Real-Time Electronic Ambulatory Monitoring of Substance Use and Symptom Expression in Schizophrenia
Real-Time Electronic Ambulatory Monitoring of Substance Use and Symptom Expression in Schizophrenia
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DOI：
10.1176/appi.ajp.2010.10030463
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发表时间：
2011-02-01
影响因子：
17.7
通讯作者：
Granholm, Eric
中科院分区：
文献类型：
--
作者：
Swendsen, Joel;Ben-Zeev, Dror;Granholm, Eric
目的：尽管有证据表明精神分裂症和物质使用障碍之间的共病率升高，但相关的潜在机制仍然知之甚少。日常生活中物质使用和精神病症状之间相互作用的短暂时间间隔是标准研究方案无法获得的。作者使用电子个人数字助理（PDA）检查时间关联的各种形式的物质使用与精神病症状和心理状态在自然context.Method：199个社区居住的个人与精神分裂症或情感障碍谁被联系参与研究，92%接受和73%完成了研究。完成研究的145名参与者通过PDAs.Results连续7天每天多次提供物质使用，精神病症状，情绪和事件消极性的报告：参与者对72%的电子访谈（N= 2，737）进行了回应。强烈的一天内的前瞻性协会，观察在两个方向之间的物质使用和消极的心理状态或精神病症状，但相当大的变化，观察到的物质类型。与自我药物治疗的概念一致，酒精使用最有可能伴随焦虑情绪或精神病症状的增加。大麻和其他非法物质，表现出更复杂的模式，更有可能遵循某些心理状态，但也与后来发病的精神病symptoms.Conclusions：物质使用和精神病症状的动态相互作用在许多情况下是一致的因果关系和自我药疗机制，这些模式的关联应考虑在治疗和预防策略的设计。
Objective: Despite evidence demonstrating elevated comorbidity between schizophrenia and substance use disorders, the underlying mechanisms of association remain poorly understood. The brief time intervals that characterize interactions between substance use and psychotic symptoms in daily life are inaccessible to standard research protocols. The authors used electronic personal digital assistants (PDAs) to examine the temporal association of diverse forms of substance use with psychotic symptoms and psychological states in natural contexts.Method: Of 199 community-dwelling individuals with schizophrenia or schizoaffective disorder who were contacted to participate in the study, 92% accepted and 73% completed the study. The 145 participants who completed the study provided reports of substance use, psychotic symptoms, mood, and event negativity multiple times per day over 7 consecutive days through PDAs.Results: Participants responded to 72% of the electronic interviews (N=2,737) across daily life contexts. Strong within-day prospective associations were observed in both directions between substance use and negative psychological states or psychotic symptoms, but considerable variation was observed by substance type. Consistent with the notion of self-medication, alcohol use was most likely to follow increases in anxious mood or psychotic symptoms. Cannabis and other illicit substances, demonstrating more complex patterns, were more likely to follow certain psychological states but were also associated with the later onset of psychotic symptoms.Conclusions: The dynamic interplay of substance use and psychotic symptoms is in many cases consistent with both causal and self-medication mechanisms, and these patterns of association should be considered in the design of treatment and prevention strategies.