轴I和轴II障碍作为心理困扰的长期预测因素：对物质依赖患者的六年前瞻性随访
Axis I and II disorders as long-term predictors of mental distress: a six-year prospective follow-up of substance-dependent patients.
作者信息
Bakken Kjell, Landheim Anne Signe, Vaglum Per
机构信息
Centre for Addiction Issues, Department for Substance Abuse, Innlandet Hospital Trust, Norway.
出版信息
BMC Psychiatry. 2007 Jun 26;7:29. doi: 10.1186/1471-244X-7-29.
BACKGROUND
A high prevalence of lifetime psychiatric disorders among help-seeking substance abusers has been clearly established. However, the long-term course of psychiatric disorders and mental distress among help-seeking substance abusers is still unclear. The aim of this research was to examine the course of mental distress using a six-year follow-up study of treatment-seeking substance-dependent patients, and to explore whether lifetime Axis I and II disorders measured at admission predict the level of mental distress at follow-up, when age, sex, and substance-use variables measured both at baseline and at follow-up are controlled for.
METHODS
A consecutive sample of substance dependent in- and outpatients (n = 287) from two counties of Norway were assessed at baseline (T1) with the Composite International Diagnostic Interview (Axis I), Millon's Clinical Multiaxial Inventory (Axis II), and the Hopkins Symptom Checklist (HSCL-25 (mental distress)). At follow-up (T2), 48% (137/287 subjects, 29% women) were assessed with the HSCL-25, the Alcohol Use Disorders Identification Test, and the Drug Use Disorders Identification Test.
RESULTS
The stability of mental distress is a main finding and the level of mental distress remained high after six years, but was significantly lower among abstainers at T2, especially among female abstainers. Both the number of and specific lifetime Axis I disorders (social anxiety disorder, generalized anxiety disorder, and somatization disorder), the number of and specific Axis II disorders (anxious and impulsive personality disorders), and the severity of substance-use disorder at the index admission were all independent predictors of a high level of mental distress at follow-up, even when we controlled for age, sex, and substance use at follow-up.
CONCLUSION
These results underscore the importance of diagnosing and treating both substance-use disorder and non-substance-use disorder Axis I and Axis II disorders in the same programme.
背景
在寻求帮助的药物滥用者中，终生精神障碍的高患病率已得到明确证实。然而，寻求帮助的药物滥用者中精神障碍和精神痛苦的长期病程仍不清楚。本研究的目的是通过对寻求治疗的药物依赖患者进行为期六年的随访研究，来检查精神痛苦的病程，并探讨入院时测量的终生轴I和轴II障碍是否能预测随访时的精神痛苦水平，同时控制基线和随访时测量的年龄、性别和药物使用变量。
方法
对来自挪威两个县的连续样本的药物依赖住院和门诊患者（n = 287）在基线（T1）时进行评估，使用复合国际诊断访谈（轴I）、米隆临床多轴问卷（轴II）和霍普金斯症状清单（HSCL - 25（精神痛苦））。在随访（T2）时，对48%（137/287名受试者，29%为女性）进行了HSCL - 25、酒精使用障碍识别测试和药物使用障碍识别测试。
结果
精神痛苦的稳定性是一个主要发现，六年之后精神痛苦水平仍然很高，但在T2时戒断者中的水平显著较低，尤其是女性戒断者。索引入院时的终生轴I障碍（社交焦虑障碍、广泛性焦虑障碍和躯体化障碍）的数量和特定类型、轴II障碍（焦虑和冲动人格障碍）的数量和特定类型，以及药物使用障碍的严重程度，即使在我们控制了随访时的年龄、性别和药物使用情况后，都是随访时精神痛苦高水平的独立预测因素。
结论
这些结果强调了在同一项目中诊断和治疗药物使用障碍以及非药物使用障碍轴I和轴II障碍的重要性。
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