患有阿片类物质使用障碍的孕妇的精神共病：患病率、影响及治疗意义
Psychiatric Co-Morbidities in Pregnant Women with Opioid Use Disorders: Prevalence, Impact, and Implications for Treatment.
作者信息
Arnaudo Camila L, Andraka-Christou Barbara, Allgood Kacy
机构信息
Department of Psychiatry, Indiana University School of Medicine, 355 West 16th Street, Suite 2800, Indianapolis, IN 46202 USA.
Department of Health Policy and Management, Indiana University, Richard M. Fairbanks School of Public Health, Indianapolis, IN USA.
出版信息
Curr Addict Rep. 2017;4(1):1-13. doi: 10.1007/s40429-017-0132-4. Epub 2017 Mar 9.
PURPOSE OF REVIEW
This review seeks to investigate three questions: What is the prevalence of comorbid psychiatric diagnoses among pregnant women with opioid use disorder (OUD)? How do comorbid psychiatric illnesses impact pregnant women with OUD? And how do comorbid psychiatric illnesses affect the ability of pregnant women with OUD to adhere to and complete OUD treatment?
RECENT FINDINGS
Based on this literature review, 25-33% of pregnant women with OUD have a psychiatric comorbidity, with depression and anxiety being especially common. However, of the 17 studies reviewed only 5 have prevalence rates of dual diagnosis in pregnant women with OUD as their primary outcome measures, their N's were typically small, methods for determining psychiatric diagnosis were variable, and many of the studies were undertaken with women presenting for treatment which carries with its implicit selection bias. Of the women enrolled in treatment programs for SUD, those with psychiatric comorbidity were more likely to have impaired psychological and family/social functioning than those without psychiatric comorbidity. Greater severity of comorbid psychiatric illness appears to predict poorer adherence to treatment, but more research is needed to clarify this relationship with the psychiatric illness is less severe.
SUMMARY
While cooccurrence of psychiatric disorders in pregnant women with opioid use disorder appears to be common, large population-based studies with validated diagnostic tools and longitudinal assessments are needed to obtain definitive rates and characteristics of cooccurring illnesses. Integrated prenatal, addiction, and psychiatric treatment in a setting that provides social support to pregnant patients with OUD is most effective in maintaining women in treatment. More research is still needed to identify optimal treatment settings, therapy modalities, and medication management for dually diagnosed pregnant women with OUD.
综述目的
本综述旨在探讨三个问题：患有阿片类物质使用障碍（OUD）的孕妇中合并精神疾病诊断的患病率是多少？合并精神疾病如何影响患有OUD的孕妇？以及合并精神疾病如何影响患有OUD的孕妇坚持并完成OUD治疗的能力？
最新发现
基于此文献综述，25%-33%患有OUD的孕妇存在精神疾病合并症，其中抑郁症和焦虑症尤为常见。然而，在 reviewed 的17项研究中，只有5项将患有OUD的孕妇的双重诊断患病率作为主要结局指标，其样本量通常较小，确定精神疾病诊断的方法各不相同，而且许多研究是针对前来接受治疗的女性进行的，这存在内在的选择偏倚。在参加物质使用障碍治疗项目的女性中，有精神疾病合并症的女性比没有精神疾病合并症的女性更有可能出现心理以及家庭/社会功能受损的情况。合并精神疾病的严重程度越高，似乎预示着治疗依从性越差，但对于精神疾病不太严重的情况，还需要更多研究来阐明这种关系。
总结
虽然患有阿片类物质使用障碍的孕妇中精神疾病共病似乎很常见，但需要进行基于人群的大型研究，采用经过验证的诊断工具和纵向评估，以获得共病疾病的确切发生率和特征。在为患有OUD的孕妇提供社会支持的环境中，综合产前、成瘾和精神治疗对于维持女性接受治疗最为有效。对于双重诊断的患有OUD的孕妇，仍需要更多研究来确定最佳治疗环境、治疗方式和药物管理。
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