Sutor B, Tinsley J A, Morse R M
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
J Addict Dis. 1999;18(1):83-93. doi: 10.1300/J069v18n01_08.
Nine patients with bipolar mood disorder and concurrent substance dependence were treated in an 18-bed inpatient addiction unit over a 3-month period. A multidisciplinary team approach used a medicalized Minnesota model and stressed the establishment of a positive diagnosis and individualization of management strategies for each patient. Clinically significant affective symptoms that required acute psychiatric intervention developed in several patients during hospitalization. Manic symptoms developed in three patients during sedative withdrawal, requiring the team to differentiate manic symptoms from physiologic withdrawal; and two patients became severely depressed, requiring pharmacologic management and suicide-prevention strategies.
Our experience with the patients in this case series supports the contention that there is no simple, uniform approach to the substance-dependent patient with bipolar disorder. Treatment teams must be prepared to differentiate complex syndromes and to manage manic, depressive, and addictive behaviors.
在三个月的时间里，一个拥有18张床位的住院成瘾治疗单元对9名患有双相情感障碍并伴有物质依赖的患者进行了治疗。一个多学科团队采用了医学化的明尼苏达模式，并强调为每位患者确立明确的诊断以及制定个性化的管理策略。在住院期间，有几名患者出现了需要急性精神科干预的具有临床意义的情感症状。三名患者在镇静剂戒断期间出现躁狂症状，这要求团队将躁狂症状与生理戒断症状区分开来；还有两名患者出现严重抑郁，需要药物治疗和预防自杀策略。
我们在这个病例系列中对患者的治疗经验支持了这样一种观点，即对于患有双相情感障碍的物质依赖患者，没有简单、统一的治疗方法。治疗团队必须准备好区分复杂的综合征，并处理躁狂、抑郁和成瘾行为。
