Cornelius J R, Salloum I M, Mezzich J, Cornelius M D, Fabrega H, Ehler J G, Ulrich R F, Thase M E, Mann J J
Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213.
Am J Psychiatry. 1995 Mar;152(3):358-64. doi: 10.1176/ajp.152.3.358.
The two purposes of this study were to provide a comprehensive description of the clinical features of patients who presented to an intake psychiatric setting with major depression and alcohol dependence and to determine which clinical features distinguished this dual-diagnosis group from patients with the two relevant single diagnoses.
During a recent 5-year period, a total of 107 patients who came to a psychiatric facility for initial evaluation were diagnosed as having both major depression and alcohol dependence. The clinical profile of this dual-diagnosis group was compared to that of nondepressed alcoholics (N = 497) and nonalcoholic patients with major depression (N = 5,625), assessed at the same facility, on the basis of information from the Initial Evaluation Form, a semistructured instrument containing a standardized symptom inventory that includes ratings of severity.
The psychiatric symptom that most strongly distinguished the depressed alcoholics from the two comparison groups was the level of suicidality. The depressed alcoholics differed significantly from the nonalcoholic depressed patients on only two depressive symptoms, suicidality (59% higher) and low self-esteem (22% higher); they were also significantly distinguished from the nonalcoholic depressed patients by factors such as greater impulsivity, functional impairment, and abnormal personal and social history markers.
Suicidality was disproportionately greater than other psychiatric symptoms in the depressed alcoholics. The clinical profile of depressed alcoholics suggests that they suffer an additive or synergistic effect of two separate disorders, resulting in a disproportionately high level of acute suicidality upon initial psychiatric evaluation.
本研究的两个目的是全面描述在精神病初诊时患有重度抑郁症和酒精依赖的患者的临床特征，并确定哪些临床特征将这个双重诊断组与患有两种相关单一诊断的患者区分开来。
在最近5年期间，共有107名到精神病院进行初次评估的患者被诊断为同时患有重度抑郁症和酒精依赖。根据初次评估表（一种包含标准化症状清单并包括严重程度评级的半结构化工具）中的信息，将这个双重诊断组的临床特征与在同一机构评估的非抑郁酗酒者（N = 497）和患有重度抑郁症的非酗酒患者（N = 5625）的临床特征进行比较。
将抑郁酗酒者与两个对照组区分开来的最显著的精神症状是自杀倾向水平。抑郁酗酒者与非酗酒抑郁患者仅在两种抑郁症状上存在显著差异，即自杀倾向（高59%）和低自尊（高22%）；他们在冲动性更强、功能损害以及个人和社会历史标记异常等因素方面也与非酗酒抑郁患者有显著区别。
在抑郁酗酒者中，自杀倾向比其他精神症状更为突出。抑郁酗酒者的临床特征表明，他们遭受两种独立疾病的相加或协同作用，导致在初次精神病评估时急性自杀倾向水平过高。
