Bauer Mark S, Altshuler Lori, Evans Denise R, Beresford Thomas, Williford William O, Hauger Richard
VAMC and Brown University, 116R, 830 Chalkstone Avenue, Providence, RI 02908-4799, USA.
J Affect Disord. 2005 Apr;85(3):301-15. doi: 10.1016/j.jad.2004.11.009.
Recent data indicate high prevalence of both anxiety and substance comorbidity in bipolar disorder. However, few studies have utilized public sector samples, and only one has attempted to separate contributions of each type of comorbidity.
328 inpatient veterans with bipolar disorder across 11 sites were assessed using selected Structured Clinical Interview for DSM-IV modules and self-reports.
Comorbidity was common (current: 57.3%; lifetime: 78.4%), with multiple current comorbidities in 29.8%. Substance comorbidity rate was comparable to rates typically reported in non-veteran inpatient samples (33.8% current, 72.3% lifetime). Selected anxiety comorbidity rates exceeded those in other inpatient samples and appeared more chronic than episodic/recurrent (38.3% current, 43.3% lifetime). 49% of PTSD was due to non-combat stressors. Major correlates of current substance comorbidity alone were younger age, worse marital status, and higher current employability. Correlates of current anxiety comorbidity alone were early age of onset, greater number of prior-year depressive episodes, higher rates of disability pension receipt, and lower self-reported mental and physical function. Combined comorbidity resembled anxiety comorbidity.
This is a cross-sectional analysis of acutely hospitalized veterans.
Distinct patterns of substance and anxiety comorbidity are striking, and may be subserved by distinct neurobiologic mechanisms. The prevalence, chronicity and functional impact of anxiety disorders indicate the need for improved recognition and treatment of this other dual diagnosis group is warranted. Clinical and research interventions should recognize these divergent comorbidity patterns and provide individualized treatment built "from the patient out."
近期数据表明双相情感障碍中焦虑与物质使用共病的发生率很高。然而，很少有研究使用公共部门样本，且仅有一项研究尝试区分每种共病类型的影响。
对来自11个地点的328名双相情感障碍住院退伍军人，使用选定的《精神疾病诊断与统计手册》第四版模块的结构化临床访谈和自我报告进行评估。
共病情况很常见（目前：57.3%；终生：78.4%），29.8%的患者目前存在多种共病。物质使用共病率与非退伍军人住院样本中通常报告的率相当（目前33.8%，终生72.3%）。选定的焦虑共病率超过其他住院样本，且似乎比发作性/复发性更具慢性（目前38.3%，终生43.3%）。49%的创伤后应激障碍是由非战斗应激源引起的。仅目前物质使用共病的主要相关因素是年龄较小、婚姻状况较差和目前就业能力较高。仅目前焦虑共病的相关因素是发病年龄较早、前一年抑郁发作次数较多、领取残疾抚恤金的比例较高以及自我报告的心理和身体功能较低。合并共病与焦虑共病相似。
这是对急性住院退伍军人的横断面分析。
物质使用和焦虑共病的不同模式很显著，可能由不同的神经生物学机制所支持。焦虑障碍的患病率、慢性程度和功能影响表明，有必要更好地识别和治疗这一另一种双重诊断群体。临床和研究干预应认识到这些不同的共病模式，并提供“从患者出发”的个体化治疗。
