Pozzi G, Bacigalupi M, Tempesta E
Institute of Psychiatry, Catholic University of Sacro Cuore, Rome, Italy.
Drug Alcohol Depend. 1997 Jun 6;46(1-2):69-77. doi: 10.1016/s0376-8716(97)00042-2.
A cross-sectional multicentre study aimed at evaluating the prevalence of DSM III-R Axis I morbidity among drug addicts seeking treatment. Consecutive outpatients of the National Health Service's treatment units (aged 18-60 years, fulfilling criteria for drug dependence and without primary diagnosis of alcohol dependence) were enrolled at intake. In the first phase of the study, professional staff members evaluated current psychiatric morbidity of 317 clients clinically. In the second phase, trained interviewers administered the Composite International Diagnostic Interview and a European adaptation of the Addiction Severity Index to 65 probands. Some current psychiatric morbidity was found in 26.2% of subjects recruited during the first phase and in 22.2% during the second; lifetime comorbidity was ascertained in 32.3% of probands recruited in the second phase. Unfortunately, remarkable rates of undetermined diagnostic assessment during the second phase are due to refusers. The distribution of categorical diagnoses is somewhat different between the two samples, but the most frequent are Anxiety and Mood disorders in both. Primary versus secondary psychiatric diagnoses were also distinguished when evaluated over a lifetime. The rates of psychiatric comorbidity are low in this study as compared with previous investigations, but suffer from a poor compliance with structured diagnostic procedures by unselected probands. Other methodological factors may also affect this kind of research. Prospective studies are needed to evaluate the validity of comorbid diagnostic constructs and their prognostic significance. Also a concurrent assessment of Axis II disorders may be helpful to explain symptomatic polymorphism in case of multiple Axis I comorbidity.
一项横断面多中心研究旨在评估寻求治疗的吸毒者中 DSM III-R 轴 I 发病率。连续纳入国民健康服务治疗单位的门诊患者（年龄 18 - 60 岁，符合药物依赖标准且无酒精依赖的初步诊断）。在研究的第一阶段，专业工作人员对 317 名患者的当前精神疾病发病率进行临床评估。在第二阶段，经过培训的访谈者对 65 名先证者进行综合国际诊断访谈以及欧洲版成瘾严重程度指数调查。在第一阶段招募的受试者中，26.2%发现有当前精神疾病发病率，第二阶段为 22.2%；在第二阶段招募的先证者中，终生共病率为 32.3%。遗憾的是，由于拒绝者的存在，第二阶段未确定诊断评估的比例很高。两个样本的分类诊断分布略有不同，但最常见的都是焦虑和情绪障碍。在评估终生情况时，还区分了原发性与继发性精神疾病诊断。与先前的调查相比，本研究中的精神疾病共病率较低，但未经过筛选的先证者对结构化诊断程序的依从性较差。其他方法学因素也可能影响这类研究。需要进行前瞻性研究以评估共病诊断结构的有效性及其预后意义。同时对轴 II 障碍进行评估可能有助于解释在多个轴 I 共病情况下的症状多态性。
