Caton Carol L M, Drake Robert E, Hasin Deborah S, Dominguez Boanerges, Shrout Patrick E, Samet Sharon, Schanzer Bella
New York State Psychiatric Institute/Columbia University Department of Psychiatry, New York, NY 10032, USA.
Arch Gen Psychiatry. 2005 Feb;62(2):137-45. doi: 10.1001/archpsyc.62.2.137.
The distinction between a substance-induced psychosis and a primary psychotic disorder that co-occurs with the use of alcohol or other drugs is critical for understanding illness course and planning appropriate treatment, yet there has been little study and evaluation of the differences between these 2 diagnostic groups.
To identify key demographic, family, and clinical differences in substance-induced psychosis and primary psychotic disorders diagnosed according to DSM-IV criteria using a research diagnostic instrument for psychiatric and substance use comorbidity.
Data on demographic, family, and clinical factors were gathered at baseline as part of a 3-year longitudinal study of early-phase psychosis and substance use comorbidity in New York, NY.
Psychiatric emergency department admissions.
The study is based on a referred sample of 400 subjects interviewed at baseline. Participants had at least 1 psychotic symptom assessed during administration of the research protocol, had used alcohol and/or other drugs within the past 30 days, and had no psychiatric inpatient history before the past 6 months. Subject race included 43.5% black, 42.0% Hispanic, and 14.5% white or other.
Psychotic disorders defined by the DSM-IV.
Overall, 169 (44%) were diagnosed as having substance-induced psychosis and 217 (56%), as having primary psychosis. Significant differences were observed in all 3 domains. Multivariate analysis using logistic regression identified the following 3 key predictors as being greater in the substance-induced group: parental substance abuse (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.00-2.85), a diagnosis of dependence on any drug (OR, 9.41; 95% CI, 5.26-16.85), and visual hallucinations (OR, 2.13; 95% CI, 1.10-4.13). The key predictor of total positive and negative symptom score was greater in the primary psychosis group (OR, 0.96; 95% CI, 0.94-0.97).
Differences in demographic, family, and clinical domains confirm substance-induced and primary psychotic disorders as distinct entities. Key predictors could help emergency clinicians to correctly classify early-phase psychotic disorders that co-occur with substance use.
物质所致精神病与在使用酒精或其他药物时同时出现的原发性精神病性障碍之间的区别，对于理解疾病病程和规划适当治疗至关重要，但对这两个诊断组之间的差异几乎没有进行研究和评估。
使用针对精神疾病和物质使用共病的研究诊断工具，确定根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准诊断的物质所致精神病和原发性精神病性障碍在关键人口统计学、家庭和临床方面的差异。
作为纽约市一项为期3年的早期精神病和物质使用共病纵向研究的一部分，在基线时收集了关于人口统计学、家庭和临床因素的数据。
精神科急诊科入院患者。
该研究基于400名在基线时接受访谈的转诊样本。参与者在研究方案研究方案实施期间至少有1种精神病性症状被评估，在过去30天内使用过酒精和/或其他药物，且在过去6个月内无精神科住院史。受试者种族包括43.5%为黑人，42.0%为西班牙裔，14.5%为白人或其他种族。
由DSM-IV定义的精神病性障碍。
总体而言，169例（44%）被诊断为物质所致精神病，217例（56%）被诊断为原发性精神病。在所有3个领域均观察到显著差异。使用逻辑回归的多变量分析确定了以下3个关键预测因素在物质所致组中更为常见：父母物质滥用（优势比[OR]，1.69；95%置信区间[CI]，1.00 - 2.85）、对任何药物的依赖诊断（OR，9.41；95% CI，5.26 - 16.85）以及视幻觉（OR，2.13；95% CI，1.10 - 4.13）。原发性精神病组中总阳性和阴性症状评分的关键预测因素更高（OR，0.96；95% CI，0.94 - 0.97）。
人口统计学、家庭和临床领域的差异证实了物质所致精神病和原发性精神病性障碍是不同的实体。关键预测因素可帮助急诊临床医生正确分类与物质使用同时出现的早期精神病性障碍。
