DSM-IV 和 DSM-5 酒精使用障碍特征的差异：对临床医生的启示。
Differences in the profiles of DSM-IV and DSM-5 alcohol use disorders: implications for clinicians.
机构信息
Laboratory of Epidemiology and Biometry, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA.
出版信息
Alcohol Clin Exp Res. 2013 Jan;37 Suppl 1(0 1):E305-13. doi: 10.1111/j.1530-0277.2012.01930.x. Epub 2012 Sep 13.
BACKGROUND
Existing information on consequences of the DSM-5 revision for the diagnosis of alcohol use disorders (AUD) has gaps, including missing information critical to understanding implications of the revision for clinical practice.
METHODS
Data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were used to compare AUD severity, alcohol consumption and treatment, sociodemographic and health characteristics, and psychiatric comorbidity among individuals with DSM-IV abuse versus DSM-5 moderate AUD and DSM-IV dependence versus DSM-5 severe AUD. For each pair of disorders, we additionally compared 3 mutually exclusive groups: individuals positive solely for the DSM-IV disorder, those positive solely for the DSM-5 disorder, and those positive for both.
RESULTS
Whereas 80.5% of individuals positive for DSM-IV dependence were positive for DSM-5 severe AUD, only 58.0% of those positive for abuse were positive for moderate AUD. The profiles of individuals with DSM-IV dependence and DSM-5 severe AUD were almost identical. The only significant (p < 0.005) difference, more AUD criteria among the former, reflected the higher criterion threshold (≥ 4 vs. ≥ 3) for severe AUD relative to dependence. In contrast, the profiles of individuals with DSM-5 moderate AUD and DSM-IV abuse differed substantially. The former endorsed more AUD criteria, had higher rates of physiological dependence, were less likely to be White individuals and men, had lower incomes, were less likely to have private and more likely to have public health insurance, and had higher levels of comorbid anxiety disorders than the latter.
CONCLUSIONS
Similarities between the profiles of DSM-IV and DSM-5 AUD far outweigh differences; however, clinicians may face some changes with respect to appropriate screening and referral for cases at the milder end of the AUD severity spectrum, and the mechanisms through which these will be reimbursed may shift slightly from the private to public sector.
背景
现有的关于 DSM-5 修订对酒精使用障碍（AUD）诊断影响的信息存在空白，包括对理解修订对临床实践影响至关重要的缺失信息。
方法
利用来自国家酒精相关状况和流行病学调查的第 2 波数据，比较 DSM-IV 滥用与 DSM-5 中度 AUD、DSM-IV 依赖与 DSM-5 重度 AUD 患者的 AUD 严重程度、饮酒量和治疗、社会人口学和健康特征以及精神共病情况。对于每一对障碍，我们还比较了 3 个相互排斥的组别：仅对 DSM-IV 障碍呈阳性、仅对 DSM-5 障碍呈阳性以及对两者均呈阳性的个体。
结果
DSM-IV 依赖阳性者中 80.5%也对 DSM-5 重度 AUD 呈阳性，而 DSM-IV 滥用阳性者中仅有 58.0%对中度 AUD 呈阳性。DSM-IV 依赖者和 DSM-5 重度 AUD 患者的特征几乎完全相同。唯一显著的（p < 0.005）差异是前者有更多的 AUD 标准，这反映了与依赖相比，重度 AUD 的标准阈值更高（≥4 与≥3）。相比之下，DSM-5 中度 AUD 和 DSM-IV 滥用患者的特征差异很大。前者有更多的 AUD 标准，更有可能出现生理依赖，不太可能是白人和男性，收入较低，更有可能有公共医疗保险，且焦虑障碍共病水平更高。
结论
DSM-IV 和 DSM-5 AUD 患者的特征相似性远大于差异性；然而，对于 AUD 严重程度谱较轻度病例，临床医生可能需要面对一些关于适当筛查和转介的变化，而这些变化的报销机制可能会从私人部门略微转向公共部门。
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