Myers M G, Stewart D G, Brown S A
School of Medicine, University of California, San Diego, USA.
Am J Psychiatry. 1998 Apr;155(4):479-85. doi: 10.1176/ajp.155.4.479.
This study investigated the progression from conduct disorder to antisocial personality disorder among individuals treated for adolescent substance abuse. This issue is important because of the poor outcomes observed among individuals with antisocial pathology after treatment for alcohol and drug problems. The utility of factors assessed at the time of treatment in predicting progression to adult antisocial personality disorder was evaluated in the context of developmental models of antisocial behavior.
This was a prospective longitudinal study of 137 substance-abusing adolescents (53 female and 84 male), whose average age was 15.9 years and who met the DSM-III-R criteria for conduct disorder. Consecutively admitted patients were recruited from two adolescent inpatient alcohol and drug treatment facilities. Participants were interviewed again 4 years after treatment.
Four years after treatment, 61% of the study group met the DSM-III-R criteria for antisocial personality disorder. Results of a logistic regression analysis indicated that onset of deviant behavior at or before age 10, a greater diversity of deviant behavior, and more extensive pre-treatment drug use best predicted progression to antisocial personality disorder. At 4-year follow-up, the subjects with an antisocial personality disorder diagnosis exhibited more involvement with alcohol and drugs and poorer functioning across important life domains than the subjects without antisocial personality disorder.
This study found a high rate of progression to antisocial personality disorder among substance-abusing adolescents and identified factors predictive of this progression. Careful assessment of conduct disorder history at the time of treatment may be valuable for treatment planning and intervention.
本研究调查了接受青少年药物滥用治疗的个体从品行障碍发展为反社会人格障碍的情况。这个问题很重要，因为在酒精和药物问题治疗后，患有反社会病理的个体预后较差。在反社会行为的发展模型背景下，评估了治疗时所评估的因素在预测发展为成人反社会人格障碍方面的效用。
这是一项对137名药物滥用青少年（53名女性和84名男性）进行的前瞻性纵向研究，他们的平均年龄为15.9岁，符合品行障碍的DSM-III-R标准。连续入院的患者从两个青少年住院酒精和药物治疗机构招募。治疗4年后对参与者再次进行访谈。
治疗4年后，61%的研究组符合反社会人格障碍的DSM-III-R标准。逻辑回归分析结果表明，10岁及以前出现偏差行为、偏差行为种类更多以及治疗前药物使用更广泛最能预测发展为反社会人格障碍。在4年随访时，被诊断为反社会人格障碍的受试者比没有反社会人格障碍的受试者更多地涉及酒精和药物问题，并且在重要生活领域的功能更差。
本研究发现药物滥用青少年发展为反社会人格障碍的比例很高，并确定了预测这种发展的因素。治疗时仔细评估品行障碍病史可能对治疗计划和干预很有价值。
