Buydens-Branchey L, Branchey M H, Noumair D
Department of Psychiatry, Mount Sinai School of Medicine, City University of New York, New York.
Arch Gen Psychiatry. 1989 Mar;46(3):225-30. doi: 10.1001/archpsyc.1989.01810030031004.
Numerous attempts have been made to subdivide populations of alcoholics into homogeneous subgroups. Although no consensus has been reached about the characteristics of these subgroups, a number of classification schemes have identified a subgroup of patients with a high genetic loading for alcoholism, an early onset of alcoholism, a severe course, and coexisting psychiatric problems consisting of aggressive tendencies or criminality. In a recent typology proposed by Cloninger on the basis of adoption studies, this subgroup has been classified as type 2. Another group of patients who were found to differ in their mode of inheritance and clinical characteristics was classified as type 1. The identification of etiologically homogeneous subgroups is easier in studies of adoptees than in studies of individuals who were not adopted. In an attempt to divide alcoholics into two groups of individuals presenting type 1 and type 2 characteristics, we used as a criterion the age of alcoholism onset because type 2 alcoholics as well as their fathers had been found to abuse alcohol at a younger age than type 1 patients. Patients with an onset of alcoholism before their 20th birthday were found to have a significantly higher incidence of paternal alcoholism and were twice as likely to have been incarcerated for crimes involving physical violence. We also observed other features not previously described in this patient subgroup. Patients who started abusing alcohol in their teens were three times as likely to be depressed and four times as likely to have attempted suicide as patients with a later onset of alcohol abuse.
人们已经进行了多次尝试，将酗酒人群细分为同质亚组。尽管对于这些亚组的特征尚未达成共识，但一些分类方案已经识别出一个亚组的患者，他们具有较高的酗酒遗传负荷、酗酒发病早、病程严重，并且存在由攻击倾向或犯罪行为组成的共存精神问题。在克隆宁格最近基于收养研究提出的一种类型学中，这个亚组被归类为2型。另一组在遗传方式和临床特征上存在差异的患者被归类为1型。在收养者的研究中，识别病因同质的亚组比在非收养个体的研究中更容易。为了将酗酒者分为呈现1型和2型特征的两组个体，我们以酗酒发病年龄作为标准，因为已发现2型酗酒者及其父亲比1型患者更早开始酗酒。发现在20岁生日之前开始酗酒的患者，其父亲酗酒的发生率显著更高，并且因涉及身体暴力的罪行而被监禁的可能性是其他患者的两倍。我们还观察到了这个患者亚组以前未描述过的其他特征。与酗酒发病较晚的患者相比，十几岁就开始酗酒的患者患抑郁症的可能性是其三倍，自杀未遂的可能性是其四倍。
