Keramatian Kamyar, Levit Alexander
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia.
Carlile Youth Concurrent Disorders Centre, North Vancouver, British Columbia.
J Can Acad Child Adolesc Psychiatry. 2023 Aug;32(3):202-208. Epub 2023 Aug 1.
Appropriate interventions for psychiatric conditions that commonly emerge during adolescence and early adulthood play a crucial role in modifying both acute risks as well as long-term outcomes. Substance use disorder is a common comorbidity during the early stages of mood and psychotic disorders that further heightens acute risks and is considered a negative prognostic factor. New presentations of mood and psychotic symptoms with co-occurring substance use are inherently challenging to formulate due to the uncertainty surrounding the relative impact of multiple intrinsic and extrinsic factors. Given such uncertainty, it is natural for clinicians to rely on heuristics to guide assessment and management. These heuristics however may bring about premature diagnostic closure by favouring the primacy of substance use, which in turn can result in a missed window of opportunity for a timely and appropriate intervention. We caution clinicians against over-attributing early symptoms of mood and psychotic disorders to substances use alone.
针对青少年期和成年早期常见精神疾病的适当干预措施，对于降低急性风险和改善长期预后都起着至关重要的作用。物质使用障碍是情绪和精神障碍早期阶段常见的共病情况，它会进一步增加急性风险，并被视为一个负面的预后因素。由于多种内在和外在因素的相对影响存在不确定性，同时出现物质使用问题的新的情绪和精神症状的表现形式在诊断上具有固有挑战性。鉴于这种不确定性，临床医生依靠启发式方法来指导评估和管理是很自然的。然而，这些启发式方法可能会因倾向于将物质使用视为首要因素而导致过早的诊断性结论，进而可能错过及时进行适当干预的机会窗口。我们提醒临床医生，不要将情绪和精神障碍的早期症状仅仅过度归因于物质使用。
