Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Biol Psychiatry. 2021 Feb 15;89(4):407-414. doi: 10.1016/j.biopsych.2020.09.014. Epub 2020 Sep 22.
It remains unclear if individuals with Tourette syndrome (TS) or chronic tic disorder (CTD) have an elevated risk of subsequent substance misuse.
In this population-based cohort study, we investigated the association between ICD diagnoses of TS/CTD and substance misuse outcomes, accounting for psychiatric comorbidity and familial factors. The cohort included all individuals living in Sweden at any time between January 1, 1973, and December 31, 2013. Substance misuse outcomes were defined as an ICD code of substance use-related disorder or cause of death, or as a substance use-related criminal conviction in the nationwide registers.
The cohort included 14,277,199 individuals, of whom 7832 had a TS/CTD diagnosis (76.3% men). TS/CTD was associated with an increased risk of any subsequent substance misuse outcomes (adjusted hazard ratio [aHR], 3.11; 95% confidence interval [CI], 2.94-3.29), including alcohol-related disorder (aHR, 3.45; 95% CI, 3.19-3.72), drug-related disorder (aHR, 6.84; 95% CI, 6.32-7.40), substance-related criminal convictions (aHR, 2.56; 95% CI, 2.36-2.77), and substance-related death (aHR, 2.54; 95% CI, 1.83-3.52). Excluding psychiatric comorbidities had little effect on the magnitude of the associations, with the exception of attention-deficit/hyperactivity disorder, which attenuated the risk of any substance misuse outcomes (aHR, 2.00; 95% CI, 1.82-2.19). The risk of any substance misuse outcomes in individuals with TS/CTD was substantially attenuated but remained significant when compared with their unaffected siblings (aHR, 1.74; 95% CI, 1.53-1.97).
TS/CTD were associated with various types of subsequent substance misuse outcomes, independently of psychiatric comorbidity and familial factors shared between siblings. Screening for drug and alcohol use should become part of the standard clinical routines, particularly in patients with comorbid attention-deficit/hyperactivity disorder.
目前尚不清楚患有妥瑞氏综合征（TS）或慢性抽动障碍（CTD）的个体是否存在随后物质滥用的风险增加。
在这项基于人群的队列研究中，我们研究了 ICD 诊断为 TS/CTD 与物质滥用结局之间的关联，同时考虑了精神共病和家族因素。该队列包括 1973 年 1 月 1 日至 2013 年 12 月 31 日期间在瑞典生活过的所有人。物质滥用结局的定义为 ICD 编码的物质使用相关障碍或病因，或全国登记册中物质使用相关刑事定罪。
该队列包括 14277199 人，其中 7832 人患有 TS/CTD（76.3%为男性）。TS/CTD 与任何后续物质滥用结局的风险增加相关（调整后的危害比[aHR]，3.11；95%置信区间[CI]，2.94-3.29），包括酒精相关障碍（aHR，3.45；95%CI，3.19-3.72）、药物相关障碍（aHR，6.84；95%CI，6.32-7.40）、物质相关刑事定罪（aHR，2.56；95%CI，2.36-2.77）和物质相关死亡（aHR，2.54；95%CI，1.83-3.52）。排除精神共病对关联的幅度几乎没有影响，除了注意缺陷/多动障碍，它减弱了任何物质滥用结局的风险（aHR，2.00；95%CI，1.82-2.19）。与未受影响的兄弟姐妹相比，TS/CTD 个体的任何物质滥用结局风险虽然明显降低，但仍然显著（aHR，1.74；95%CI，1.53-1.97）。
TS/CTD 与各种类型的后续物质滥用结局相关，与兄弟姐妹之间共享的精神共病和家族因素无关。应该将药物和酒精使用筛查纳入标准临床常规，特别是在伴有共患注意缺陷/多动障碍的患者中。
