Ley A, Jeffery D P, McLaren S, Siegfried N
South Devon Healthcare Trust, Kitson Hall, Torbay Hospital, Lawes Bridge, Torquay, Devon, UK, TQ2 7AA.
Cochrane Database Syst Rev. 2000(4):CD001088. doi: 10.1002/14651858.CD001088.
Substance misuse in the context of severe mental illness can have detrimental effects. A variety of treatments exist, but the drive has been to provide programmes integrating treatment of both substance misuse and severe mental illness. Such programmes require additional resources and may require radical redesign of service delivery systems.
To evaluate the effectiveness of treatment programmes within psychiatric care for people with problems of both substance misuse and serious mental illness.
Biological Abstracts (1985-1998), CINAHL (1982-1998), The Cochrane Library (Issue 3, 1998), The Cochrane Schizophrenia Group's Register of trials (August 1998), EMBASE (1980-1998), MEDLINE (1966-1998), PsycLIT (1974-1998) and Sociofile (1974-1998) were comprehensively searched. Citations of all trials were searched and further studies sought from published trials and their authors.
All randomised trials of any programme of substance misuse treatment for people with serious mental illness and current problems of substance misuse.
Citations and, where possible, abstracts were independently inspected by reviewers, papers ordered, re-inspected and quality assessed. Data were also independently extracted. For homogeneous dichotomous data the Peto odds ratio (OR), and 95% confidence intervals (CI) were calculated on an intention-to-treat basis.
Six relevant studies, four of which were small, were identified. In general, the quality of design and reporting was not high. Clinically important outcomes such as relapse of severe mental illness, violence to others, patient or carer satisfaction, social functioning and employment were not reported. There is no clear evidence supporting an advantage of any type of substance misuse programme for those with serious mental illness over the value of standard care. No one programme is clearly superior to another.
REVIEWER'S CONCLUSIONS: The problems posed by substance misuse in the context of severe mental illness will not go away. The current momentum for integrated programmes is not based on good evidence. Implementation of new specialist substance misuse services for those with serious mental illnesses should be within the context of simple, well designed controlled clinical trials.
在严重精神疾病背景下的物质滥用会产生有害影响。现存在多种治疗方法，但目前的趋势是提供将物质滥用治疗与严重精神疾病治疗相结合的项目。此类项目需要额外资源，且可能需要对服务提供系统进行彻底重新设计。
评估针对患有物质滥用问题和严重精神疾病的人群在精神科护理中治疗项目的有效性。
全面检索了《生物学文摘》（1985 - 1998年）、《护理学与健康领域数据库》（1982 - 1998年）、《考克兰图书馆》（1998年第3期）、《考克兰精神分裂症研究组试验注册库》（1998年8月）、《荷兰医学文摘数据库》（1980 - 1998年）、《医学索引》（1966 - 1998年）、《心理学文摘》（1974 - 1998年）和《社会科学文献索引》（1974 - 1998年）。检索了所有试验的参考文献，并从已发表的试验及其作者处寻找进一步的研究。
针对患有严重精神疾病且目前存在物质滥用问题的人群的任何物质滥用治疗项目的所有随机试验。
参考文献以及在可能的情况下的摘要由评审人员独立检查，论文排序、再次检查并进行质量评估。数据也独立提取。对于同质二分数据，基于意向性分析计算Peto比值比（OR）和95%置信区间（CI）。
确定了6项相关研究，其中4项规模较小。总体而言，设计和报告质量不高。未报告诸如严重精神疾病复发、对他人的暴力行为、患者或护理人员满意度、社会功能和就业等具有临床重要意义的结果。没有明确证据支持对于患有严重精神疾病的人群，任何类型的物质滥用项目优于标准护理。没有一个项目明显优于另一个项目。
在严重精神疾病背景下物质滥用所带来的问题不会自行消失。目前综合项目的发展趋势并非基于充分的证据。为患有严重精神疾病的人群实施新的专门物质滥用服务应在简单、设计良好的对照临床试验背景下进行。
