Korsgaard Hans Ole, Torgersen Svenn, Wentzel-Larsen Tore, Ulberg Randi
Department for Child and Adolescent Mental Health (The Nic Waal Institute), Lovisenberg Diakonale Hospital, Oslo, Norway.
Department of Psychology, University of Oslo, Oslo, Norway.
Child Adolesc Psychiatry Ment Health. 2016 Apr 11;10:8. doi: 10.1186/s13034-016-0096-5. eCollection 2016.
Substance use disorders (SUDs) constitute a major health problem and are associated with an extensive psychiatric comorbidity. Personality disorders (PDs) and SUDs commonly co-occur. Comorbid PD is characterized by more severe addiction problems and by an unfavorable clinical outcome. The present study investigated the prevalence of SUDs, PDs and common Axis I disorders in a sample of adolescent outpatients. We also investigated the association between PDs and SUDs, and how this association was influenced by adjustment for other Axis I disorders, age and gender.
The sample consisted of 153 adolescents, aged 14-17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. SUDs and other Axis I conditions were assessed using the mini international neuropsychiatric interview. PDs were assessed using the structured interview for DSM-IV personality.
18.3 % of the adolescents screened positive for a SUD, with no significant gender difference. There was a highly significant association between number of PD symptoms and having one or more SUDs; this relationship was practically unchanged by adjustment for gender, age and presence of Axis I disorders. For boys, no significant associations between SUDs and specific PDs, conduct disorder (CD) or attention deficit hyperactivity disorder (ADHD) were found. For girls, there were significant associations between SUD and BPD, negativistic PD, more than one PD, CD and ADHD.
We found no significant gender difference in the prevalence of SUD in a sample of adolescents referred to a general mental health outpatient clinic. The association between number of PD symptoms and having one or more SUDs was practically unchanged by adjustment for gender, age and presence of one or more Axis I disorders, which suggested that having an increased number of PD symptoms in itself may constitute a risk factor for developing SUDs in adolescence. The association in girls between SUDs and PDs, CD and ADHD raises the question if adolescent girls suffering from these conditions may be especially at risk for developing SUDs. In clinical settings, they should therefore be monitored with particular diligence with regard to their use of psychoactive substances. Trial registration The regional committee for medical research ethics for eastern Norway approved the study protocol in October 2004 (REK: 11395). Address correspondence and reprint requests to: Hans Ole Korsgaard, The Nic Waal Institute, Lovisenberg Diakonale Hospital, P.O. Box 2970 Nydalen, N-0440 Oslo, Norway; E-mail hansole.korsgaard@tele5.no.
物质使用障碍（SUDs）是一个主要的健康问题，并且与广泛的精神共病相关。人格障碍（PDs）和SUDs通常同时出现。共病的PD以更严重的成瘾问题和不良的临床结果为特征。本研究调查了青少年门诊患者样本中SUDs、PDs和常见的轴I障碍的患病率。我们还研究了PDs与SUDs之间的关联，以及这种关联如何受到对其他轴I障碍、年龄和性别的调整的影响。
样本包括153名年龄在14 - 17岁的青少年，他们被转介到一个有明确服务区域的非专科心理健康门诊。使用迷你国际神经精神访谈评估SUDs和其他轴I疾病。使用DSM-IV人格结构化访谈评估PDs。
18.3%的青少年SUD筛查呈阳性，无显著性别差异。PD症状数量与患有一种或多种SUDs之间存在高度显著的关联；在对性别、年龄和轴I障碍的存在进行调整后，这种关系基本不变。对于男孩，未发现SUDs与特定的PDs、品行障碍（CD）或注意力缺陷多动障碍（ADHD）之间有显著关联。对于女孩，SUD与边缘型人格障碍（BPD）、消极型人格障碍、一种以上的PD、CD和ADHD之间存在显著关联。
在转介到普通心理健康门诊的青少年样本中，我们发现SUD的患病率没有显著的性别差异。在对性别、年龄和一种或多种轴I障碍的存在进行调整后，PD症状数量与患有一种或多种SUDs之间的关联基本不变，这表明PD症状数量增加本身可能构成青少年发生SUDs的一个风险因素。女孩中SUDs与PDs、CD和ADHD之间的关联提出了一个问题，即患有这些疾病的青少年女孩是否特别容易发生SUDs。因此，在临床环境中，应特别密切监测她们使用精神活性物质的情况。试验注册：挪威东部地区医学研究伦理委员会于2004年10月批准了该研究方案（REK：11395）。如有通信和重印请求，请寄至：Hans Ole Korsgaard，尼克瓦尔研究所，洛维森堡迪亚科纳医院，邮政信箱2970，尼达伦，N - 0440奥斯陆，挪威；电子邮件：hansole.korsgaard@tele5.no。
