Weiss R D, Mirin S M, Griffin M L, Michael J L
Alcohol and Drug Abuse Treatment Center, McLean Hospital, Belmont, Massachusetts 02178.
J Nerv Ment Dis. 1988 Dec;176(12):719-25. doi: 10.1097/00005053-198812000-00004.
The authors studied a group of 149 hospitalized cocaine abusers as a follow-up to previous research performed in 1980-82, which had revealed a high prevalence of affective disorder in cocaine abusers. The authors hypothesized that the changing epidemiology of cocaine abuse since that time may have been accompanied by changes in the characteristics of patients seeking treatment for dependence on the drug. The cocaine abusers were compared with 293 other drug abusers to see whether clinical changes over time were specific to individuals abusing cocaine. The authors found slightly more affective disorder in the cocaine abusers when compared with the other patients (26.8% vs. 20.1%), with a significantly higher rate of cyclothymic disorder (11.4% vs. 2.7%, p less than .001). Affective illness was significantly more prevalent in the first-degree relatives of the cocaine abusers when compared with the sex-matched relatives of the other patients (p less than .05). Diagnostic trends changed a great deal, however, between the original 1980-82 study sample and the follow-up 1982-86 sample. The rate of affective disorder decreased over time from 50.0% to 21.0% (p less than .01), and the rate of affective illness in the families also declined, from 31.0% to 11.5% in females (p less than .001) and from 14.3% to 2.2% in males (p less than .001). No such change occurred in the comparison group of opioid and central nervous system depressant abusers. The authors conclude that although a substantial number of cocaine abusers suffer from concurrent affective disorder, this form of premorbid psychopathology has become a less important risk factor for the development of chronic cocaine abuse as cocaine use has become more widespread.
作者对149名住院的可卡因滥用者进行了研究，作为1980 - 1982年之前所做研究的后续跟进，之前的研究显示可卡因滥用者中情感障碍的患病率很高。作者推测，自那时以来可卡因滥用流行病学的变化可能伴随着寻求药物依赖治疗的患者特征的变化。将可卡因滥用者与293名其他药物滥用者进行比较，以观察随着时间推移临床变化是否是可卡因滥用者所特有的。与其他患者相比，作者发现可卡因滥用者中情感障碍略多一些（26.8%对20.1%），环性心境障碍的发生率显著更高（11.4%对2.7%，p小于0.001）。与其他患者的性别匹配亲属相比，可卡因滥用者的一级亲属中情感疾病的患病率显著更高（p小于0.05）。然而，在1980 - 1982年的原始研究样本和1982 - 1986年的随访样本之间，诊断趋势发生了很大变化。情感障碍的发生率随时间从50.0%降至21.0%（p小于0.01），家庭中情感疾病的发生率也有所下降，女性从31.0%降至11.5%（p小于0.001），男性从14.3%降至2.2%（p小于0.001）。阿片类药物和中枢神经系统抑制剂滥用者的对照组未发生此类变化。作者得出结论，虽然相当数量的可卡因滥用者同时患有情感障碍，但随着可卡因使用变得更加普遍，这种病前精神病理学形式已成为慢性可卡因滥用发展中不太重要的危险因素。
