Department of Adult Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
Alcohol Clin Exp Res. 2011 Sep;35(9):1716-22. doi: 10.1111/j.1530-0277.2011.01518.x. Epub 2011 Jun 15.
The assessment of a Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) life-time history of alcohol dependence (LTH-AD) has been found to be moderately reliable and substantially heritable. However, in studies of the heritability of LTH-AD, measurement error could not be discriminated from the true unique environmental effects. The aims of this study were to: (i) estimate the reliability of LTH-AD in a population based sample, (ii) identify characteristics of LTH-AD predicting a reliable diagnosis, (iii) investigate the heritability of LTH-AD as a function of diagnostic confidence, and (iv) to estimate the genetic and environmental influences on LTH-AD correcting for measurement error.
An unselected sample of 4,203 male twins was interviewed twice approximately 1-year apart assessing DSM-IV LTH-AD over the same period of life. Logistic regression was used to identify clinical features that predict a reliable diagnosis LTH-AD. Genetic and environmental influences on reliable LTH-AD were examined using structural equation models.
Reliability of the diagnosis of LTH-AD was moderate (κ = 0.54) and was predicted by the number of AD symptoms, treatment seeking, duration of most severe episode, and a great deal of time spent to obtain, use, or recover from alcohol use (DSM-IV AD criterion #5). Using an index of caseness, heritability of LTH-AD increased as a function of diagnostic confidence. Accounting for errors of measurement in a multivariate twin model, the heritability of LTH-AD increased from 55 to 71%.
Reliably diagnosed LTH-AD can be predicted by characteristics relevant to the disorder. LTH-AD appears to be a moderately reliable disorder of high heritability.
评估《精神疾病诊断与统计手册第四版》（DSM-IV）的终生酒精依赖史（LTH-AD）已被证明具有中等可靠性和显著的遗传性。然而，在对 LTH-AD 的遗传性进行研究时，无法将测量误差与真正的独特环境效应区分开来。本研究的目的是：（i）在基于人群的样本中估计 LTH-AD 的可靠性，（ii）确定预测可靠诊断的 LTH-AD 的特征，（iii）调查 LTH-AD 的遗传性作为诊断置信度的函数，以及（iv）通过纠正测量误差来估计 LTH-AD 的遗传和环境影响。
对 4203 名未选择的男性双胞胎进行了两次访谈，两次访谈大约相隔一年，评估了同一时期的 DSM-IV LTH-AD。使用逻辑回归确定了预测可靠诊断 LTH-AD 的临床特征。使用结构方程模型研究了可靠的 LTH-AD 的遗传和环境影响。
LTH-AD 的诊断可靠性中等（κ=0.54），由 AD 症状的数量、寻求治疗、最严重发作的持续时间以及大量时间用于获取、使用或从酒精使用中恢复（DSM-IV AD 标准#5）预测。使用病例索引，随着诊断置信度的增加，LTH-AD 的遗传性增加。在多变量双胞胎模型中考虑到测量误差，LTH-AD 的遗传性从 55%增加到 71%。
可靠诊断的 LTH-AD 可以通过与该疾病相关的特征来预测。LTH-AD 似乎是一种可靠性中等、遗传性高的障碍。
