Chander Geetanjali, McCaul Mary E
Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, 8033, Baltimore, MD 21287, USA.
Obstet Gynecol Clin North Am. 2003 Sep;30(3):469-81. doi: 10.1016/s0889-8545(03)00079-2.
There is clinically important comorbidity between psychiatric and substance use disorders, particularly in women. Women with affective and anxiety disorders are more likely to present with alcohol or drug abuse/dependence. In turn, substance-abusing women are more likely to experience clinically significant depression and anxiety. Emerging evidence is pointing to an etiological role for anxiety disorders in the development of substance abuse/dependence; however, etiologic evidence is not as clear-cut for major depressive disorder. PTSD appears to be a particularly important factor for alcohol and drug dependence in women who have experienced childhood or adult sexual and or physical abuse. Although pharmacotherapy for affective or anxiety disorders is useful for ameliorating psychiatric symptoms, research is mixed on the effectiveness for improving alcohol- and drug-related outcomes. There is some limited evidence that women-specific services can improve treatment retention, substance use outcomes, and possibly psychosocial functioning compared with traditional mixed-gender programs. However, it is clear that women with co-occurring psychiatric and substance use problems are challenging to engage and retain in care. Physicians providing women's reproductive health services can serve a vital role in the identification and referral of substance-abusing women. Particular attention should be focused on screening and assessment of alcohol and drug use and problem severity among women who have identified psychiatric disorders or who are receiving antidepressant or anxiolytic medications. Recognition and referral for both psychiatric and substance use disorders are critical for long-term health and psychosocial improvement.
精神疾病与物质使用障碍之间存在临床上重要的共病现象，在女性中尤为如此。患有情感障碍和焦虑症的女性更有可能出现酒精或药物滥用/依赖问题。反过来，滥用物质的女性更有可能经历具有临床意义的抑郁和焦虑。新出现的证据表明焦虑症在物质滥用/依赖的发展中具有病因学作用；然而，对于重度抑郁症，病因学证据并不那么明确。创伤后应激障碍似乎是经历过童年或成年期性虐待和/或身体虐待的女性酒精和药物依赖的一个特别重要的因素。虽然针对情感障碍或焦虑症的药物治疗有助于改善精神症状，但关于改善与酒精和药物相关结果的有效性的研究结果不一。有一些有限的证据表明，与传统的混合性别项目相比，针对女性的服务可以提高治疗依从性、物质使用结果，并可能改善心理社会功能。然而，很明显，患有精神疾病和物质使用问题并存的女性在参与治疗和坚持治疗方面具有挑战性。提供女性生殖健康服务的医生在识别和转诊滥用物质的女性方面可以发挥至关重要的作用。应特别关注对已确诊精神疾病或正在接受抗抑郁药或抗焦虑药治疗的女性的酒精和药物使用情况及问题严重程度进行筛查和评估。识别并转诊精神疾病和物质使用障碍对于长期健康和心理社会改善至关重要。
