海洛因依赖者与精神障碍的共病分析

目的:了解海洛因依赖者其它精神障碍的患病情况.方法:应用DSM-Ⅲ-R用定式临床检查手册和DSM-Ⅲ-R人格障碍用定式临床检查手册,调查了113名自愿戒毒的海洛因依赖者DSM-Ⅲ-R轴Ⅰ其它精神障碍和DSM-Ⅲ-R轴Ⅱ人格障碍的诊断情况.结果:心境障碍与物质滥用共患率较高.终生患病率55.7%,现患率60.2%.海洛因依赖者还伴有其它类型的精神活性物质使用障碍,终生患病率是59.2%,现患率是37.2%.轴Ⅱ人格障碍总患病率达到89.7%.边缘型人格障碍(61.7%)和强迫型人格障碍(58.5%)最常见,其次是偏执型人格障碍(52.1%).结论:自愿戒毒的海洛因依赖者中较多合并其它精神障碍.为了加强治疗效果预防复吸应更加关注共患疾病的诊断和治疗.     

美沙酮维持治疗人员与精神障碍的共病分析

目的:调查美沙酮维持治疗人员共病其他精神障碍情况。方法:采用DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查(SCID-P)及人格障碍用定式临床检查手册(SCID-Ⅱ)调查100名美沙酮维持治疗人员精神障碍情况。结果:美沙酮维持治疗人员共患轴Ⅰ障碍主要是心境障碍(终生患病率26.0%)、焦虑障碍(终生患病率为23.0%)、其他活性物质所致精神障碍(11.0%);共患轴Ⅱ障碍主要是反社会人格障碍的比例最高(20.0%),其次是边缘性人格障碍(18.0%)、强迫性人格障碍(17.0%)。结论:美沙酮维持治疗人员中较多合并其他精神障碍,应积极关注共患疾病的诊断和治疗。     

海洛因依赖者脱毒过程中并发精神障碍分析

目的··:了解海洛因依赖者发生精神障碍的临床特点 ,以利于治疗和预防。方法··:通过对826例入所强制戒毒的海洛因依赖者进行调查 ,对符合CCMD -2 -R相应精神疾病诊断标准的患者进行分类研究。结果··:发现其中81例在脱毒过程中并发严重的精神障碍 ,患病率为9.79%。病种以癫痫样精神病、反应性精神病、分裂样精神病和严重病态人格为主(81.48%)。结论··:海洛因依赖者并发的精神障碍有增多和呈多样化发展的趋势 ,脱毒治疗中应予以注意。     

男性海洛因依赖患者的反社会性人格障碍对初次滥用年龄的影响

目的：了解男性海洛因依赖患者（MPHD）反社会型人格障碍及其对初次滥用年龄的影响。方法：采用《DSM～IV人格障碍用定式临床检查手册》（SCID-Ⅱ）对MPHD进行访谈，对其共患各型人格障碍进行明确诊断并统计其患病率。分别比较反社会性人格障碍组患者与非反社会性人格障碍组、反社会性人格障碍组患者与无人格障碍组在初次滥用海洛因年龄上的差异。结果：MPHD共患反社会型人格障碍的患病率为48．8％，与无人格障碍组比较，反社会性人格障碍组的MPHD初次滥用海洛因的年龄较早，有显著性差异。结论：反社会性人格障碍在MPHD中普遍存在，且共患反社会性人格障碍的MPHD初次滥用海洛因的年龄较早，可能更早发生海洛因依赖，宜重点早期干预。     

海洛因依赖者罹患皮肤感染性疾病的临床调查

目的··:了解海洛因依赖者所患皮肤病的种类和发病机制。方法··:采用《临床皮肤病鉴别诊断学》皮肤感染性疾病诊断标准,对本院1997-1998年强制戒毒的428例符合DSM-Ⅲ-R阿片类依赖诊断标准的428例男性海洛因依赖者的皮肤感染性疾病进行回顾性调查分析。结果··:皮肤疾病的发病率占本院同期住院的11.7%,皮肤感染性疾病类型主要为细菌性皮炎,占56%;真菌性皮炎,占4%;湿疹,占40%。结论··:导致皮肤感染性疾病的原因与海洛因所致免疫功能低下,皮肤血管及微循环功能障碍,海洛因内掺杂质及使用毒品的方式,以及植物神经功能紊乱有一定关系。     

70例男性海洛因依赖患者的人格障碍与心理状况分析

目的:了解男性海洛因依赖者的人格障碍与心理状况,探讨患者人格障碍对其心理状况有无影响。方法:采用《DSM-IV人格障碍定式临床检查手册》(SCID-Ⅱ)对男性海洛因依赖者进行访谈,采用症状自评量表(SCL-90)对男性海洛因依赖者进行测评,共收集有效资料70例,对访谈和测试结果进行统计分析。结果:65.7%的男性海洛因依赖者共患人格障碍。反社会性人格障碍和边缘性人格障碍共患率最高,分别为50.0%和30.0%。男性海洛因依赖者的SCL-90测试结果在躯体化、抑郁、焦虑、精神病性和生活问题5个因子上与相同环境下的对照组比较分数较高且存在显著差异。未发现共患反社会性人格障碍和边缘性人格障碍对患者心理状况的影响。结论:MPHD常共患反社会性人格障碍和边缘性人格障碍,而无论共患上述人格障碍与否,MPHD普遍的心理状况是躯体化、抑郁、焦虑、精神病性和生活问题。     

海洛因依赖者抑郁症状的临床调查

目的··:了解海洛因依赖者在强制戒毒康复期抑郁症状的发生率和出现抑郁症状的原因。方法··:采用Zung抑郁自评量表对本院2000年3月 -2000年6月强制戒毒的24例符合DSM -Ⅳ阿片类依赖诊断标准的海洛因依赖者进行抑郁症状的调查评定。结果··:抑郁症状的出现率为75.0 % ,其中轻度抑郁占33.3 % ,中度抑郁占33.3 % ,重度抑郁占8.3 %。结论··:海洛因依赖者在强制戒毒康复期抑郁症发生率很高 ,产生抑郁症状的原因与负性生活事件 (占50.0 % ) ,拘禁反应 (占5.6 % ) ,稽延性戒断症状 (占33.3 % )以及适应障碍 (占11.1 % )有一定关系     

海洛因依赖者脑干听觉诱发电位研究

目的:探讨海洛因依赖者脑干听觉诱发电位的变化特点及其应用。方法:使用意大利百胜有限公司GalileoSirius全数字化32导脑诱发电位仪对32例海洛因依赖者和30例正常人脑干听觉诱发电位的变化进行对照分析。结果:海洛因依赖者波形稳定性较差,波Ⅰ、Ⅲ、Ⅴ出现率100%,以后依次为波Ⅳ、波Ⅱ、波Ⅵ、波Ⅶ,但与正常对照组比较,差异无显著性(P>0·05);波Ⅱ-波Ⅶ绝对潜伏期较正常人延长,其差异有显著性(P<0·05,P<0·01);波Ⅱ-波Ⅶ绝对波幅较正常人降低,其差异有显著性(P<0·05,P<0·01)。结论:海洛因依赖者的脑干听觉诱发电位具有波Ⅱ-波Ⅶ绝对潜伏期延长、绝对波幅降低的特点,这些特点除可作辅助诊断外,还能对早期预防依赖者的中枢神经系统并发症提供依据,同时建议对依赖者进行神经营养治疗。     

506例物质依赖者DSM-Ⅳ轴I诊断结果分析

目的:了解506例物质依赖者的物质滥用和精神障碍情况。方法:应用DSM-Ⅳ-TR轴I障碍定式临床检查病人版,调查了506例物质依赖者DSM-Ⅳ轴I诊断情况。结果:阿片类物质使用障碍者、酒精使用障碍者、镇静催眠抗焦虑剂使用障碍者、大麻使用障碍者和多种物质使用障碍者分别达到99.0%、4.5%、9.3%、6.5%和4.2%,其中大麻使用障碍者年龄分组比较有统计学差异;兴奋剂使用障碍者和致幻剂使用障碍者达到20.0%和5.9%,男女分组比较和年龄分组比较均有统计学差异。终生患有其他精神障碍者为16.0%;心境障碍者为8.1%,主要为重度抑郁障碍和物质滥用引起的心境障碍;精神分裂症和其他精神病性障碍者为5.7%,主要为物质滥用引起的精神病性障碍;焦虑障碍者为4.0%。结论:在阿片类物质依赖者诊治过程中,其他物质滥用和多种物质依赖及其相关的精神问题都不容忽视;年轻的,特别是女性群体受兴奋剂、大麻、氯胺酮和多种物质滥用影响更明显,并出现相关精神障碍问题,在物质滥用防治中应予以同样关注。     

552例男性甲基苯丙胺依赖者DSM-Ⅳ轴Ⅰ障碍的共病情况

目的:探究男性甲基苯丙胺依赖者DSM-IV轴Ⅰ障碍的时点患病率与终身患病率。方法:应用自制的一般人口学资料调查表、吸毒相关因素调查表与DSM-Ⅳ-TR轴I障碍定式临床检查病人版,对来自湖南省三家戒毒机构的552名男性甲基苯丙胺依赖者进行调查。结果:非物质障碍的时点患病率为10.87%,终身病率为20.47%。其中时点患病情况:以共病物质所致精神障碍(35.5%)最为普遍。终身患病情况:以共病物质所致精神障碍(36.59%)最为普遍,其次为原发性心境障碍(15.58%),原发性精神障碍(10.69%)及物质所致心境障碍(10.51%)。甲基苯丙胺依赖合并其他物质障碍的时点患病率为27.07%,终身患病率为66.30%。时点患病情况:共病其他物质使用障碍相对较少。终身患病情况:与鸦片类物质使用障碍(36.96%)共病最为普遍,其次为酒精使用障碍(32.25%)及致幻剂使用障碍(30.25%)。以是否共患其他物质使用障碍将被试分组,甲基苯丙胺依赖合并其他物质使用障碍组与仅甲基苯丙胺依赖组相比,物质所致精神障碍的终身患病率(χ2=13.217,P<0.001);原发性心境障碍的终身患病率(χ2=13.217,P<0.001)及物质所致心境障碍的终身患病率(χ2=13.217,P<0.001)更高。结论:男性甲基苯丙胺依赖者共病其他DSM-Ⅳ-TR轴Ⅰ精神障碍诊断情况较为普遍。为了提高治疗效果及预防复吸,应重视其的共病问题。     

Psychiatric comorbidity in young heroin users

In order to determine the prevalence of psychiatric comorbidity in a population of young heroin users recruited from outside of the healthcare context, a sample was assembled by targeted sampling and nomination techniques; it was comprised of regular current users of heroin aged between 18 and 30 years and resident in Barcelona, Spain. Psychiatric evaluation was done with the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) semi-structured interview. Of 149 individuals evaluated, 33% were women, whose mean age was 25.1 years; 93% received a diagnosis of heroin dependence and 71% of cocaine dependence. Thirty-two percent of the subjects had never been treated for substance use. Around two-thirds (67.1%, 95% CI: 59.6-74.7%) of the sample had lifetime psychiatric comorbidity, with antisocial personality and mood disorders being the most frequent conditions (33% and 26%, respectively). Mood, anxiety and eating disorders were more common among women than men. There were no differences in ever having been in treatment for drug use according to the presence of psychiatric comorbidity, although comorbidity was lower among those currently in treatment. Young heroin users recruited on the street presented a high prevalence of psychiatric comorbidity which was unrelated to past treatment history.     

Comorbidity among Oxford House residents: a preliminary outcome study

This study used a structured diagnostic interview to investigate the prevalence of psychiatric comorbidity among 29 men and 23 women substance abusers residing in 1 of 11 Oxford House communities located within a Midwestern metropolitan area. The Diagnostic Interview Schedule (DIS) was used to measure current and lifetime DSM-III-R diagnosis in addition to sociodemographic and substance abuse information. Considerable psychiatric comorbidity was present. Antisocial personality (ASP) disorder, affective disorders, and anxiety disorders were the most frequently observed comorbid disorders among these substance abusers, whose drugs of choice were cocaine, alcohol, and cannabis. Chi-square and t tests revealed diverse psychiatric diagnoses and variability of client characteristics, demonstrating heterogeneity within this sample of substance abusers. Gender differences were identified on several client characteristics as well. Peer social support was the most common reason why participants entered an Oxford House. Outcome measures at 6 months found that 42% of participants was still residing in an Oxford House while 27% left on good terms, demonstrating a 69% overall success rate among participants in this study. Implications of this study suggest that substance abusers with psychiatric comorbidity are heterogeneous groups that benefit from living in an Oxford House.     

Non-injecting routes of administration among entrants to three treatment modalities for heroin dependence

A sample of 535 entrants to opioid dependence treatments across three treatment modalities were administered a structured interview to ascertain the prevalence of non-injecting heroin use. Ten per cent of participants had used heroin primarily by smoking/inhaling in the month preceding interview, and 9% had used heroin and other drugs exclusively by non-injecting routes. Non-injectors were younger (25.3 vs. 29.5 years), had higher levels of education (10.6 vs. 10.0 years), were more likely to be employed (33 vs. 18%) and had lower levels of recent crime (31 vs. 56%). They also had shorter heroin using careers (5.1 vs. 9.9 years), fewer symptoms of dependence (5.1 vs. 5.6), had been enrolled in fewer previous treatment episodes (3.3 vs. 11.5) and had less extensive lifetime (8.0 vs. 9.1 drug classes) and recent (3.6 vs. 4.9) polydrug use. Non-injectors were substantially less likely to report lifetime (13% vs. 58%) or recent (2% vs. 29%) heroin overdoses. There were no differences between the general physical and psychological health of the two groups. While non-injectors had a lower level of post-traumatic stress disorder (29% vs. 34%), there were no differences in levels of major depression, attempted suicide, antisocial personality disorder, or borderline personality disorder. A substantial minority of Australian treatment entrants are now using heroin exclusively by non-injecting routes. While this group is younger, and has substantially reduced risk of overdose and blood borne virus transmission, the physical and psychological health of non-injectors mirrors that of injectors.     

The characteristics of heroin users entering treatment: findings from the Australian treatment outcome study (ATOS)

The current study aimed to describe the characteristics (demographics, drug use, mental and physical health) of entrants to treatment for heroin dependence in three treatment modalities; and to compare these characteristics with heroin users not in or seeking treatment. Participants were 825 current heroin users recruited from Sydney, Adelaide and Melbourne: 277 entering methadone/buprenorphine maintenance treatment (MT), 288 entering detoxification (DTX), 180 entering drug-free residential rehabilitation (RR) and 80 not in treatment (NT). Treatment entrants were generally long-term heroin users with previous treatment experience. The majority of the sample (55%) were criminally active in the month preceding interview. Injection-related health problems (74%) and a history of heroin overdose (58%) were commonly reported. There were high degrees of psychiatric co-morbidity, with 49% reporting severe psychological distress, 28% having current major depression, 37% having attempted suicide and 42% having a lifetime history of post-traumatic stress disorder. Personality disorders were also prevalent, with 72% meeting criteria for antisocial personality disorder and 47% screening positive for borderline personality disorder. Striking similarities were noted between the non-treatment and treatment groups in length of heroin use career, drug use and treatment histories. [Ross J, Teesson M, Darke S, Lynskey M, Ali R, Ritter A, Cooke R. The characteristics of heroin users entering treatment: findings from the Australian Treatment Outcome Study (ATOS). Drug Alcohol Rev 2005;24:411-418]     

Prevalence of psychiatric and substance use disorders in opioid abusers in a community syringe exchange program

The present study evaluates the prevalence of psychiatric and substance use disorders in male and female intravenous opioid abusers participating at a community needle exchange program (NEP). All participants (n = 422) were administered the Structured Clinical Interview for the DSM-IV (SCID) for Axis I disorders and antisocial personality disorder (APD). Psychiatric and substance abuse comorbidity were highly prevalent. Major depression was the most common current and lifetime Axis I non-substance use disorder (6 and 21% of the sample, respectively); 37% were diagnosed with APD. Over 50% of the sample was diagnosed with at least one non-substance use Axis I disorder or APD. In addition to opioid dependence, cocaine dependence was the most prevalent current and lifetime substance use disorder (68 and 78% of the sample, respectively), followed by alcohol and cannabis dependence. Overall, participants reported a mean of over one current and over three lifetime substance use disorders in addition to opioid dependence. Women reported higher rates of post-traumatic stress disorder (PTSD), while men were more likely diagnosed with APD. Presence of a psychiatric disorder was associated with increased prevalence of substance use disorder for all drug classes. The high rates of comorbidity observed in this sample suggest that the harm reduction efforts of NEPs can be significantly enhanced through referral of participants to programs that treat substance use and/or other psychiatric disorders.