精神分裂症与随后的物质滥用诊断风险增加有关：一项全国范围内基于人群的登记研究。
Schizophrenia is associated with increased risk of subsequent substance abuse diagnosis: A nation-wide population-based register study.
机构信息
Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.
The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.
出版信息
Addiction. 2019 Dec;114(12):2217-2226. doi: 10.1111/add.14746. Epub 2019 Aug 4.
AIMS
We aimed to investigate whether or not a diagnosis of schizophrenia increases the risk of a substance abuse diagnosis.
DESIGN
Prospective cohort study using a longitudinal study design.
SETTING AND PARTICIPANTS
Individuals born in Denmark from 1955 to 1999 and registered in the Danish registers between 1 January 1968 and 1 July 2013.
MEASUREMENTS
We investigated the associations between schizophrenia and ICD diagnoses of substance abuse, both established through various Danish registers. The Cox regression model was used and adjusted for calendar year, gender, urbanicity, co-abuse, other psychiatric diagnoses, parents' substance abuse and psychiatric history, parents' immigration and parents' socio-economic position. Individuals diagnosed with substance abuse less than a year after diagnosis of schizophrenia were classified as not diagnosed with schizophrenia.
FINDINGS
The cohort consisted of 3 133 968 individuals. During follow-up (103 212 328 person-years at risk), a total of 14 007 individuals developed schizophrenia, with 2885 subsequently diagnosed with substance abuse. A diagnosis of schizophrenia was positively associated with the risk of developing substance abuse [hazard ratio (HR) = 3.69, 95% confidence interval (CI) = 3.56-3.83]. Additionally, adjusting for a co-abuse markedly affected the associations, making schizophrenia primarily associated with an increased risk of abuse of cannabis, alcohol, stimulants and other substances (adjusted HR = 2.48, 95% CI = 2.34-2.64 for cannabis; HR = 1.94, 95% CI = 1.87-2.02 for alcohol; HR = 1.77, 95% CI = 1.61-1.95 for stimulants; HR = 1.36, 95% CI = 1.20-1.54 for other substances). The association was still significant 10-15 years subsequent a diagnosis of schizophrenia (HR = 2.50, 95% CI = 2.26-2.76).
CONCLUSIONS
In Denmark a diagnosis of schizophrenia is significantly associated with increased risk of subsequent diagnosis of substance abuse.
目的
本研究旨在探讨精神分裂症的诊断是否会增加物质滥用的诊断风险。
设计
采用前瞻性队列研究设计的纵向研究。
地点和参与者
1955 年至 1999 年在丹麦出生且于 1968 年 1 月 1 日至 2013 年 7 月 1 日期间在丹麦登记处登记的个人。
测量方法
我们通过各种丹麦登记处调查了精神分裂症与物质滥用 ICD 诊断之间的关联。使用 Cox 回归模型进行分析，并根据日历年份、性别、城市化程度、共同滥用、其他精神科诊断、父母的物质滥用和精神病史、父母的移民和父母的社会经济地位进行调整。将精神分裂症诊断后不到一年就诊断为物质滥用的个体归类为未诊断为精神分裂症。
结果
该队列共纳入 3133968 人。在随访期间（103212328 人年风险期），共有 14007 人被诊断为精神分裂症，其中 2885 人随后被诊断为物质滥用。精神分裂症的诊断与物质滥用风险呈正相关[风险比（HR）=3.69，95%置信区间（CI）=3.56-3.83]。此外，调整共同滥用因素后，这些关联更为显著，使精神分裂症主要与滥用大麻、酒精、兴奋剂和其他物质的风险增加相关（调整后的 HR 为 2.48，95%CI 为 2.34-2.64，用于大麻；HR 为 1.94，95%CI 为 1.87-2.02，用于酒精；HR 为 1.77，95%CI 为 1.61-1.95，用于兴奋剂；HR 为 1.36，95%CI 为 1.20-1.54，用于其他物质）。在精神分裂症诊断后 10-15 年，这种关联仍然显著（HR=2.50，95%CI=2.26-2.76）。
结论
在丹麦，精神分裂症的诊断与随后物质滥用诊断的风险增加显著相关。
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