BIPOLAR AFFECTIVE-DISORDER AND SUBSTANCE-ABUSE
BIPOLAR AFFECTIVE-DISORDER AND SUBSTANCE-ABUSE
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DOI：
10.1097/00004714-199202001-00004
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发表时间：
1992-02-01
影响因子：
2.9
通讯作者：
LYDIARD, RB
中科院分区：
文献类型：
--
作者：
BRADY, KT;LYDIARD, RB
流行病学数据以及来自寻求治疗人群的数据表明，药物滥用障碍和其他精神障碍共同发生的情况比偶然发生的情况更常见。特别是，物质滥用，尤其是可卡因滥用或依赖和酗酒，在双相情感障碍患者群体中比在一般人群中更为常见。国家精神卫生研究所流行病学集水区的数据表明，双相情感障碍是轴I障碍最有可能与某种形式的物质滥用或依赖。来自寻求药物滥用障碍和精神障碍治疗的患者样本的证据表明，临床样本反映了类似的模式。有证据表明，药物滥用的双相情感障碍患者的病程更严重。在药物滥用的情况下诊断双相情感障碍是困难的，因为药物滥用的影响，特别是长期使用，几乎可以模仿任何精神疾病。目前，关于双相情感障碍和物质滥用障碍之间的遗传联系的数据是不确定的。很少有对照数据涉及该人群的临床特征或特定治疗努力。在这一人群中使用抗惊厥药、抗点燃剂有一定的理论依据，但尚未有对照研究报告。特别是，情绪稳定剂，如锂，与抗点燃剂，如丙戊酸盐或卡马西平的比较，将具有理论和实际意义。
Epidemiologic data as well as data from treatment-seeking populations indicate that substance abuse disorders and other psychiatric disorders co-occur more commonly than would be expected by chance. In particular, substance abuse, especially cocaine abuse or dependence and alcoholism, is a far more common phenomenon in the population of patients with bipolar affective disorder than in the general population. National Institute of Mental Health Epidemiologic Catchment Area data indicate that bipolar affective disorder is the axis I disorder most likely to be associated with some form of substance abuse or dependence. Evidence from patient samples seeking treatment for substance abuse disorders as well as for psychiatric disorders suggests that clinical samples reflect similar patterns. There is evidence that bipolar patients with substance abuse have a worse course of illness. Diagnosing bipolar affective disorder in the face of substance abuse is difficult because the effects of drugs of abuse, particularly with chronic use, can mimic nearly any psychiatric disorder. At present, the data concerning a genetic link between bipolar affective disorder and substance abuse disorders are inconclusive. There are very few controlled data addressing either clinical features of, or specific treatment efforts with, this population. There is some theoretic rationale for the use of anticonvulsant, antikindling agents in this population, but no controlled studies have as yet been reported. In particular, a comparison of a mood-stabilizing agent, such as lithium, with an antikindling agent, such as valproate or carbamazepine, would be of theoretic and practical interest.