Kocur Józef, Trendak Wiesława
Zakład Rehabilitacji Psychospołecznej UM w Łodzi.
Psychiatr Pol. 2009 Sep-Oct;43(5):601-9.
Addiction to alcohol or any other psychoactive substance can run parallel with other diseases or mental disorders. One can then observe co-occurrence and mutual interaction of dysfunctions typical of addiction and of other mental disorders that accompany addiction. That is why, clinical pictures of such states (double diagnosis) are usually less unique, have an unusual course and cause diagnostic and therapeutic difficulty. The problem of forensic psychiatric opinion and treatment of people with a double diagnosis is another aspect of these difficulties. It is caused by the fact that forensic psychiatric assessment of the mental state of such people requires taking into consideration a very complex clinical and legal situation triggered by the interference of various ethiopathogenetic and clinical disorders. It leads to the need for complex evaluation and reference to sanity or other signs of functioning within the current law should result, first of all, from the analyses directly pertaining to the influence of the diagnosed disorders on the state of patients with double diagnosis. The forensic psychiatric aspect of disorders connected with double diagnosis is particularly significant as there is a relatively high risk of behaviours posing a threat to public order in this group of patients.
对酒精或任何其他精神活性物质上瘾可能与其他疾病或精神障碍同时存在。人们可以观察到成瘾典型功能障碍与伴随成瘾的其他精神障碍的共同出现和相互作用。这就是为什么，这种状态（双重诊断）的临床症状通常不那么独特，病程异常，会导致诊断和治疗困难。法医精神病学对双重诊断患者的评估和治疗问题是这些困难的另一个方面。这是因为对此类人群精神状态进行法医精神病学评估需要考虑到由各种病因发病机制和临床疾病的相互干扰引发的非常复杂的临床和法律情况。首先，基于与诊断出的疾病对双重诊断患者状态的影响直接相关的分析，有必要进行综合评估并参照现行法律中的心智健全或其他功能迹象。与双重诊断相关的疾病的法医精神病学方面尤为重要，因为在这类患者中存在对公共秩序构成威胁的行为的相对较高风险。
