Lejoyeux M, Feuché N, Loi S, Solomon J, Adès J
Department of Psychiatry, Groupe Hospitalier Bichat-Claude Bernard, Paris, France.
J Clin Psychiatry. 1999 May;60(5):302-5. doi: 10.4088/jcp.v60n0506.
Impulse-control disorders (ICDs) include intermittent explosive disorder, kleptomania, trichotillomania, pyromania, and pathological gambling. Several studies have suggested that the incidence of pathological gambling is substantially higher in alcoholics than in the general population. The rate of co-occurrence of other ICDs and alcohol dependence has never been systematically investigated. In our study, we assessed the frequency of all ICDs in a population of alcohol-dependent patients. We also examined the possibility that the presence of an ICD can correspond to earlier onset and more severe forms of alcoholism, which have a greater association with antisocial personality.
All patients hospitalized at our psychiatric unit for detoxification between January and August 1997 met DSM-IV criteria for alcohol dependence and were included in this study. Diagnosis of alcohol dependence was confirmed with the Mini-International Neuropsychiatric Interview. ICDs were investigated using the Minnesota Impulsive Disorders Interview. All patients completed the Michigan Alcoholism Screening Test.
Among the 79 patients included in the study, 30 (38.0%) met criteria for an ICD. Included in the study were 19 cases of intermittent explosive disorder, 7 cases of pathological gambling, 3 cases of kleptomania, and 1 case of trichotillomania. Patients with co-occurring ICDs were significantly younger than patients without an ICD (mean age = 40.7 vs. 44.5 years; p = .03). Patients with co-occurring pathological gambling were significantly younger at the onset of alcohol dependence than patients without ICDs (mean age = 19.5 vs. 25.9 years; p = .0008). Pathological gamblers had significantly longer duration of alcohol dependence compared with patients without ICDs (26.0 vs. 17.9 years; p = .02). Patients with co-occurring intermittent explosive disorder had the shortest duration of alcohol dependence of all patients (9.9 years). Prevalence of antisocial personality disorder was no different in patients with or without co-occurring ICDs.
Thirty-eight percent of the alcohol-dependent patients studied presented with an ICD. Patients with ICDs were younger than those without an ICD. The presence of an ICD was not associated with a specific form of alcohol dependence or with antisocial personality. Co-occurrence of pathological gambling, however, was associated with lower age at onset of alcohol dependence, a higher number of detoxifications, and a longer duration of alcohol dependence than was absence of an ICD.
冲动控制障碍（ICD）包括间歇性爆发障碍、盗窃癖、拔毛癖、纵火癖和病态赌博。多项研究表明，酗酒者中病态赌博的发生率显著高于普通人群。其他ICD与酒精依赖共病的发生率从未得到系统研究。在我们的研究中，我们评估了酒精依赖患者群体中所有ICD的发生频率。我们还研究了ICD的存在是否可能与更早发病和更严重形式的酒精中毒相关，而这些与反社会人格有更大关联。
1997年1月至8月期间在我们精神科病房接受戒酒治疗的所有患者均符合酒精依赖的DSM-IV标准，并纳入本研究。使用迷你国际神经精神访谈确认酒精依赖的诊断。使用明尼苏达冲动障碍访谈对ICD进行调查。所有患者均完成密歇根酒精ism筛查测试。
在纳入研究的79名患者中，30名（38.0%）符合ICD标准。纳入研究的有19例间歇性爆发障碍、7例病态赌博、3例盗窃癖和1例拔毛癖。共病ICD的患者比无ICD的患者显著年轻（平均年龄 = 40.7岁对44.5岁；p = 0.03）。共病病态赌博的患者在酒精依赖发病时比无ICD的患者显著年轻（平均年龄 = 19.5岁对25.9岁；p = 0.0008）。与无ICD的患者相比，病态赌博者的酒精依赖持续时间显著更长（26.0年对17.9年；p = 0.02）。共病间歇性爆发障碍的患者在所有患者中酒精依赖持续时间最短（9.9年）。有无共病ICD的患者中反社会人格障碍的患病率无差异。
在研究的酒精依赖患者中，38%患有ICD。患有ICD的患者比没有ICD的患者年轻。ICD的存在与特定形式的酒精依赖或反社会人格无关。然而，与无ICD相比，病态赌博的共病与酒精依赖发病年龄较低、戒酒次数较多以及酒精依赖持续时间较长有关。
