Rounsaville B J, Kranzler H R, Ball S, Tennen H, Poling J, Triffleman E
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06519, USA.
J Nerv Ment Dis. 1998 Feb;186(2):87-95. doi: 10.1097/00005053-199802000-00004.
Previous studies have documented high but variable rates of DSM personality disorders (axis II) in clinical samples of substance abusers. Distinguishing between personality disorder symptoms that are independent versus substance-related (SR) is a particular challenge for diagnosing comorbid axis II disorders in substance abusers. DSM-IV guidelines currently recommend excluding axis II symptoms that are accounted for by an axis I disorder, including a substance use disorder. In this study, axis II diagnoses were made on a heterogenous clinical sample of 370 patients entering treatment for substance use disorders. Axis II diagnoses were made according to DSM-III-R criteria using the Structured Clinical Interview for DSM-III-R (SCID-II), which was modified to determine, on an item-by-item basis, whether symptoms were attributed to subjects' substance use disorders or independent of these disorders. The majority (57.0%) of substance use disorder patients met criteria for at least one comorbid axis II disorder, with cluster B (45.7%) being particularly prominent, especially antisocial personality disorder (ASP) (27.0%) and borderline personality disorder (BPD) (18.4%). Notably, inclusion of SR symptoms led to a substantial number of newly diagnosed cases, especially for ASP (19.2%) and BPD (11.4%). Including SR symptoms improved the reliability of ASP and did not change the reliability of BPD diagnoses. Generally, patients with SR and independent personality disorders had a similar clinical profile.
以往研究记录了药物滥用者临床样本中精神疾病诊断与统计手册（DSM）人格障碍（轴II）的发生率较高但存在差异。区分独立的人格障碍症状与物质相关（SR）症状，对于诊断药物滥用者的共病轴II障碍而言是一项特殊挑战。DSM-IV指南目前建议排除由轴I障碍（包括物质使用障碍）所解释的轴II症状。在本研究中，对370名因物质使用障碍而接受治疗的患者组成的异质性临床样本进行了轴II诊断。根据DSM-III-R标准，使用针对DSM-III-R的结构化临床访谈（SCID-II）进行轴II诊断，该访谈经过修改，以便逐项目确定症状是归因于受试者的物质使用障碍还是独立于这些障碍。大多数（57.0%）物质使用障碍患者符合至少一种共病轴II障碍的标准，其中B类（45.7%）尤为突出，特别是反社会人格障碍（ASP）（27.0%）和边缘型人格障碍（BPD）（18.4%）。值得注意的是，纳入SR症状导致大量新诊断病例，尤其是ASP（19.2%）和BPD（11.4%）。纳入SR症状提高了ASP诊断的可靠性，且未改变BPD诊断的可靠性。总体而言，患有SR人格障碍和独立人格障碍的患者具有相似的临床特征。
