Rounsaville B J, Dolinsky Z S, Babor T F, Meyer R E
Arch Gen Psychiatry. 1987 Jun;44(6):505-13. doi: 10.1001/archpsyc.1987.01800180015002.
We performed a one-year follow-up study of 266 alcoholics who had received extensive psychiatric assessment, including diagnosis with the National Institute of Mental Health Diagnostic Interview Schedule and DSM-III criteria, during their index treatment episode. The aims were to evaluate the relationship between additional DSM-III diagnoses in alcoholics and outcome at follow-up, assess the relative prognostic power of different ways of measuring psychopathology by comparing categorical DSM-III diagnoses and a global symptom severity measure, and assess whether ratings of psychopathology add to the prognostic power of an alcohol-dependence measure. While coexistent psychiatric diagnoses generally predicted poorer treatment outcome, there were significant interactions in the relationship between diagnoses and treatment outcome for men and women. For men, having an additional diagnosis of major depression, antisocial personality, or drug abuse was associated with poorer outcome. For women, having major depression was associated with a better outcome in drinking-related measures, while antisocial personality and drug abuse were associated with poorer prognosis. The value of determining psychiatric diagnosis was supported by covariance analyses that suggested that prognostic significance of specific disorders was not accounted for by general psychopathology or general dependence dimensions.
我们对266名酗酒者进行了为期一年的随访研究，这些酗酒者在其首次治疗期间接受了广泛的精神病学评估，包括使用美国国立精神卫生研究所诊断访谈表和《精神疾病诊断与统计手册》第三版（DSM - III）标准进行诊断。目的是评估酗酒者额外的DSM - III诊断与随访结果之间的关系，通过比较分类的DSM - III诊断和整体症状严重程度测量方法，评估不同测量精神病理学方式的相对预后能力，并评估精神病理学评分是否增加了酒精依赖测量的预后能力。虽然并存的精神病学诊断通常预示着较差的治疗结果，但男性和女性在诊断与治疗结果之间的关系存在显著差异。对于男性，额外诊断为重度抑郁症、反社会人格或药物滥用与较差的结果相关。对于女性，患有重度抑郁症在饮酒相关指标上与较好的结果相关，而反社会人格和药物滥用则与较差的预后相关。协方差分析支持了确定精神病学诊断的价值，该分析表明特定障碍的预后意义不能由一般精神病理学或一般依赖维度来解释。
