Walker R D, Lambert M D, Walker P S, Kivlahan D R
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle.
Cult Med Psychiatry. 1992;16(4):555-72. doi: 10.1007/BF00053594.
This paper discusses treatment implications of comorbid psychopathology in the context of American Indian and Alaska Native culture and in the context of the Indian Health Service's Mental Health and Alcohol and Substance Abuse Program Branches. Treatment of comorbidity in this population is a particularly difficult problem due to numerous barriers to treatment and a poorly defined treatment system. As in other clinical populations, these patients are high utilizers of the limited treatment services available, but may not receive the type of treatment they need. After describing the extent of comorbidity in this population, we present an historical perspective of mental illness that provides an Indian's view of why we are where we are today in treating these problems. Next, we discuss Western and traditional treatment implications for comorbidity among adults and adolescents. Finally, we suggest directions for future research in this area.
本文在美国印第安人和阿拉斯加原住民文化背景以及印第安卫生服务局心理健康与酒精及药物滥用项目分支的背景下，探讨了共病心理病理学的治疗意义。由于存在众多治疗障碍且治疗系统定义不明确，该人群中共病的治疗是一个特别棘手的问题。与其他临床人群一样，这些患者对有限的可用治疗服务利用率很高，但可能无法获得他们所需的治疗类型。在描述了该人群中共病的程度之后，我们呈现了一个精神疾病的历史视角，提供了一个印第安人对于我们如今在治疗这些问题时所处状况的看法。接下来，我们讨论成人和青少年共病的西方和传统治疗意义。最后，我们提出该领域未来研究的方向。
