Strakowski S M, Sax K W, McElroy S L, Keck P E, Hawkins J M, West S A
Department of Psychiatry, University of Cincinnati College of Medicine, Ohio 45267-0559, USA.
J Clin Psychiatry. 1998 Sep;59(9):465-71. doi: 10.4088/jcp.v59n0905.
Patients with bipolar disorder frequently meet criteria for other psychiatric and substance abuse diagnoses. To clarify relationships among these disorders, the authors examined the course of syndromes co-occurring with bipolar disorder for 12 months after a first hospitalization.
Seventy-seven patients were recruited from consecutive inpatient admissions who met DSM-III-R criteria for bipolar disorder, manic or mixed with psychosis. The 12-month syndromal course of co-occurring DSM-III-R alcohol and drug abuse disorders, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and other anxiety disorders were longitudinally recorded.
The rates of all syndromes, except other anxiety disorders, were elevated. OCD demonstrated an interval course that frequently mirrored the course of the bipolar disorder. The courses of PTSD and substance abuse syndromes were separate from that of the bipolar disorder in many of those with both syndromes. Alcohol and drug abuse syndromes were strongly correlated.
The obsessive-compulsive syndrome may represent an alternative expression of bipolar disorder in some patients. In contrast, PTSD appears to represent a truly separate disorder, which is possibly more prevalent in bipolar patients due to a shared risk factor. Substance abuse does not appear to simply result from attempts at self-medication or from the impulsivity of mania. These results suggest that future studies examining the course of syndromes co-occurring with bipolar disorder are warranted.
双相情感障碍患者常常符合其他精神疾病及物质滥用的诊断标准。为了阐明这些疾病之间的关系，作者对首次住院后12个月内与双相情感障碍共病的综合征病程进行了研究。
从连续住院的符合DSM-III-R双相情感障碍、躁狂或伴有精神病性症状的混合发作标准的患者中招募了77例患者。对共病的DSM-III-R酒精和药物滥用障碍、创伤后应激障碍（PTSD）、强迫症（OCD）及其他焦虑症的12个月综合征病程进行纵向记录。
除其他焦虑症外，所有综合征的发生率均有所升高。强迫症呈现出一种常与双相情感障碍病程相平行的间歇性病程。在许多同时患有PTSD和物质滥用综合征及双相情感障碍的患者中，PTSD和物质滥用综合征的病程与双相情感障碍的病程相互独立。酒精和药物滥用综合征之间存在强相关性。
在一些患者中，强迫综合征可能是双相情感障碍的另一种表现形式。相比之下，创伤后应激障碍似乎是一种真正独立的疾病，由于存在共同的危险因素，它在双相情感障碍患者中可能更为普遍。物质滥用似乎并非仅仅源于自我治疗的尝试或躁狂的冲动性。这些结果表明，有必要开展进一步研究以探讨双相情感障碍共病综合征的病程。
