KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Psychiatry Section, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.
Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
Compr Psychiatry. 2014 Feb;55(2):274-82. doi: 10.1016/j.comppsych.2013.08.018. Epub 2013 Oct 19.
Longitudinal studies on first-episode psychosis (FEP) patients have shown a decrease of substance use disorders (SUDs) over the first years of illness, but there has been less focus on the gender aspect. The present study examines stability of alcohol and illicit substance use, with specific focus on gender, in a one year follow-up investigation of 154 FEP patients (91 men, 63 women) in Oslo, Norway, using criteria for DSM-IV substance use disorder diagnosis, the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT). The results show that cannabis was the most frequently used illicit substance at both times. Significantly more men (34%) than women (13%) had a current illicit SUD at baseline. At follow-up, the rate of illicit SUDs was significantly reduced in men (18%) but not in women (11%). There were no significant gender differences in the rate of current alcohol use disorders (AUD) (men 14%; women 8%) at baseline, and no significant reduction in AUD in any of the genders at follow-up. At follow-up, total AUDIT and DUDIT scores were reduced in men only. In conclusion, the high and persistent rate of SUDs, particularly of cannabis, among men and women during the first year of treatment for psychosis should be addressed in the clinical management of the patients. Female FEP patients who are also substance users may be particularly vulnerable in this regard and warrant closer attention.
纵向研究首发精神病（FEP）患者表明，在疾病的最初几年中，物质使用障碍（SUD）的发生率有所下降，但对性别方面的关注较少。本研究使用DSM-IV 物质使用障碍诊断标准、酒精使用障碍识别测试（AUDIT）和药物使用障碍识别测试（DUDIT），对挪威奥斯陆的 154 名 FEP 患者（91 名男性，63 名女性）进行了为期一年的随访调查，以考察酒精和非法物质使用的稳定性，特别关注性别因素。结果显示，大麻是两次测试中最常使用的非法药物。基线时，男性（34%）比女性（13%）有更多的当前非法 SUD。随访时，男性的非法 SUD 发生率（18%）显著降低，但女性（11%）没有。在基线时，当前酒精使用障碍（AUD）的发生率在男性（14%；女性 8%）和女性之间没有显著差异，而且任何性别的 AUD 在随访时都没有显著减少。随访时，只有男性的 AUDIT 和 DUDIT 总分降低。总之，在精神病治疗的第一年，男性和女性 SUD 的高发生率和持续性，特别是大麻，应在患者的临床管理中加以解决。同时也是物质使用者的女性 FEP 患者在这方面可能特别脆弱，需要更密切的关注。
