Tolliver Bryan K, Anton Raymond F
Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
Dialogues Clin Neurosci. 2015 Jun;17(2):181-90. doi: 10.31887/DCNS.2015.17.2/btolliver.
Recognition and management of mood symptoms in individuals using alcohol and/or other drugs represent a daily challenge for clinicians in both inpatient and outpatient treatment settings. Diagnosis of underlying mood disorders in the context of ongoing substance abuse requires careful collection of psychiatric history, and is often critical for optimal treatment planning and outcomes. Failure to recognize major depression or bipolar disorders in these patients can result in increased relapse rates, recurrence of mood episodes, and elevated risk of completed suicide. Over the past decade, epidemiologic research has clarified the prevalence of comorbid mood disorders in substance-dependent individuals, overturning previous assumptions that depression in these patients is simply an artifact of intoxication and/or withdrawal, therefore requiring no treatment. However, our understanding of the bidirectional relationships between mood and substance use disorders in terms of their course(s) of illness and prognoses remains limited. Like-wise, strikingly little treatment research exists to guide clinical decision making in co-occurring mood and substance use disorders, given their high prevalence and public health burden. Here we overview what is known and the salient gaps of knowledge where data might enhance diagnosis and treatment of these complicated patients.
识别和处理使用酒精和/或其他药物的个体的情绪症状，对住院和门诊治疗环境中的临床医生来说都是一项日常挑战。在持续存在药物滥用的情况下诊断潜在的情绪障碍，需要仔细收集精神病史，这对于优化治疗计划和治疗结果通常至关重要。未能识别这些患者中的重度抑郁症或双相情感障碍，可能会导致复发率增加、情绪发作复发以及自杀身亡风险升高。在过去十年中，流行病学研究已经明确了物质依赖个体中共病情绪障碍的患病率，推翻了之前认为这些患者的抑郁症仅仅是中毒和/或戒断的产物、因此无需治疗的假设。然而，我们对情绪障碍和物质使用障碍在疾病进程和预后方面的双向关系的理解仍然有限。同样，鉴于共病情绪障碍和物质使用障碍的高患病率和公共卫生负担，指导其临床决策的治疗研究少之又少。在此，我们概述了已知的情况以及知识上的显著空白，这些空白之处的数据可能会改善对这些复杂患者的诊断和治疗。
