Differences between early-phase primary psychotic disorders with concurrrent substance use and substance-induced psychoses
Differences between early-phase primary psychotic disorders with concurrrent substance use and substance-induced psychoses
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DOI：
10.1001/archpsyc.62.2.137
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发表时间：
2005-02-01
影响因子：
--
通讯作者：
Schanzer, WB
中科院分区：
文献类型：
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作者：
Caton, CLM;Drake, RE;Schanzer, WB
背景：区分物质所致精神障碍和同时使用酒精或其他药物的原发精神障碍对于了解病程和计划适当的治疗是至关重要的，然而对这两个诊断组之间的差异的研究和评估很少。目的：使用精神和药物使用共病的研究诊断工具，确定根据DSM-IV标准诊断的物质所致精神障碍和原发精神障碍的关键人口统计学、家族性和临床差异。设计：收集人口统计学、家庭和临床因素的数据，作为纽约早期精神病和药物使用共病三年纵向研究的一部分，背景：精神科急诊科入院。参与者：这项研究基于400名基线访谈的受试者的参考样本。参与者在执行研究方案期间至少有一种精神病症状被评估，在过去30天内使用过酒精和/或其他药物，并且在过去6个月内没有精神病住院史。研究对象的种族包括43.5%的黑人，42.0%的西班牙裔，14.5%的白人或其他人。主要结果衡量标准：DSM-IV定义的精神障碍。169人(44%)被诊断为物质所致精神病，217人(56%)被诊断为物质所致精神障碍。患有原发精神错乱。3个领域的得分均有显著差异。Logistic回归的多因素分析表明，在物质诱导组中，以下g3个关键预测因素更重要：母体物质基础(优势比[OR]1.69；95%可信区间[CI]1.00-2.85)。任何药物依赖的诊断(OR，9.41；：95%CI 5.26-16.85)。视觉幻觉(OR，2.1；95%CI，1.10~4.13)。阳性和阴性症状总分的关键预测因子在原发精神病组中较大(OR，0.96；95%CI：0.941~0.97)。结论：人口学、家族和临床领域的差异证实了物质诱导性精神障碍和原发精神障碍是不同的实体。关键的预测指标可以帮助急诊临床医生正确地对与药物使用并存的早期精神障碍进行分类。
Context: The distinction between a substance-induced psychosis and a primary psychotic disorder that co-occurs with the use of alcohol or other drugs is critical for understanding illness course and planning appropriate treatment, yet there has been little study and evaluation of the differences between these 2 diagnostic groups.Objective: To identify key demographic, family, and clinical differences in substance-induced psychosis and primary psychotic disorders diagnosed according to DSM-IV criteria using a research diagnostic instrument for psychiatric and substance use comorbidity.Design: Data on demographic, family, and clinical factors were gathered at baseline as part of a 3-year longitudinal study of early-phase psychosis and substance use comorbidity in New York, NY.Setting: Psychiatric emergency department admissions.Participants: The study is based on a referred sample of 400 subjects interviewed at baseline. Participants had at least 1 psychotic symptom assessed during administration of the research protocol, had used alcohol and/or other drugs within the past 30 days, and had no psychiatric inpatient history before the past 6 months. Subject race included 43.5% black, 42.0% Hispanic, and 14.5% white or other.Main Outcome Measure: Psychotic disorders defined by the DSM-IV.Results: Overall. 169 (44%) were diagnosed as having substance-induced psychosis and 217 (56%). as having primary psychosis. Significant differences were observed in all 3 domains. Multivariate analysis using logistic regression identified the following g 3 key predictors as being greater in the substance-induced group: parental substance abase (odds ratio [OR] 1.69; 95% confidence interval [CI], 1.00-2.85). a diagnosis of dependence on any drug (OR, 9.41;: 95% CI 5.26-16.85). and Visual hallucinations (OR, 2.1; 95% CI, 1.10-4.13). The key predictor of total positive and negative symptom score was greater in the primary, psychosis group (OR, 0.96; 95% CI: 0.941-0.97).Conclusions: Differences in demographic family, and clinical domains confirm substance-induced and primary psychotic disorders as distinct entities. Key predictors could help emergency clinicians to correctly the classify early-phase psychotic disorders, that co-occur with substance use.