Schaar I, Ojehagen A
Department of Clinical Neuroscience, Division of Psychiatry, University of Lund, Sweden.
Soc Psychiatry Psychiatr Epidemiol. 2001 Feb;36(2):70-8. doi: 10.1007/s001270170066.
The aims of this study were to investigate initial characteristics and improvement after 18 months in patients with comorbidity of severe mental illness and substance dependence. These patients took part in a multicentre study aimed at improving co-operation between psychiatric health care units and social services.
A total of 358 patients, 66% men, were included. There were four diagnostic subgroups: psychosis 29%, depression 17%, borderline personality disorder 23%, and other diagnoses of equal severity 31%. Initially and at follow-up the following measurements were used: global functioning axis V DSM-III-R (GAF), seven areas of Addiction Severity Index (ASI) and psychological symptoms (SCL-90). The outcome of substance use during the past 6 months was estimated by the Clinical Rating Scale (CRS).
Most patients were single (77%) and few (10%) had income from employment. Many (61%) had made suicide attempts, and 52% had somatic diseases before entering this project. After 18 months, 14 patients (3.9%) had died, and 288 patients (84%) could be interviewed. There were significant improvements in all but one ASI area (employment), in psychological symptoms and in global functioning. There was a positive correlation between the reductions in severity of alcohol abuse, drug abuse, psychiatric symptoms, relationships (ASI) and psychological symptoms. Forty-eight percent of patients with mainly alcohol-related problems, and 57% of those with mainly drug-related problems were either "abstinent" or using drugs "without impairment" (CRS) after 18 months. Improvement did not differ between psychiatric subgroups.
These patients have weak social integration. Alcohol dependence was the most common substance use disorder. In most areas investigated, patients had improved. No substance abuse was found in half of the patients at follow-up.
本研究旨在调查患有严重精神疾病和物质依赖合并症患者的初始特征以及18个月后的改善情况。这些患者参与了一项旨在改善精神卫生保健单位与社会服务机构之间合作的多中心研究。
共纳入358例患者，其中66%为男性。有四个诊断亚组：精神病29%，抑郁症17%，边缘性人格障碍23%，以及其他同等严重程度的诊断31%。在初始阶段和随访时使用了以下测量方法：全球功能轴V DSM-III-R（GAF）、成瘾严重程度指数（ASI）的七个领域以及心理症状（SCL-90）。通过临床评定量表（CRS）评估过去6个月内物质使用的结果。
大多数患者单身（77%），很少有患者（10%）有工作收入。许多患者（61%）曾尝试自杀，52%在进入本项目之前患有躯体疾病。18个月后，14例患者（3.9%）死亡，288例患者（84%）可接受访谈。除了一个ASI领域（就业）外，其他所有领域、心理症状和全球功能均有显著改善。酒精滥用、药物滥用、精神症状、人际关系（ASI）和心理症状严重程度的降低之间存在正相关。18个月后，主要存在酒精相关问题的患者中有48%，主要存在药物相关问题的患者中有57%“戒断”或“无损害地”使用药物（CRS）。各精神亚组之间的改善情况没有差异。
这些患者的社会融合较弱。酒精依赖是最常见的物质使用障碍。在大多数调查领域，患者都有改善。随访时一半的患者未发现物质滥用情况。
