Pozzi G, Tacchini G, Di Giannantonio M, Tempesta E
Itituto di Psichiatria e Psicologia, Università Cattolica del Sacro Cuore, Roma.
Minerva Psichiatr. 1995 Sep;36(3):139-54.
The aim of this research is to evaluate current and lifetime psychiatric morbidity according to ICD-10 criteria of subjects in treatment for psychoactive substance dependence. It is a cross-sectional clinical-epidemiological study also collecting retrospective information by means of structured diagnostic interviews. Ninety-nine outpatients fulfilling criteria of eligibility were recruited by systematic sampling at 8 Italian National Health Service's Drug Dependence Units. Criteria of inclusion were the presence of clinical diagnosis of psychoactive substance dependence according to ICD-10 and age 18-45, while criteria of exclusion were pharmacological distress related to acute withdrawal from street drugs and the presence of severe cognitive impairment, delirium or acute psychoses in order to assure reliability of the interviews. Only 75 patients accepted to participate, were enrolled in the study and interviewed by means of a European adaptation of the Addiction Severity Index. Finally, the Composite International Diagnostic Interview was completed in 65 cases. The prevalence of current psychiatric morbidity for any disorder in addition to substance use disorders was 22.2%, and lifetime prevalence was 35.4% (but, if drop-out cases are excluded from calculation, the prevalence rates grow up to 30-35% and 50-55% respectively). Psychiatric morbidity is more frequent among females and is unrelated to age or lifetime duration of substance use. In almost one-half of the cases mental disorders arose before the beginning of substance use. By order of frequence, anxiety, affective, and schizophrenic syndromes are the most common comorbid diagnoses. Affective disorders are more often secondary, since they mostly develop after the beginning of psychotropic substance use and are uncommon among currently abstinent subjects. Finally, outpatients affected by psychotic disorders are not likely to abstain from psychotropic drugs during the treatment. Psychiatric comorbidity is a considerable point in the clinical management of drug dependence, and for primary and secondary prevention of substance use disorders.
本研究旨在根据国际疾病分类第10版（ICD - 10）标准，评估接受精神活性物质依赖治疗的受试者当前及终生的精神疾病发病率。这是一项横断面临床流行病学研究，还通过结构化诊断访谈收集回顾性信息。通过系统抽样，在意大利国家卫生服务机构的8个药物依赖治疗单元招募了99名符合入选标准的门诊患者。入选标准为根据ICD - 10存在精神活性物质依赖的临床诊断且年龄在18 - 45岁之间，排除标准为与街头毒品急性戒断相关的药物不适以及存在严重认知障碍、谵妄或急性精神病，以确保访谈的可靠性。只有75名同意参与的患者被纳入研究，并通过欧洲版的成瘾严重程度指数进行访谈。最后，65例患者完成了复合国际诊断访谈。除物质使用障碍外，任何疾病的当前精神疾病发病率为22.2%，终生发病率为35.4%（但如果计算时排除失访病例，发病率分别增至30 - 35%和50 - 55%）。女性的精神疾病发病率更高，且与年龄或物质使用的终生时长无关。在近一半的病例中，精神障碍在物质使用开始之前就已出现。按频率排序，焦虑、情感和精神分裂症综合征是最常见的共病诊断。情感障碍多为继发性，因为它们大多在精神otropic物质使用开始后出现，且在当前已戒断的受试者中并不常见。最后，患有精神障碍的门诊患者在治疗期间不太可能戒除精神otropic药物。精神疾病共病是药物依赖临床管理以及物质使用障碍一级和二级预防中的一个重要问题。
