Ghosh Abhishek, Malhotra Savita, Basu Debasish
Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Indian J Med Res. 2016 Sep;144(3):385-392. doi: 10.4103/0971-5916.198673.
BACKGROUND & OBJECTIVES: The subtyping of alcohol dependence (AD) into early-onset (EO) and late-onset (LO) subgroups has been shown to have clinical and biological validity. As externalizing disorders (EDs) predate AD, the link of ED with age of onset of alcohol dependence needs to be investigated. The aim of this study was to examine the relationship of EDs such as disruptive behaviour disorder (DBD) and attention deficit hyperactivity disorder (ADHD) with age at onset of AD in a sample of male subjects.
One hundred consecutive male subjects with AD presenting to the De-Addiction Services and an equal number of biologically unrelated non-substance-dependent control subjects were included in the study. The AD subjects were divided into EO (age of onset of AD ≤25 yr; n = 21) and LO (age of onset of AD >25 yr; n = 79). Subjects were examined for evidence of DBD and ADHD in childhood, and current ADHD using structured instruments such as Semi-Structured Assessment for the Genetic of Alcoholism-IV (SSAGA-IV) and Kiddie - SADS - Present and Lifetime Version (K-SADS-PL). The odds ratio of association of EDs with EO and LO AD was calculated by comparing these subgroups with the biologically unrelated control group. Later, both the subgroups of alcohol dependence were compared for the presence of EDs.
All EDs (DBDs/childhood or adult ADHD) were more common in AD individuals as compared to the controls. However, when AD subgroups were compared with controls, the association of DBDs and ADHD reached a significant level only in the EO subgroup. A comparison of EO and LO AD showed that more EO individuals had history of both childhood disruptive disorder and ADHD compared to LO subgroup. Adult ADHD was also over-represented in EO subgroup.
INTERPRETATION & CONCLUSIONS: Our study showed more EDs in alcohol dependent individuals compared to controls. Further, the association observed between EDs and EO alcohol dependence points towards a developmental continuum between these two conditions.
酒精依赖（AD）分为早发型（EO）和晚发型（LO）亚组已被证明具有临床和生物学效度。由于外化性障碍（EDs）先于AD出现，因此需要研究ED与酒精依赖发病年龄之间的联系。本研究的目的是在男性受试者样本中检验诸如破坏性行为障碍（DBD）和注意力缺陷多动障碍（ADHD）等EDs与AD发病年龄之间的关系。
本研究纳入了100名连续就诊于戒毒服务机构的男性AD患者以及数量相等的生物学上无亲缘关系的非物质依赖对照受试者。AD患者被分为EO组（AD发病年龄≤25岁；n = 21）和LO组（AD发病年龄>25岁；n = 79）。使用诸如酒精中毒遗传学半结构化评估-IV（SSAGA-IV）和儿童情感障碍及精神分裂症问卷-目前及终生版（K-SADS-PL）等结构化工具检查受试者童年期DBD和ADHD的证据以及当前的ADHD情况。通过将这些亚组与生物学上无亲缘关系的对照组进行比较，计算EDs与EO和LO AD关联的优势比。随后，比较酒精依赖的两个亚组中EDs的存在情况。
与对照组相比，所有EDs（DBDs/儿童期或成人ADHD）在AD个体中更为常见。然而，当将AD亚组与对照组进行比较时，DBDs和ADHD的关联仅在EO亚组中达到显著水平。EO和LO AD的比较表明，与LO亚组相比，更多的EO个体有童年期破坏性行为障碍和ADHD的病史。成人ADHD在EO亚组中也占比过高。
我们的研究表明，与对照组相比，酒精依赖个体中的EDs更多。此外，EDs与EO酒精依赖之间观察到的关联表明这两种情况之间存在发育连续性。
