Winokur G, Turvey C, Akiskal H, Coryell W, Solomon D, Leon A, Mueller T, Endicott J, Maser J, Keller M
The National Institute of Mental Health Collaborative Program on the Psychobiology of Depression--Clinical Studies, Iowa, USA.
J Affect Disord. 1998 Sep;50(2-3):81-9. doi: 10.1016/s0165-0327(98)00108-6.
Previous work has shown that manic-depressive illness and alcohol abuse are linked. This study further explores the relationship of alcohol and drug abuse in bipolar I patients and unipolar depressives and a comparison group obtained through the acquaintance method.
Diagnosis was accomplished according to Research Diagnostic Criteria (RDC): controls = 469; bipolars = 277; unipolar depressives = 678. Systematic data were gathered using the SADS on lifetime and current drug abuse and alcoholism. Both patients and comparison subjects were then followed prospectively for 10 years. First degree family members were interviewed using the RDC family history method.
The group of bipolar patients and the group of unipolar patients had higher rates of drug and alcohol abuse than the comparison group when primary and secondary affective disorder patients were combined. However, primary unipolar patients did not have higher rates of alcohol or drug abuse than the comparison group. In contrast, primary bipolar patients had higher rates of alcoholism, stimulant abuse, and ever having abused a drug than the primary unipolar group and the control group. In an evaluation of the bipolar patients, drug abusers were significantly younger at intake and had a significantly younger age of onset of bipolar disorder. There was a significant increase in family history of mania or schizoaffective mania in the drug-abusing bipolar patients as compared to the non-abusing bipolar patients.
As in all adult samples of patients with affective illness, the chronology of alcohol and substance problems vis-à-vis the onset of illness was determined retrospectively.
(1) Alcoholism and drug abuse are more frequent in bipolar than unipolar patients. (2) The drug abuse of bipolar patients tends toward the abuse of stimulant drugs. (3) In a bipolar patient, familial diathesis for mania is significantly associated with the abuse of alcohol and drugs. (4) More provocatively, these findings suggest the hypothesis of a common familial-genetic diathesis for a subtype of bipolar I, alcohol and stimulant abuse.
The present analyses, coupled with two previous ones from the CDS, suggest that drug abuse may precipitate an earlier onset of bipolar I disorder in those who already have a familial predisposition for mania. Furthermore, in dually diagnosed patients with manic-depressive and alcohol/stimulant abuse history, mood stabilization of the bipolar disorder represents a rational approach to control concurrent alcohol and drug problems, and should be studied in systematic controlled trials.
先前的研究表明躁郁症与酒精滥用有关。本研究进一步探讨了双相I型患者、单相抑郁症患者以及通过熟人介绍法选取的对照组中酒精和药物滥用之间的关系。
根据研究诊断标准（RDC）进行诊断：对照组 = 469人；双相情感障碍患者 = 277人；单相抑郁症患者 = 678人。使用情感障碍和精神分裂症日程表（SADS）系统收集有关终生及当前药物滥用和酗酒情况的数据。随后对患者和对照组进行了为期10年的前瞻性随访。使用RDC家族史方法对一级家庭成员进行访谈。
当将原发性和继发性情感障碍患者合并计算时，双相情感障碍患者组和单相抑郁症患者组的药物和酒精滥用率高于对照组。然而，原发性单相抑郁症患者的酒精或药物滥用率并不高于对照组。相比之下，原发性双相情感障碍患者的酗酒、兴奋剂滥用以及曾滥用药物的比例高于原发性单相抑郁症组和对照组。在对双相情感障碍患者的评估中，药物滥用者在入院时年龄显著更小，双相情感障碍的发病年龄也显著更小。与未滥用药物的双相情感障碍患者相比，滥用药物的双相情感障碍患者中躁狂或分裂情感性躁狂的家族史显著增加。
与所有成年情感障碍患者样本一样，酒精和物质问题相对于疾病发作的时间顺序是通过回顾性确定的。
（１）双相情感障碍患者中酗酒和药物滥用比单相抑郁症患者更常见。（２）双相情感障碍患者的药物滥用倾向于兴奋剂药物滥用。（３）在双相情感障碍患者中，躁狂的家族素质与酒精和药物滥用显著相关。（４）更具启发性的是，这些发现提示了双相I型的一个亚型、酒精和兴奋剂滥用存在共同家族遗传素质的假说。
目前的分析以及来自合作抑郁症研究（CDS）的前两项分析表明，药物滥用可能会使那些已有躁狂家族易感性的人双相I型障碍发病更早。此外，对于同时患有躁郁症和有酒精/兴奋剂滥用史且已确诊的患者，稳定双相情感障碍的病情是控制同时存在的酒精和药物问题的合理方法，应在系统对照试验中进行研究。
