Lukasiewicz Michael, Blecha Lisa, Falissard Bruno, Neveu Xavier, Benyamina Amine, Reynaud Michel, Gasquet Isabelle
Université Paris-Sud, U669, and Université Paris-V, Paris, France.
Alcohol Clin Exp Res. 2009 Jan;33(1):160-8. doi: 10.1111/j.1530-0277.2008.00819.x. Epub 2008 Oct 31.
Axis I psychiatric disorders (PD) and substance use disorders (SUD) are common in prison, but only few studies have focused on their association in this setting. Dual diagnosis (DD) (the co-occurrence of a SUD and any axis I disorder) is known to have a poorer prognosis and to require more intense supportive care.
The objectives of this study were (1) to describe prisoners with DD (prevalence and characteristics); (2) to compare DD prisoners with 3 other groups of prisoners: no diagnosis (ND), SUD alone, or other isolated PD; and (3) to evaluate the impact of DD on suicide risk in prison.
A random stratified strategy was used to select 23 various types of prisons and 998 prisoners. Diagnoses were assessed using a unique procedure, each prisoner being evaluated by 2 psychiatrists, 1 junior, using a structured interview (MINI 5 plus), and 1 senior, using an open clinical interview. Following interviews, clinicians met to establish a list of diagnoses. Cloninger's temperament and character inventory was also used.
Of the prisoners, 26.3% had a DD. DD prevalence was almost 80% in prisoners with SUD, while only one-third of the prisoners with an axis I PD had co-morbid SUD. No significant differences were observed in drug use patterns between DD and SUD without co-morbid PDs. DD showed the strongest association with suicide risk [OR = 5.7 (1.7-4.6)].
DD is very frequent in prison and is a major risk factor for suicide. Systematic psychiatric/SUD screening of prisoners with either a SUD or an axis I PD should be encouraged.
轴I精神障碍（PD）和物质使用障碍（SUD）在监狱中很常见，但只有少数研究关注它们在这种环境中的关联。已知双重诊断（DD）（SUD与任何轴I障碍同时出现）预后较差，需要更强化的支持性护理。
本研究的目的是：（1）描述患有DD的囚犯（患病率和特征）；（2）将患有DD的囚犯与其他三组囚犯进行比较：无诊断（ND）、仅患有SUD或其他孤立的PD；（3）评估DD对监狱自杀风险的影响。
采用随机分层策略选取23所不同类型的监狱和998名囚犯。使用独特的程序进行诊断评估，每位囚犯由2名精神科医生进行评估，1名初级医生使用结构化访谈（MINI 5 plus），1名高级医生使用开放式临床访谈。访谈后，临床医生开会确定诊断清单。还使用了克隆宁格的气质和性格量表。
在囚犯中，26.3%患有DD。在患有SUD的囚犯中，DD患病率近80%，而在患有轴I PD的囚犯中，只有三分之一患有共病SUD。在DD和无共病PD的SUD之间，药物使用模式没有观察到显著差异。DD与自杀风险的关联最强[比值比=5.7（1.7 - 4.6）]。
DD在监狱中非常常见，是自杀的主要危险因素。应鼓励对患有SUD或轴I PD的囚犯进行系统的精神科/SUD筛查。
