慢性甲基苯丙胺使用者与剂量相关的精神病症状：一项前瞻性纵向研究的证据。

Dose-related psychotic symptoms in chronic methamphetamine users: evidence from a prospective longitudinal study.

机构信息

Centre for Research on Ageing, Health and Well-being, Australian National University, Canberra, Australia.

出版信息

JAMA Psychiatry. 2013 Mar;70(3):319-24. doi: 10.1001/jamapsychiatry.2013.283.

DOI:10.1001/jamapsychiatry.2013.283

PMID:23303471

Abstract

CONTEXT

Methamphetamine is associated with psychotic phenomena, but it is not clear to what extent this relationship is due to premorbid psychosis among people who use the drug.

OBJECTIVE

To determine the change in the probability of psychotic symptoms occurring during periods of methamphetamine use.

DESIGN

Longitudinal prospective cohort study. A fixed-effects analysis of longitudinal panel data, consisting of 4 noncontiguous 1-month observation periods, was used to examine the relationship between changes in methamphetamine use and the risk of experiencing psychotic symptoms within individuals over time.

SETTING

Sydney and Brisbane, Australia.

PARTICIPANTS

A total of 278 participants 16 years of age or older who met DSM-IV criteria for methamphetamine dependence on entry to the study but who did not meet DSM-IV criteria for lifetime schizophrenia or mania.

MAIN OUTCOME MEASURES

Clinically significant psychotic symptoms in the past month, defined as a score of 4 or more on any of the Brief Psychiatric Rating Scale items of suspiciousness, hallucinations, or unusual thought content. The number of days of methamphetamine use in the past month was assessed using the Opiate Treatment Index.

RESULTS

There was a 5-fold increase in the likelihood of psychotic symptoms during periods of methamphetamine use relative to periods of no use (odds ratio [OR], 5.3 [95% CI, 3.4-8.3]; P < .001), this increase being strongly dose-dependent (1-15 days of methamphetamine use vs abstinence in the past month: OR, 4.0 [95% CI, 2.5-6.5]; ≥16 days of methamphetamine use vs abstinence in the past month: OR, 11.2 [95% CI, 5.9-21.1]). Frequent cannabis and/or alcohol use (≥16 days of use in the past month) further increased the odds of psychotic symptoms (cannabis: OR, 2.0 [95% CI, 1.1-3.5]; alcohol: OR, 2.1 [95% CI, 1.1-4.2]).

CONCLUSIONS

There was a large dose-dependent increase in the occurrence of psychotic symptoms during periods of methamphetamine use among users of the drug.

摘要

背景

甲基苯丙胺与精神病症状有关，但尚不清楚在使用该药物的人群中，这种关系在多大程度上是由于先前存在的精神病。

目的

确定在使用甲基苯丙胺期间出现精神病症状的概率变化。

设计

纵向前瞻性队列研究。使用固定效应分析纵向面板数据，包括 4 个不连续的 1 个月观察期，以检查个体在时间内随时间变化的甲基苯丙胺使用变化与经历精神病症状的风险之间的关系。

地点

澳大利亚悉尼和布里斯班。

参与者

共有 278 名年龄在 16 岁或以上的参与者，他们在进入研究时符合 DSM-IV 甲基苯丙胺依赖标准，但不符合 DSM-IV 终身精神分裂症或躁狂症标准。

主要观察指标

过去 1 个月内出现临床显著精神病症状，定义为 Brief Psychiatric Rating Scale 项目中的可疑、幻觉或异常思维内容任何一项得分为 4 或更高。过去 1 个月内使用甲基苯丙胺的天数使用阿片类药物治疗指数进行评估。

结果

与无使用期相比，使用甲基苯丙胺期间出现精神病症状的可能性增加了 5 倍（优势比[OR]，5.3 [95%CI，3.4-8.3]；P<.001），这种增加与剂量密切相关（1-15 天使用甲基苯丙胺与过去 1 个月内禁欲相比：OR，4.0 [95%CI，2.5-6.5]；≥16 天使用甲基苯丙胺与过去 1 个月内禁欲相比：OR，11.2 [95%CI，5.9-21.1]）。频繁使用大麻和/或酒精（过去 1 个月内使用≥16 天）进一步增加了出现精神病症状的几率（大麻：OR，2.0 [95%CI，1.1-3.5]；酒精：OR，2.1 [95%CI，1.1-4.2]）。