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，很少有系统的研究做过。 对原发性抑郁症和继发性酒精中毒患者的影响。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，将 合并有原发性抑郁症和继发性抑郁症病史的患者 两个对照组的酒精依赖：有酒精依赖病史的患者 抑郁症，但没有酗酒或依赖史，以及患有 有酒精依赖史，但没有情感性疾病。患者被 根据年龄、性别和全球功能评估得分进行匹配。 每组11名患者完成了标准化检查，在检查中我们 有特征的症状、家族史和吸毒和酗酒的模式 虐待。结果表明，合并的患者明显更多 比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(除 指一个并发的病人)既不是抑郁的病人，也不是合并的病人 符合双相情感障碍的标准。特别是，合并有 原发性抑郁症和继发性酒精中毒可能倾向于“三重病态”， 有抑郁、焦虑和酗酒的症状。此外， 共病患者所经历的焦虑和易怒的增加可能 导致他们酗酒的倾向。 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使用情况 特定的抑郁症状。调查问卷已经发放给了 季节性情感障碍、非季节性情感障碍患者， 原发性抑郁症伴继发性酒精依赖，酒精依赖 没有情感障碍，也没有正常人。数据目前正在 分析以建立重测信度，并确定差异 在这些物质的使用上，这两组人之间存在差异。

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. In particular, comorbid patients with primary depression and secondary alcoholism may tend to be "trimorbid", with symptoms of depression, anxiety, and alcoholism. Furthermore, the increased anxiety and irritability experienced by the comorbid patients may contribute to their tendency to abuse alcohol. 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. The questionnaire has been administered to patients with seasonal affective disorder, nonseasonal affective disorder, primary depression with secondary alcohol dependence, alcohol dependence without affective disorder, and normals. The data is currently being analyzed to establish test-retest reliability, and to ascertain differences between the groups in their use of these substances.