Yale School of Medicine, Department of Psychiatry, New Haven, CT, United States.
Yale School of Medicine, Department of Psychiatry, New Haven, CT, United States; Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, United States.
Schizophr Res. 2018 Nov;201:39-45. doi: 10.1016/j.schres.2018.04.035. Epub 2018 Apr 27.
While "dual diagnosis" involving both psychiatric and substance use disorders has long been a focus of schizophrenia research, recent studies have advocated for a shift of focus to multimorbidity, addressing comorbidity from both additional psychiatric disorders and substance use disorders. We hypothesized that more extensive mental health multimorbity would be associated with poorer quality of life (QOL) and functioning, and that additional psychiatric comorbidity in schizophrenia would have similar adverse effects on QOL as substance use comorbidity.
Participants with schizophrenia in the NIMH-funded Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) were classified using baseline diagnostic data into four groups: 1) monomorbid schizophrenia: 2) additional psychiatric comorbidity, 3) additional substance use comorbidity, and 4) both additional psychiatric and substance use comorbidity. Mixed models compared groups on self-reported QOL (SF-12 and Lehman QOLI) and rater-evaluated QOL (the Quality of Life Scale) using baseline, 6, 12 and 18-month follow-up data.
As hypothesized, patients with schizophrenia alone had a better QOL than those with any multimorbidity; patients with both psychiatric and substance use comorbidities had a worse QOL than those with fewer comorbidities; and patients with comorbid substance use alone were not significantly worse off than those with comorbid psychiatric disorder.
The multimorbidity framework more richly differentiates complex clinical presentations of schizophrenia than the current dual diagnosis concept and deserves further study as to its etiology, consequences, and treatment.
虽然涉及精神和物质使用障碍的“双重诊断”一直是精神分裂症研究的重点，但最近的研究主张将重点转移到多病共存上，既要解决其他精神障碍和物质使用障碍的共病问题。我们假设更广泛的心理健康多病共存与较差的生活质量（QOL）和功能有关，精神分裂症的额外精神共病对 QOL 的不良影响与物质使用共病相似。
使用 NIMH 资助的临床抗精神病药物干预效果试验（CATIE）中的基线诊断数据，将精神分裂症患者分为以下四组：1）单病种精神分裂症：2）额外的精神共病，3）额外的物质使用共病，4）同时存在额外的精神和物质使用共病。使用基线、6、12 和 18 个月的随访数据，混合模型比较了各组自我报告的 QOL（SF-12 和 Lehman QOLI）和评定者评估的 QOL（生活质量量表）。
正如假设的那样，单纯患有精神分裂症的患者的 QOL 比任何多病共存的患者要好；同时患有精神和物质使用障碍的患者的 QOL 比共病较少的患者差；而同时患有物质使用障碍的患者与患有精神障碍的患者相比，生活质量并没有明显下降。
与当前的双重诊断概念相比，多病共存框架更能区分精神分裂症的复杂临床表现，值得进一步研究其病因、后果和治疗方法。
