Merikangas K R, Stevens D E, Fenton B, Stolar M, O'Malley S, Woods S W, Risch N
Department of Epidemiology, Yale University School of Medicine, New Haven, CT 06510, USA.
Psychol Med. 1998 Jul;28(4):773-88. doi: 10.1017/s0033291798006941.
This study examined the patterns of familial aggregation and co-morbidity of alcoholism and anxiety disorders in the relatives of 165 probands selected for alcoholism and/or anxiety disorders compared to those of 61 unaffected controls.
Probands were either selected from treatment settings or at random from the community. DSM-III-R diagnoses were obtained for all probands and their 1053 first-degree relatives, based on direct interview or family history information.
The findings indicate that: (1) alcoholism was associated with anxiety disorders in the relatives, particularly among females; (2) both alcoholism and anxiety disorders were highly familial; (3) the familial aggregation of alcoholism was attributable to alcohol dependence rather than to alcohol abuse, particularly among male relatives; and (4) the the pattern of co-aggregation of alcohol dependence and anxiety disorders in families differed according to the subtype of anxiety disorder; there was evidence of a partly shared diathesis underlying panic and alcoholism, whereas social phobia and alcoholism tended to aggregate independently.
The finding that the onset of social phobia tended to precede that of alcoholism, when taken together with the independence of familial aggregation of social phobia and alcoholism support a self-medication hypothesis as the explanation for the co-occurrence of social phobia and alcoholism. In contrast, the lack of a systematic pattern in the order of onset of panic and alcoholism among subjects with both disorders as well as evidence for shared underlying familial risk factors suggests that co-morbidity between panic disorder and alcoholism is not a consequence of self-medication of panic symptoms. The results of this study emphasize the importance of examining co-morbid disorders and subtypes thereof in identifying sources of heterogeneity in the pathogenesis of alcoholism.
本研究调查了165名因酒精中毒和/或焦虑症入选的先证者亲属中酒精中毒和焦虑症的家族聚集模式及共病情况，并与61名未受影响的对照者进行比较。
先证者要么从治疗机构选取，要么从社区随机选取。基于直接访谈或家族史信息，对所有先证者及其1053名一级亲属进行了DSM-III-R诊断。
研究结果表明：（1）亲属中的酒精中毒与焦虑症相关，尤其是在女性中；（2）酒精中毒和焦虑症都具有高度家族性；（3）酒精中毒的家族聚集归因于酒精依赖而非酒精滥用，尤其是在男性亲属中；（4）家庭中酒精依赖和焦虑症的共聚集模式因焦虑症亚型而异；有证据表明惊恐症和酒精中毒存在部分共同的素质，而社交恐惧症和酒精中毒倾向于独立聚集。
社交恐惧症发病往往早于酒精中毒这一发现，再加上社交恐惧症和酒精中毒家族聚集的独立性，支持了自我用药假说，作为社交恐惧症和酒精中毒共病的解释。相比之下，同时患有这两种疾病的患者中，惊恐症和酒精中毒的发病顺序缺乏系统性模式，以及存在共同潜在家族风险因素的证据表明，惊恐障碍和酒精中毒的共病不是惊恐症状自我用药的结果。本研究结果强调了在确定酒精中毒发病机制中的异质性来源时，检查共病障碍及其亚型的重要性。
