Rabinowitz J, Bromet E J, Lavelle J, Carlson G, Kovasznay B, Schwartz J E
Department of Psychiatry, State University of New York at Stony Brook, USA.
Psychol Med. 1998 Nov;28(6):1411-9. doi: 10.1017/s0033291798007399.
Past studies have found inconsistent evidence that substance use disorders are related to earlier onset of schizophrenia or more severe symptoms. This study examines prevalence and severity of current substance use disorders and onset of psychotic illness in a multi-facility sample.
Data are from the Suffolk County Mental Health Project, an epidemiological study of first admission psychosis. The SCID and instruments measuring symptomatology, personality and background characteristics were administered. Respondents were stratified into three groups: (a) no life-time substance diagnosis; (b) in remission or reporting current mild use at admission; and (c) current moderate-severe substance abuse at admission.
Using the SCID severity rating, 17.4% of males and 6.2% of the females had moderate or severe current substance abuse, while 41.5% of males and 68.2% of females had no lifetime substance diagnosis. In almost all cases categorized as moderate-severe, the substance diagnosis predated onset of psychosis. Females categorized as moderate-severe have an earlier age of onset of psychosis than did females in the other groups. There were only slight differences in symptom severity among the groups but more marked antisocial behaviour in the moderate-severe group. Variables discriminating the moderate-severe from non-abuse groups were BPRS thought disturbance, adult anti-social behaviour and current cigarette smoking for males and adult anti-social behaviour and child-teen antisocial behaviour for females.
Severity of substance abuse does not appear to be a pivotal correlate of the early features of psychotic illness.
过去的研究发现，关于物质使用障碍与精神分裂症更早发病或更严重症状之间的关系，证据并不一致。本研究在一个多机构样本中考察了当前物质使用障碍的患病率和严重程度以及精神病性疾病的发病情况。
数据来自萨福克郡心理健康项目，这是一项关于首次入院精神病的流行病学研究。使用了SCID以及测量症状学、人格和背景特征的工具。受访者被分为三组：(a) 无终生物质诊断；(b) 病情缓解或在入院时报告当前轻度使用；(c) 入院时当前存在中度至重度物质滥用。
根据SCID严重程度评分，17.4%的男性和6.2%的女性当前存在中度或重度物质滥用，而41.5%的男性和68.2%的女性无终生物质诊断。在几乎所有被归类为中度至重度的病例中，物质诊断早于精神病发作。被归类为中度至重度的女性精神病发病年龄比其他组的女性更早。各组之间症状严重程度仅有轻微差异，但中度至重度组的反社会行为更为明显。区分中度至重度组与非滥用组的变量，对于男性是BPRS思维紊乱、成人反社会行为和当前吸烟，对于女性是成人反社会行为和儿童青少年反社会行为。
物质滥用的严重程度似乎并非精神病性疾病早期特征的关键相关因素。
