Department of Psychiatry, University of Pennsylvania, PA, USA.
Department of Psychiatry, University of Pennsylvania, PA, USA; Department of Psychology, National Taiwan University, Taipei, Taiwan.
J Anxiety Disord. 2014 Dec;28(8):894-901. doi: 10.1016/j.janxdis.2014.09.023. Epub 2014 Oct 16.
Posttraumatic stress disorder (PTSD) and alcohol dependence (AD) are frequently comorbid and the order in which they develop may affect the clinical presentation and response to treatment. This study compared 73 treatment-seeking participants who developed PTSD prior to developing AD ("PTSD-first") with 64 participants who developed AD prior to developing PTSD ("AD-first") on demographics, clinical presentation, and response to treatment for PTSD and AD. All participants received BRENDA, a medication management and motivational enhancement intervention and were randomly assigned to either prolonged exposure (PE) for PTSD plus BRENDA or BRENDA alone and to either naltrexone (NAL) for AD or placebo (PBO). Results showed that participants with AD-first were more likely to report low income, meet criteria for antisocial or borderline personality disorder, report an index trauma of physical assault, compared to those with PTSD-first. Conversely, participants with PTSD-first were more likely to report an index trauma of sexual assault or a combat experience. Notably, no group differences were observed in treatment outcome despite some differences in clinical presentation.
创伤后应激障碍 (PTSD) 和酒精依赖 (AD) 经常共病，它们的发病顺序可能会影响临床症状和治疗反应。本研究比较了 73 名先出现 PTSD 后出现 AD 的治疗寻求者（“PTSD 在先”组）和 64 名先出现 AD 后出现 PTSD 的参与者（“AD 在先”组）在人口统计学、临床特征和 PTSD 和 AD 治疗反应方面的差异。所有参与者均接受 BRENDA，一种药物管理和动机增强干预，并随机分配至 PTSD 的延长暴露 (PE) 加 BRENDA 或仅 BRENDA，以及 AD 的纳曲酮 (NAL) 或安慰剂 (PBO)。结果表明，与 PTSD 在先组相比，AD 在先组更有可能报告收入低、符合反社会或边缘型人格障碍标准、报告躯体攻击的创伤性事件。相反，PTSD 在先组更有可能报告性侵犯或战斗经历的创伤性事件。值得注意的是，尽管临床特征存在一些差异，但治疗结果没有观察到组间差异。
