuse population.METHOD: The study involved a retrospective chart review of data from 295 patients admitted to an inpatient substance abuse program for men. Data were then analyzed from the 85 patients in the sample who were diagnosed as meeting DSM-IV criteria for bipolar disorder on intake into the program. Charts were reviewed for relevant clinical and demographic data. The primary outcome measure was the rate of previous misdiagnosis.RESULTS: Of the 85 patients diagnosed with bipolar disorder upon intake, 42 (49%) had not been previously diagnosed with bipolar disorder; of these 42, 6 (14%) patients had not been assessed previously, while 36 (86%) had been assessed previously and had received many other psychiatric diagnoses, including major depression (77%), attention-deficit/hyperactivity disorder (20%), and panic disorder (3%). Among the comorbid substance use disorders in these patients, alcohol dependence was the most common (62%), followed by cocaine (38%), opioid (26%), polysubstance (12%), and sedative-hypnotic (2%) dependence. Other comorbid Axis I disorders included posttraumatic stress disorder (14%), attention-deficit/hyperactivity disorder (10%), panic disorder (2%), and generalized anxiety disorder (2%).CONCLUSION: This study found that bipolar disorder had not been previously diagnosed in approximately 50% of a sample of Caucasian males in a substance abuse population who were diagnosed with bipolar disorder upon admission to an inpatient substance abuse program.