AN INVESTIGATION OF PRIMARY DEPRESSIVES WITH SECONDARY ALCOHOLISM

酒精依赖与重大精神疾病的共病， 包括情感障碍在内的疾病，正受到越来越多的关注 精神病学文献。然而，几乎没有系统的研究。 适用于患有原发性抑郁症和继发性酒精中毒的患者。这些 患者，他们通常声称自己用药来治疗他们的抑郁症 酒精，是很有趣的研究，因为他们选择的精神活性 物质可能为其背后的神经化学提供线索 症状。 在此期间，我们完成了一项初步研究，比较了患者和 合并原发性抑郁症和继发性酒依赖的病史 到两个对照组：有抑郁症病史但没有 有酗酒或依赖史，以及有酒精史的患者 有酒精依赖，但没有情感性疾病。匹配的患者 根据年龄、性别和全球功能评估评分。 每组11名患者完成标准化检查 我们描述了症状、家族史和吸毒模式 酗酒。结果表明，合并症患者显著 抑郁症患者更有可能达到DSM-III-R的恐慌标准 精神障碍(p=0.04)。与抑郁症患者相比，患有抑郁症的患者 明显更高的轻躁狂得分(p=0.03)，尽管(与 (除一名共病患者外)既不是抑郁症患者，也不是共病患者 患者符合双相情感障碍的诊断标准。这些结果表明， 合并原发性抑郁症和继发性酒精中毒的患者可能 倾向于三重病态，有抑郁、焦虑和 酗酒。 结合上述项目，我们制定了一份调查问卷，以 研究患者对酒精、碳水化合物和咖啡因的反应 与特定的抑郁症状有关。重测信度为 已经成立了。问卷已经发放到正常范围。 志愿者和四个不同诊断类别的患者： 季节性情感障碍，重度抑郁障碍，原发性 继发性酒精依赖的抑郁症，以及酒精依赖 没有情感障碍。后两组患者没有 在酒精的用法和作用的报道上不同，所以酗酒者 没有抑郁症病史的人报告饮酒的可能性 对抑郁症状的反应与那些有过抑郁症发作的人一样 原发性抑郁症。在咖啡因和碳水化合物的使用方面， 患者组的反应没有不同，但都是 与正常志愿者有显著差异。判别函数 酗酒者与非酗酒者关系辨析 酗酒者的酗酒、愤怒和快感缺乏之间的关系。

The comorbidity of alcohol dependence with major psychiatric illness, including affective disorders, is receiving increased attention in the psychiatric literature. However, little systematic research has been done on patients with primary depression and secondary alcoholism. These patients, who typically claim to "self-medicate" their depression with alcohol, are interesting to study because their choice of psychoactive substance may provide a clue to the neurochemistry underlying their symptoms. During this period, we completed a pilot study comparing patients with a history of comorbid primary depression and secondary alcohol dependence to two comparison groups: patients with a history of depression but no history of alcohol abuse or dependence, and patients with a history of alcohol dependence but no affective illness. Patients were matched according to age, sex, and Global Assessment of Functioning score. Eleven patients in each group completed a standardized work-up in which we characterized symptoms, family history, and pattern of drug and alcohol abuse. Results indicate that comorbid patients are significantly more likely than depressed patients to meet DSM-III-R criteria for panic disorder (p=0.04). Compared to depressed patients, comorbid patients have significantly higher hypomania scores (p=0.03) although (with the exception of one comorbid patient) neither the depressed nor the comorbid patients met criteria for bipolar illness. These results indicate that comorbid patients with primary depression and secondary alcoholism may tend to be "trimorbid", with symptoms of depression, anxiety, and alcoholism. In conjunction with the above project, we developed a questionnaire to study patients' use of alcohol, carbohydrates, and caffeine in response to specific depressive symptoms. Test-retest reliability was established. The questionnaire has been administered to normal volunteers and to patients in four separate diagnostic categories: seasonal affective disorder, major depressive disorder, primary depression with secondary alcohol dependence, and alcohol dependence without affective disorder. Patients in the latter two groups did not differ in the reported use and effect of alcohol so that alcoholics without a history of depression were as likely to report drinking in response to depressive symptoms as were those who had had episodes of primary depression. In terms of caffeine and carbohydrate use, the responses of the patient groups did not differ from each other, but all differed significantly from the normal volunteers. Discriminant function analysis distinguished alcoholics from non-alcoholics in the relationship between the alcoholics' reported drinking, anger, and anhedonia.