Brady K T, Lydiard R B
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, College of Medicine, Charleston 29425.
J Clin Psychopharmacol. 1992 Feb;12(1 Suppl):17S-22S. doi: 10.1097/00004714-199202001-00004.
Epidemiologic data as well as data from treatment-seeking populations indicate that substance abuse disorders and other psychiatric disorders co-occur more commonly than would be expected by chance. In particular, substance abuse, especially cocaine abuse or dependence and alcoholism, is a far more common phenomenon in the population of patients with bipolar affective disorder than in the general population. National Institute of Mental Health Epidemiologic Catchment Area data indicate that bipolar affective disorder is the axis I disorder most likely to be associated with some form of substance abuse or dependence. Evidence from patient samples seeking treatment for substance abuse disorders as well as for psychiatric disorders suggests that clinical samples reflect similar patterns. There is evidence that bipolar patients with substance abuse have a worse course of illness. Diagnosing bipolar affective disorder in the face of substance abuse is difficult because the effects of drugs of abuse, particularly with chronic use, can mimic nearly any psychiatric disorder. At present, the data concerning a genetic link between bipolar affective disorder and substance abuse disorders are inconclusive. There are very few controlled data addressing either clinical features of, or specific treatment efforts with, this population. There is some theoretic rationale for the use of anticonvulsant, antikindling agents in this population, but no controlled studies have as yet been reported. In particular, a comparison of a mood-stabilizing agent, such as lithium, with an antikindling agent, such as valproate or carbamazepine, would be of theoretic and practical interest.
流行病学数据以及来自寻求治疗人群的数据表明，物质使用障碍与其他精神障碍同时出现的情况比偶然预期的更为常见。特别是，物质滥用，尤其是可卡因滥用或依赖以及酒精中毒，在双相情感障碍患者群体中比在普通人群中更为普遍。美国国立精神卫生研究所流行病学集水区数据表明，双相情感障碍是最有可能与某种形式的物质滥用或依赖相关的轴I障碍。来自寻求物质使用障碍治疗以及精神障碍治疗的患者样本的证据表明，临床样本反映出类似的模式。有证据表明，患有物质滥用的双相情感障碍患者病程更差。在存在物质滥用的情况下诊断双相情感障碍很困难，因为滥用药物的影响，尤其是长期使用时，几乎可以模仿任何精神障碍。目前，关于双相情感障碍与物质使用障碍之间遗传联系的数据尚无定论。针对该人群的临床特征或具体治疗措施的对照数据非常少。在该人群中使用抗惊厥、抗点燃药物有一些理论依据，但尚未有对照研究报告。特别是，将一种心境稳定剂，如锂盐，与一种抗点燃药物，如丙戊酸盐或卡马西平进行比较，将具有理论和实际意义。
