Exacerbation of psychiatric symptoms during substance use disorder treatment
Exacerbation of psychiatric symptoms during substance use disorder treatment
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DOI：
10.1176/appi.ps.57.12.1758
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发表时间：
2006-12-01
影响因子：
3.8
通讯作者：
Moos, Rudolf H.
中科院分区：
文献类型：
--
作者：
Ilgen, Mark A.;Moos, Rudolf H.
目的：本研究探讨精神症状恶化（或恶化）的物质使用障碍治疗的患者。这项研究探讨了几个问题。住院治疗期间病情恶化的发生率如何？与精神症状改善的患者相比，症状恶化的患者在治疗期间和治疗开始后一年是否报告功能较差？进入治疗一年后症状恶化的患者是否会出现更多问题和应对技能较差？恶化的发生率是否与治疗取向有关？精神症状恶化的患者是否比症状改善的患者对治疗环境的看法更消极？研究方法：1992年至1995年期间，在退伍军人事务部卫生保健系统的15个住院药物滥用治疗方案中，共招募了3,322名男性患者。根据治疗期间精神症状的变化，将这些患者分为精神症状恶化或改善。将症状恶化的患者与症状改善的匹配组患者进行比较。结果：共有426名患者（13%）报告在治疗期间精神症状恶化。与改善组患者（N=426）相比，恶化组患者在治疗后一年报告了更多的精神问题和物质使用。恶化组的患者更有可能有精神病诊断，自我效能感较低，更依赖于表达情绪来应对，并更消极地看待治疗经历。结论：13%的患者在居家物质使用障碍治疗期间经历了精神症状的加重。需要改进监测程序，如定期评估精神症状的变化，以定期获得有关治疗期间精神状况下降的信息。
Objective: This study examined psychiatric symptom exacerbation (or deterioration) among patients treated for substance use disorders. The study examined several questions. What is the prevalence of deterioration during residential treatment? Compared with patients who show improvement in psychiatric symptoms, do those with deterioration of symptoms report poorer functioning during treatment and one year after treatment entry? Do patients who experience deterioration of symptoms one year after treatment entry enter treatment with more problems and poorer coping skills? Is the prevalence of deterioration associated with treatment orientation, and do patients whose psychiatric symptoms deteriorate view the treatment environment more negatively than patients whose symptoms improve? Methods: A total of 3,322 male patients were recruited at 15 residential substance abuse treatment programs in the Department of Veterans Affairs health care system between 1992 and 1995. On the basis of changes in psychiatric symptoms during treatment, these patients were categorized as having either deteriorated or improved psychiatric symptoms. Patients whose symptoms deteriorated were compared with a matched group of patients with improved symptoms. Results: A total of 426 patients (13 percent) reported a worsening of psychiatric symptoms during treatment. Compared with patients in the improved group (N=426), patients in the deteriorated group reported more psychiatric problems and substance use one year after treatment. Patients in the deteriorated group were more likely to have a psychotic diagnosis, lower self-efficacy, and more reliance on coping by expression of emotions and to view the treatment experience more negatively. Conclusions: Thirteen percent of the patients experienced an exacerbation of psychiatric symptoms during residential substance use disorder treatment. Improved monitoring procedures, such as regular assessments for changes in psychiatric symptoms, are needed to routinely obtain information about declines in psychiatric conditions during treatment.