McKinnon K, Cournos F, Sugden R, Guido J R, Herman R
Columbia University College of Physicians and Surgeons, New York, NY, USA.
J Clin Psychiatry. 1996 Nov;57(11):506-13. doi: 10.4088/jcp.v57n1101.
This study was designed to determine whether psychiatric symptoms and acquired immunodeficiency syndrome (AIDS) knowledge predict human immunodeficiency virus (HIV) risk behavior among people with severe mental illness.
We interviewed 178 psychiatric patients to determine Axis I diagnosis, level of functioning, severity of psychiatric symptoms, knowledge about AIDS, sexual risk behaviors in the previous 6 months, and drug injection since 1978. Severity of psychiatric symptoms was rated on the Positive and Negative Syndrome Scale within the classification of positive, negative, cognitive, excited, and depressed/anxious symptoms.
Ninety-two patients (51.7%) reported being sexually active in the previous 6 months. Of sexually active patients for whom data were available, 44 (47.8%) of 92 had multiple sex partners; 32 (35.2%) of 91 used drugs during sex; 27 (29.7%) of 91 traded sex for drugs, money, or other goods; and 50 (58.1%) of 86 never used condoms. Thirty-one patients (17.5%) had drug-injection histories. The median AIDS knowledge score was 23 (82.1%) of 28. Although AIDS knowledge was negatively correlated with cognitive and negative symptoms and positively correlated with excitement, knowledge alone did not predict any risk behavior. However, when AIDS knowledge was taken together with age and excited symptoms, the odds of being sexually active versus abstinent were three times higher among patients with better AIDS knowledge and twice higher among patients with greater excited symptoms. Having multiple sex partners was nearly three times as likely among patients with greater positive symptoms. Trading sex was more than three times as likely among patients with schizophrenia than among those with other diagnoses and more than five times as likely among those with more excitement symptoms.
Patients, particularly those who were sexually active, were well informed about AIDS. Specific psychiatric conditions, including the presence of positive and excited symptoms and a diagnosis of schizophrenia, predicted certain sexual risk behaviors and must be the focus of innovative prevention efforts.
本研究旨在确定精神症状和获得性免疫缺陷综合征（艾滋病）知识是否能预测严重精神疾病患者的人类免疫缺陷病毒（HIV）风险行为。
我们对178名精神科患者进行了访谈，以确定轴I诊断、功能水平、精神症状严重程度、艾滋病知识、过去6个月内的性风险行为以及自1978年以来的药物注射情况。精神症状严重程度根据阳性和阴性症状量表在阳性、阴性、认知、兴奋和抑郁/焦虑症状分类中进行评定。
92名患者（51.7%）报告在过去6个月内有性活动。在有性活动且有数据可查的患者中，92人中有44人（47.8%）有多个性伴侣；91人中有32人（35.2%）在性行为中使用药物；91人中有27人（29.7%）以性交易换取毒品、金钱或其他物品；86人中有50人（58.1%）从未使用过避孕套。31名患者（17.5%）有药物注射史。艾滋病知识得分中位数为28分中的23分（82.1%）。虽然艾滋病知识与认知和阴性症状呈负相关，与兴奋症状呈正相关，但仅凭知识并不能预测任何风险行为。然而，当将艾滋病知识与年龄和兴奋症状综合考虑时，艾滋病知识较好的患者进行性活动而非禁欲的几率高出三倍，兴奋症状较严重的患者高出两倍。阳性症状较严重的患者有多个性伴侣的可能性几乎高出三倍。精神分裂症患者进行性交易的可能性是其他诊断患者的三倍多，兴奋症状较多的患者则高出五倍多。
患者，尤其是有性活动的患者，对艾滋病有充分了解。特定的精神状况，包括阳性和兴奋症状的存在以及精神分裂症的诊断，可预测某些性风险行为，必须成为创新预防措施的重点。
