Dorard G, Bungener C, Phan O, Edel Y, Corcos M, Berthoz S
Laboratoire de psychopathologie et processus de santé (EA 4057), institut Henri-Piéron, IUPDP, université Paris Descartes-Sorbonne Paris Cité, 71, avenue Édouard-Vaillant, 92100 Boulogne-Billancourt, France.
Laboratoire de psychopathologie et processus de santé (EA 4057), institut Henri-Piéron, IUPDP, université Paris Descartes-Sorbonne Paris Cité, 71, avenue Édouard-Vaillant, 92100 Boulogne-Billancourt, France.
Encephale. 2018 Feb;44(1):2-8. doi: 10.1016/j.encep.2016.05.013. Epub 2016 Sep 13.
The use of illicit substances, in particular cannabis, among French adolescents and young adults has become an important public health concern. A better understanding of the mechanisms involved in pathological substance use is nowadays critical. Psychiatric comorbidities have been previously reported in adult substance abusers but are less documented in adolescents, especially regarding cannabis dependence.
We investigated mental health problems in adolescents and young adults, seeking treatment for their problematic cannabis use, comparatively to healthy controls, taking into account the participant's gender and age. Moreover, we explored the relationships between psychiatric diagnosis and substance use modalities.
In total, 100 young patients (80 males - mean age 18.2 (SD=2.9; [14 to 25] years old)) with a cannabis dependence (DSM-IV-TR criteria) seeking treatment in an addiction unit, and 82 healthy control subjects (50 males - mean age 18.3 (SD=3.4; [14 to 25] years old)) with no substance misuse diagnostic other than for alcohol, participated in the study. The MINI was administered to evaluate cannabis dependence, and DSM-IV axis I comorbid diagnosis, and a semi-structured interview was used to determine psychoactive substance use.
Statistical analyses revealed that 79 % of the patients reported at least one other non-drug or alcohol comorbid diagnosis, versus 30.5 % in the control group (χ=16.83; P<0.001). Logistic regression indicated that participants with a psychiatric diagnosis had an 8.6 times higher risk (P<0.001; OR 95 % CI=[4.38-16.81]) of being patients. Significant inter-group differences and OR were noted for several diagnoses: dysthymia over the previous 2years (χ=14.06; P<0.001; OR=10.63; OR 95 % CI=[2.41-46.87]), life-time panic attack disorder (χ=4.15; P<0.042; OR=3.59; OR 95 % CI=[0.98-13.19]), alcohol abuse (χ=47.72; P<0.001; OR=66.27; OR 95 % CI=[8.87-495.11]) and dependence (V=0.230; P=0.001) and generalized anxiety disorder (χ=7.46; P=0.006-OR=3.57; OR 95 % CI=[1.37-9.30]). On the whole, the females (n=20) of our clinical sample presented significantly more comorbid diagnoses than the males (n=80) (95 % versus 75 %; χ=6.25, P=0.011). These significant gender differences were found for life-time eating disorder (V=0.352; P=0.007) and generalized anxiety disorder diagnoses (V=0.278; P=0.013). Moreover, young adult patients (19-25years old; n=35) presented, on the whole, significantly more comorbid diagnoses than adolescent patients (14-18years old; n=65) (70.8 % versus 94.3 %; χ=7.58, P=0.006). These age inter-group differences were found for several diagnoses: alcohol dependence (6.2 % versus 20 %; V=0.211, P=0.047), dysthymia over the past 2years (13.8 % versus 34.3 %; χ=5.73, P=0.017) and generalized anxiety disorder (12.3 % versus 40 %; χ=10.17, P=0.001). Various associations were observed between psychiatric comorbid diagnosis and substance use indicators.
This study demonstrates that cannabis dependence in adolescents and young adults is related to great psychological distress and puts emphasis on the importance of substance use prevention as early as middle school. Moreover, the psychiatric features of adolescents and young adults need to be taken into consideration for treatment planning.
在法国青少年和青年中，非法药物的使用，尤其是大麻的使用，已成为一个重要的公共卫生问题。如今，更好地理解病理性药物使用所涉及的机制至关重要。先前已有报道称成年药物滥用者存在精神疾病共病情况，但在青少年中记录较少，尤其是关于大麻依赖。
我们调查了寻求治疗大麻使用问题的青少年和青年的心理健康问题，并与健康对照组进行比较，同时考虑参与者的性别和年龄。此外，我们还探讨了精神疾病诊断与药物使用方式之间的关系。
共有100名患有大麻依赖（符合《精神疾病诊断与统计手册》第四版修订版（DSM-IV-TR）标准）并在成瘾科寻求治疗的年轻患者（80名男性，平均年龄18.2岁（标准差=2.9；年龄范围为[14至25岁]））以及82名除酒精外无药物滥用诊断的健康对照者（50名男性，平均年龄18.3岁（标准差=3.4；年龄范围为[14至25岁]））参与了该研究。使用MINI评估大麻依赖、DSM-IV轴I共病诊断，并通过半结构化访谈确定精神活性物质的使用情况。
统计分析显示，79%的患者报告至少有一种其他非药物或酒精共病诊断，而对照组为30.5%（χ=16.83；P<0.001）。逻辑回归表明，患有精神疾病诊断的参与者成为患者的风险高8.6倍（P<0.001；优势比95%置信区间=[4.38 - 16.81]）。在几种诊断中观察到显著的组间差异和优势比：过去2年的心境恶劣（χ=14.06；P<0.001；优势比=·10.63；优势比95%置信区间=[2.41 - 46.87]）、终生惊恐障碍（χ=4.15；P<0.042；优势比=3.59；优势比95%置信区间=[0.98 - 13.19]）、酒精滥用（χ=47.72；P<0.001；优势比=66.27；优势比95%置信区间=[8.87 - 495.11]）以及依赖（V=0.230；P=0.001）和广泛性焦虑障碍（χ=7.46；P=0.006，优势比=3.57；优势比95%置信区间=[1.37 - 9.30]）。总体而言，我们临床样本中的女性（n = 20）共病诊断显著多于男性（n = 80）（95%对75%；χ=6.25，P=0.011）。在终生进食障碍（V=0.352；P=0.007）和广泛性焦虑障碍诊断（V=0.278；P=0.013）中发现了这些显著的性别差异。此外，总体而言，青年患者（19至25岁；n = 35）的共病诊断显著多于青少年患者（14至18岁；n = 65）（70.8%对94.3%；χ=7.58，P=0.006）。在几种诊断中发现了这些年龄组间差异：酒精依赖（6.2%对20%；V=0.211，P=0.047）、过去2年的心境恶劣（13.8%对34.3%；χ=5.73，P=0.017）和广泛性焦虑障碍（12.3%对40%；χ=10.17，P=0.001）。在精神疾病共病诊断与药物使用指标之间观察到了各种关联。
本研究表明，青少年和青年中的大麻依赖与严重的心理困扰有关，并强调了早在中学阶段进行药物使用预防的重要性。此外，在制定治疗计划时需要考虑青少年和青年的精神特征。
