Baigent Michael F
University Department of Psychiatry, Flinders Medical Centre, South Australia, Australia.
Curr Opin Psychiatry. 2005 May;18(3):223-8. doi: 10.1097/01.yco.0000165590.68058.b0.
This review examines the relationship between alcohol misuse and comorbid psychiatric disorders, and the treatment of these comorbid disorders. In the past, the literature was dominated by papers describing prevalence, clinical services and comorbidity with schizophrenia. It is now advancing into areas such as the relationship between alcohol misuse and the anxiety disorders, affective disorders and eating disorders, and considering the diagnostic paradigm. Knowledge is also emerging about the influences of genetics and adverse effects over different stages of the life cycle in the development of these disorders.
Recent studies have examined the relationships between alcohol dependence and psychiatric illness, particularly anxiety and depression, but also subthreshold conditions. Childhood trauma, having parents with substance dependence and genetic factors influence the development of alcohol and comorbid psychiatric disorders. There is a genetic contribution to suicidal behaviour in alcohol-dependent patients. Early diagnosis is important. Alcohol Use Disorders Identification Test scores on admission to psychiatric hospital were found to correlate with suicidal ideation and behaviour. In patients with alcohol use disorders, treatment for depression works better after a period of abstinence. Abstinence alone can help for anxiety disorders. High-intensity services had better outcomes for this comorbid population than less intensive services.
Depression in patients with alcohol use disorders cannot be ignored. Treatment of depression alone will not help the alcohol use problems. All psychiatric inpatients should be screened for alcohol use disorders as part of their risk assessment. Research is focusing more on examining the complexities of these disorders, but there are no specific pharmacotherapies to treat particular comorbid conditions.
本综述探讨酒精滥用与共病精神障碍之间的关系，以及这些共病障碍的治疗方法。过去，文献主要是描述患病率、临床服务以及与精神分裂症的共病情况。现在，该领域正朝着酒精滥用与焦虑症、情感障碍和饮食障碍之间的关系等领域发展，并考虑诊断模式。关于遗传学影响以及这些障碍在生命周期不同阶段的不良影响的知识也在不断涌现。
近期研究探讨了酒精依赖与精神疾病之间的关系，尤其是焦虑和抑郁，以及阈下状态。童年创伤、父母有物质依赖以及遗传因素会影响酒精及共病精神障碍的发展。酒精依赖患者的自杀行为存在遗传因素。早期诊断很重要。研究发现，精神科住院时的酒精使用障碍识别测试分数与自杀意念和行为相关。对于患有酒精使用障碍的患者，禁欲一段时间后治疗抑郁症效果更好。仅禁欲对焦虑症就有帮助。对于这种共病群体，高强度服务比低强度服务效果更好。
酒精使用障碍患者的抑郁症不容忽视。仅治疗抑郁症无助于解决酒精使用问题。所有精神科住院患者都应作为风险评估的一部分接受酒精使用障碍筛查。研究更多地聚焦于审视这些障碍的复杂性，但尚无治疗特定共病情况的特效药物疗法。
