Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, USA.
Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
J Nurs Scholarsh. 2023 May;55(3):646-654. doi: 10.1111/jnu.12879. Epub 2023 Feb 3.
The overarching goal of this review is to provide a clinical overview of epidemiology, diagnosis, and treatment, and to discuss the public health impact, social determinants including access to care, and implications for health care delivery and research. It is estimated that approximately 1 in 4 individuals suffering from a serious mental illness (SMI) may have a co-occurring opioid use disorder (OUD). In these individuals, the overall disease burden is higher and clinical outcomes are worse compared to those without a co-occurring illness, making an integrated approach to diagnosis and treatment an urgent priority.
We conducted a selective review of the literature to investigate prevalence, etiology for co-occurring OUD and SMI, and diagnostic and clinical guidelines in the United States, and consideration special populations.
Our findings suggest that, despite the high prevalence of co-occurring OUD and SMI, contemporary diagnostics and treatment approaches are underutilized in this patient population. The literature also suggests that both pharmacological and psychosocial treatment approaches need to be tailored to optimize clinical management, and that integrated treatment is pivotal for improving overall outcomes, yet comprehensive clinical guidelines for co-occurring OUD and SMI are lacking at this time.
本综述旨在提供流行病学、诊断和治疗的临床概述，并讨论其对公共卫生的影响、社会决定因素（包括获得医疗保健的机会），以及对医疗保健提供和研究的影响。据估计，大约每 4 个患有严重精神疾病 (SMI) 的人中就有 1 个可能同时患有阿片类药物使用障碍 (OUD)。在这些人中，与没有合并疾病的人相比，整体疾病负担更高，临床结局更差，因此，采用综合方法进行诊断和治疗是当务之急。
我们对文献进行了选择性综述，以调查美国共同发生 OUD 和 SMI 的患病率、病因，以及诊断和临床指南，并考虑了特殊人群。
我们的研究结果表明，尽管 OUD 和 SMI 同时发生的患病率很高，但在该患者群体中，当代诊断和治疗方法的使用率仍然较低。文献还表明，药物和心理社会治疗方法都需要针对个体进行调整，以优化临床管理，而综合治疗对于改善整体结局至关重要，但目前还缺乏针对 OUD 和 SMI 共同发生的综合临床指南。
