Matsumoto Toshihiko, Matsushita Sachio, Okudaira Kenichi, Naruse Nobuya, Cho Tetsuji, Muto Takeo, Ashizawa Takeshi, Konuma Kyohei, Morita Nobuaki, Ino Aro
Department of Drug Dependence Research/Center for Suicide Prevention, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-higashi, Kodaira, Tokyo 187-8553, Japan.
Nihon Arukoru Yakubutsu Igakkai Zasshi. 2010 Dec;45(6):530-42.
Substance use disorder is one of the important mental health problems related to suicide, nearly equal with depressive disorder. However, it is unclear how differences of abused substances influence the suicide risk of individuals with substance use disorder in Japan. The purpose of the present study is to compare an estimated suicide risk among patients with alcohol, amphetamine, and sedative, hypnotic or anxiolytic use disorders.
Subjects were 1082 outpatients with alcohol use disorder (AUD), 191 with amphetamine-like use disorder (AMUD), and 63 with sedative, hypnotic or anxiolytic use disorder (SUD), all of whom consecutively had consulted seven medical facilities specialized for treatment of substance use disorder during a month of December 2009. A self-reporting questionnaire including the items of Kessler 10 (K10) and the Mini International Neuropsychiatric Interview (M.I.N.I.) was administered, and scores of the K10 and M.I.N.I., and the other clinical information were compared among the patients with AUD, AMUD, and SUD.
Patients with AMUD and SUD showed significantly higher score on the M.I.N.I. than those with AUD, while those with SUD showed highest score on the K10, followed by those with AMUD. In either of patients with AUD, AMUD, or SUD, approximately 60% of the subjects who attempted suicide within a month reported to take any psychoactive substance in the attempted suicide. Additionally, a remarkable difference was found in histories of general psychiatric treatment before consulting medical facilities specialized for treatment of substance use disorder between these three groups. Most of outpatients with SUD reported such histories.
Outpatients with SUD appeared to involve the highest risk for suicide of all patients with substance use disorder, probably because of the comorbid-severe depression. In our speculation, SUD which our subjects suffered from might be induced or accelerated by pharmacotherapy performed in general psychiatric facilities. Education on dependency of prescribed psychotropic drugs to general psychiatrists is required.
物质使用障碍是与自杀相关的重要心理健康问题之一，与抑郁症几乎相当。然而，在日本，滥用物质的差异如何影响物质使用障碍患者的自杀风险尚不清楚。本研究的目的是比较酒精、苯丙胺以及镇静催眠或抗焦虑药物使用障碍患者的估计自杀风险。
研究对象为1082例酒精使用障碍（AUD）门诊患者、191例苯丙胺类使用障碍（AMUD）门诊患者和63例镇静催眠或抗焦虑药物使用障碍（SUD）门诊患者，他们均于2009年12月的一个月内连续到七家专门治疗物质使用障碍的医疗机构就诊。采用包括凯斯勒10项量表（K10）和简明国际神经精神访谈（M.I.N.I.）项目的自填问卷进行调查，并比较AUD、AMUD和SUD患者的K10和M.I.N.I.得分以及其他临床信息。
AMUD和SUD患者的M.I.N.I.得分显著高于AUD患者，而SUD患者的K10得分最高，其次是AMUD患者。在AUD、AMUD或SUD患者中，近60%在一个月内有自杀未遂行为的受试者报告在自杀未遂时使用了任何精神活性物质。此外，这三组患者在到专门治疗物质使用障碍的医疗机构就诊之前的一般精神科治疗史存在显著差异。大多数SUD门诊患者报告有此类病史。
SUD门诊患者似乎是所有物质使用障碍患者中自杀风险最高的，可能是因为合并严重抑郁症。据我们推测，我们的受试者所患的SUD可能是由一般精神科机构进行的药物治疗诱发或加速的。需要对普通精神科医生进行关于处方精神药物依赖性的教育。
