von Limbeek J, Wouters L, Kaplan C D, Geerlings P J, von Alem V
Subdivision of Social and Psychiatric Epidemiology, Municipal Health Service, Department of Mental Health, Amsterdam, The Netherlands.
J Subst Abuse Treat. 1992;9(1):43-52. doi: 10.1016/0740-5472(92)90009-d.
In Dutch samples of treated heroin addicts, high prevalences of a heterogeneous psychiatric co-morbidity can be found with regard to Diagnostic and Statistical Manual (third edition) (DSM-III) classifications, Zung Depression Inventory, and sum scores of a 90-item Symptom Checklist (SCL-90). A high-threshold (N = 87) and a low-threshold (N = 116) program are compared with regard to psychopathology and severity of psychopathology. A consecutive admissions design was used. More than 50% of the respondents suffered from a lifetime DSM-III Axis I disorder (70% with antisocial personality disorder included), and 40% were still suffering from one of the disorders in the year preceding the interview. Schizophrenia was diagnosed five times as much as in normal population samples (5%). The most frequently diagnosed disorders were recurrent major depression, phobic disorders, alcohol abuse and dependence, dysthymic disorder, and antisocial personality disorder. The prevalences of DSM-III disorders, the total number of symptoms, and the score on the Zung Depression Inventory and 90-item Symptom Checklist were all significantly higher in treatment-seeking drug addicts entering the high-threshold program. Within each program, three clinically meaningful subgroups can be distinguished: one group with DSM-III Axis I lifetime or current psychopathology and/or antisocial personality disorder, one with antisocial personality disorder only, and one with neither DSM-III psychopathology nor antisocial personality disorder. Possibly, self-selection results in patients with more serious conditions entering more treatment-oriented facilities. Odds ratios show that schizophrenia and mood disorders and especially associated on a lifetime and current basis.
在荷兰接受治疗的海洛因成瘾者样本中，根据《诊断与统计手册》（第三版）（DSM - III）分类、zung抑郁量表以及90项症状清单（SCL - 90）的总分，可发现精神疾病共病的异质性患病率较高。比较了一个高门槛项目（N = 87）和一个低门槛项目（N = 116）在精神病理学及精神病理学严重程度方面的差异。采用连续入院设计。超过50%的受访者患有终生DSM - III轴I障碍（包括70%患有反社会人格障碍者），40%在访谈前一年仍患有其中一种障碍。精神分裂症的诊断率是正常人群样本（5%）的五倍。最常诊断出的障碍是复发性重度抑郁症、恐惧症、酒精滥用和依赖、心境恶劣障碍以及反社会人格障碍。进入高门槛项目的寻求治疗的吸毒成瘾者中，DSM - III障碍的患病率、症状总数以及zung抑郁量表和90项症状清单的得分均显著更高。在每个项目中，可以区分出三个具有临床意义的亚组：一组患有DSM - III轴I终生或当前精神病理学和/或反社会人格障碍，一组仅患有反社会人格障碍，一组既无DSM - III精神病理学也无反社会人格障碍。可能是自我选择导致病情更严重的患者进入更具治疗导向性的机构。优势比表明精神分裂症和心境障碍在终生和当前基础上尤其相关。
