AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France.
Psychiatry Res. 2011 Jan 30;185(1-2):129-34. doi: 10.1016/j.psychres.2010.06.005. Epub 2010 Jun 27.
Bipolar disorder has been considered to have a better prognosis than schizophrenia at the very beginning of its definition. However, psychosocial functioning may vary not only because of the characteristics of the disorder, but also of co-morbid conditions, especially regarding substance use disorder (SUD). The purpose of this study was to compare the social adjustment level of patients with bipolar disorder with that observed in patients with schizophrenia, taking into account substance use disorder (SUD). Forty subjects with schizophrenia and 40 subjects with bipolar disorder, in the stable phase of the disorder, were matched for age, gender and presence of SUD (DSM-IV criteria). The social adjustment scale was completed with socio-demographic and clinical characteristics of illness. The global adaptation score of bipolar patients with SUD was poorer than bipolar patients without SUD, but was not observed as being significantly different from that of patients with schizophrenia, with or without associated SUD. Suicide attempts, poor compliance, longer hospitalisation, shorter remissions and criminal activity were also more frequently observed in the group of patients with bipolar disorder and SUD. Presence of substance use disorder seems to have a greater weight than the main diagnostic (schizophrenia versus bipolar disorder) to predict worse social adjustment and poorer outcome.
双相情感障碍在其定义之初被认为比精神分裂症预后更好。然而，心理社会功能可能不仅因疾病特征而异，还可能因合并症，尤其是物质使用障碍（SUD）而异。本研究的目的是比较双相情感障碍患者与精神分裂症患者的社会适应水平，同时考虑物质使用障碍（SUD）的情况。将 40 名精神分裂症患者和 40 名双相情感障碍患者，按年龄、性别和 SUD（DSM-IV 标准）匹配。使用社会人口统计学和疾病临床特征完成社会适应量表。有 SUD 的双相情感障碍患者的总体适应评分较差，但与有或没有相关 SUD 的精神分裂症患者相比，差异无统计学意义。有 SUD 的双相情感障碍患者更常出现自杀企图、依从性差、住院时间长、缓解时间短和犯罪活动。物质使用障碍的存在似乎比主要诊断（精神分裂症与双相情感障碍）更能预测较差的社会适应和较差的预后。
