精神科门诊边缘型人格障碍的共病情况调查

目的调查边缘型人格障碍（Borderline Personality Disorder,BPD）与轴I、轴Ⅱ疾病的共病情况。方法2006年5月至2006年11月随机抽取符合入组标准的3402名就诊者进行调查。先由研究对象自行填写一般情况问卷及人格诊断问卷（PDQ-4^＋）进行筛查,再由精神科医生按照美国精神障碍诊断与统计手册第四版（DSM-Ⅳ）人格障碍定式临床检查（SCID-Ⅱ）对PDQ-4^＋筛查阳性者进行临床诊断。结果1.诊断为BPD者178人（5．8％）;2.BPD常与多种人格障碍共病,抑郁型人格障碍共病率最高（35．4％）;3.轴I疾病中,BPD与心境障碍者共病率最高（46．1％）。结论边缘型人格障碍与轴I、轴Ⅱ疾病存在广泛共病。     

海洛因依赖者的人格特征初步探讨

海洛因依赖者的人格特征初步探讨林厚福侯剑辉通过应用明尼苏达多项人格测查表（ＭＭＰＩ）及艾森克个性问卷（ＥＰＱ），对我院３６例海洛因依赖者进行测验，现报道于下。１．资料和方法：符合中国精神疾病与诊断标准第２版标准的男性海洛因依赖者３６例。平均年龄２７．...     

海洛因依赖者的人格障碍及性别差异分析

目的了解海洛因依赖者的人格障碍及其性别差异。方法用DSM-Ⅲ-R人格障碍用定式临床检查手册,调查了93名自愿戒毒的海洛因依赖者DSM-Ⅲ-R轴Ⅱ人格障碍的诊断情况并对其进行不同性别间比较。结果轴Ⅱ人格障碍发生率达到89．2％。边缘型人格障碍(62．4％)和强迫型人格障碍(59．1％)最常见,其次是偏执型人格障碍(52．7％)。除反社会型人格障碍外,其它类型人格障碍不同性别间未发现显著性差异。结论海洛因依赖者存在各种类型的人格障碍。反社会型人格障碍更多见于男性患者。为了加强治疗效果预防复吸应针对不同性别个体采取个性化的治疗方法。     

Mu阿片受体多态性与海洛因依赖的关联研究

目的：探讨上海汉族人群中Mu阿片受体（OPRMI）基因A118G位点、C1031G位点多态性与海洛因依赖关联性。方法：采用病例对照研究,分别检测201名海洛因依赖者（依赖组）和249名健康对照（对照组）OPRMI基因A118G和C1031G位点基因型及等位基因频率,分析海洛因依赖者OPRMI受体基因多态与物质依赖的相关性。结果：A118G和C1031G位点多态性在依赖组和对照组间的分布差异无显著性;单体型分析两位点4种单体型均与海洛因依赖间无关联。结论：OPRMI基因A118G和C1031G位点与海洛因依赖无显著相关性。     

5-HT_(2A)受体基因102T/C多态性与海洛因依赖易感性的关系

家系调查、双生子研究、寄养子研究及现代分子遗传学研究都支持遗传因素在物质依赖中起一定的作用。许多研究证实５－羟色胺与物质依赖有关，本研究以５－ＨＴ２Ａ受体基因１０２Ｔ／Ｃ多态性位点为研究靶点，探讨其与海洛因依赖及反社会人格障碍的关系。１ 资料与方法Ａ组：海洛因依赖者１１３例，男６７例，女４６例，均为汉族，平均年龄（２７．６±６．８）岁。Ｂ组：正常对照组９７名，男５４人，女４３人，均为汉族，平均年龄（２３．２±５．８）岁。两组的性别、年龄构成无显著差异（Ｐ＞０．０５）。对两组人群的Ｈａｒｄｙ－ｗｅ…     

海洛因依赖者血小板5—羟色胺水平的观察

目的：探讨海洛因依赖者血小板5－羟色胺（5－HT）水平。方法：采用高效液相色谱－电化学检测方法（HPLC－ECD）测定26例海洛因依赖者及26例正常对照者的血小板5－HT水平。结果：海洛因依赖者血小板5－HT水平显著较对照组为高。结论：研究结果提示海洛因依赖者存在5－HT神经功能失调。     

海洛因依赖与多巴胺D2受体基因的关联分析

目的：探讨海洛因依赖与多巴胺D2受体基因的相关性。方法：应用聚合酶链反应-限制性片段长度多态性分析技术，检测302例海洛因依赖者和177名正常对照者的D2受体基因-141C Ins/Del多态性的基因型和等位基因频率。结果：共检测出三种基因型：纯合子-141C Del/Del(304bp、304bp)、杂合子-141C Ins/Del(304bp、160bp、144bp)、纯合子-141C Ins/Ins(160bp、144bp)。海洛因依赖组的-141C Ins/Del多态性的基因型频率与对照组的差异无显著性（X^2=5.33，P=0.07），但海洛因依赖组-141C Del等位基因频率（16.6％）高于对照组（11.0％；X^2=5.37，P=0.02）。结论：D2受体基因-141 Cins/Del多态性可能与海洛因依赖的易感性相关。     

海洛因依赖者的脑电超慢涨落分析

目的：了解海洛因依赖者的脑功能特征。方法：用脑电超慢涨落分析仪记录50例海洛因依赖者和21名正常人的脑功能图谱，并进行比较分析。结果：海洛因依赖组的γ-氨基丁酸和谷氨酸分别为（11.7±1.1）mHz和（11.5±1.9）mHz，明显高于对照组（7.6±2.4）mHz和（5.6±3.0）mHz（P〈0.01）;多巴胺为（3.3±3.7）mHz，明显低于对照组的（7.0±4.0）mHz，两组差异有显著性（P〈0.01）。结论：从脑电生理结果观察，海洛因依赖者的大脑功能有明显损害。     

海洛因依赖者垂体-甲状腺轴变化

目的：观察海洛因依赖者垂体-甲状腺轴神经内分泌变化。方法：采集海洛因依赖者及健康对照者血样，检测促甲状腺素（TSH）、游离三碘甲状腺原氨酸（FT3）和游离甲状腺素（FT4）。结果：强制组急性戒断期TSH降低，FT3和FT4与对照组无统计学差异；戒断后第30天TSH仍低，而凡升高，FT4降低；戒断后第90天TSH与对照组无统计学差异，FT3与FT4仍分别处于升高与降低状态。自愿组TSH降低，FT3和FT4与对照组无统计学差异。结论：相关激素在海洛因依赖及戒断期处于紊乱状态，某些激素恢复较慢。     

海洛因依赖者环境线索诱发心理生理反应

目的：了解海洛因依赖者对吸毒相关环境线索诱发反应。方法：对来自自愿戒毒机构的36例刚完成生理脱毒（康复早期）的海洛因依赖者和劳教戒毒机构112例康复期满1年的海洛因依赖者观看吸毒相关视频同时给予海洛因模拟物及吸毒用具刺激,于暴露前后自评渴求程度、情绪以及戒断症状反应;用生物反馈仪自动记录暴露前后的生理反应。结果：环境线索暴露后海洛因依赖者心理渴求、害怕／焦虑、抑郁／悲伤、戒断症状、心率、皮肤导电和肌电增高（P〈0．05）,中性／放松／自然降低（P〈0．05）。自愿戒毒机构康复早期海洛因依赖者环境诱发心率增高,比康复期满一年以上者更明显（P〈0．05）,其余与康复期长短无显著关系。结论：海洛因依赖者戒断康复期的延长并不会使渴求和环境诱发心理生理反应减弱或消褪。     

Substance use disorder and personality disorder

Personality disorders (PDs) and substance use disorders (SUDs) frequently co-occur in both the general population and in clinical settings. Literature is reviewed documenting high comorbidity between these two classes of disorders, possible mechanisms of comorbidity, and the clinical implications of this comorbidity. Special emphasis is given to antisocial personality disorder (ASPD) and borderline personality disorder (BPD) as these disorders not only co-occur frequently with SUDs in the clinical populations and present clinical challenges, but also because recent research points to etiologic processes that are common to these specific PDs and SUDs. Although most attention on comorbidity between PDs and SUDs has focused on ASPD and BPD, it is also clear that other PDs (in particular, avoidant PD and paranoid PD) are prevalent among those suffering from SUDs.     

Relationship between perfectionism,personality disorders and agoraphobia in patients with panic disorder

OBJECTIVE: In earlier reports, we found that perfectionism might be involved in the development and/or maintenance of agoraphobia in panic disorder. The present report extends this work by examining the relationship between perfectionism and comorbidity with personality disorders in panic disorder patients with agoraphobia (PDA) and those without agoraphobia (PD). METHOD: We examined comorbidity of personality disorders by Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and assessed perfectionism using multidimensional perfectionism scale in 56 PDA and 42 PD patients. RESULTS: The PDA group met criteria for at least one personality disorder significantly more often than the PD group. With stepwise regression analyses, avoidant and obsessive-compulsive personality disorders emerged as significant indicators of perfectionism in patients with panic disorder. CONCLUSION: These findings suggest that perfectionism in panic disorder patients may be more common in those with comorbid personality disorders, and may be an important target for preventive and therapeutic efforts.     

Axis II comorbidity in borderline personality disorder is influenced by sex, age, and clinical severity

Borderline personality disorder (BPD) is a severe psychiatric disorder that has a high clinical heterogeneity and frequent co-occurrence with other personality disorders (PDs). Although several studies have been performed to assess axis II comorbidity in BPD, more research is needed to clarify associated factors. The aim of this study was to determine the prevalence of co-occurrent axis II disorders in a large sample of patients with BPD and to investigate the influence of sex, age, and severity on this comorbidity.Data were collected from 484 patients with BPD through 2 semistructured interviews. We analyzed the frequency of axis II comorbidity and assessed differences regarding sex, age, and severity of BPD. About 74% of patients with BPD had at least 1 co-occurrent axis II disorder. The most common were paranoid, passive-aggressive, avoidant, and dependent PDs. Significant sex differences were found. Women presented more comorbidity with dependent PD, whereas men showed higher rates of comorbidity with antisocial PD. We also observed a significant positive correlation between age and the number of co-occurrent axis II disorders in women with BPD. Another finding was the positive correlation between BPD severity and the number of co-occurrent axis II disorders. These findings suggest that comorbidity with other axis II disorders and sex, age, and severity should be taken into account when developing treatment strategies and determining the prognosis of BPD.     

男女海洛因依赖者成瘾严重程度的比较

目的：了解男女海洛因依赖者成瘾严重程度的差异,为针对不同性别海洛因依赖者制定干预措施提供依据。方法：采用自制个案调查表和成瘾行为严重度指数量表（addiction severity index,ASI）对199例男性和239例女性海洛因依赖者进行评估,比较不同性别海洛因依赖者ASI量表中各维度分值的差异。结果：女性依赖者ASI中因子4（药物使用）评分平均为（0.52±0.28）分和因子7（精神健康状况）平均（0.15±0.24）分显著高于男性的（0.43±0.34）分和（0.08±0.19）分（P〈0.05或P〈0.01）;男性依赖者因子5（法律状况）评分平均（0.07±0.13）分高于女性的（0.03±0.10）分（P〈0.01）。将年龄、首次吸毒年龄及吸毒时间与ASI分量表进行偏相关分析发现,年龄（r=-0.182）、吸毒时间（r=0.158）与因子4（药物使用）分数存在显著相关;进一步相关分析发现,年龄与吸毒时间存在显著相关（r=0.364,P〈0.01）。结论：男女海洛因依赖者在成瘾行为严重程度方面存在差异,临床治疗与康复过程中应针对不同性别特征制定个体化的治疗方案以满足不同性别患者的需求。     

Serotonergic function in mothers of opioid addicts: correlation with comorbid depression

The serotonergic (5-HT) function of 36 mothers of heroin addicts, of whom 16 subjects were without psychopathological features (group A) and 20 subjects had major depressive disorders (group B), as well as 10 age- and sex-matched healthy controls, was examined by L-D-fenfluramine stimulation of secretion of prolactin (PRL) and cortisol. The subjects’ addict relatives were also tested for personality features and hormonal responses to L-D-fenfluramine. The PRL and cortisol responses to the stimulus were normal in mothers of group A, and blunted in mothers of group B. A high frequency (70%) of heroin addicts with comorbid depression was found among the sons of group B mothers. The sons of depressed mothers showed reduced PRL and cortisol responses to fenfluramine. A significant direct correlation has been demonstrated between the PRL areas under curves (AUC) of mothers and sons in response to the 5-HT agonist. Our data suggest that genetic 5-HT impairment is not involved in the pathogenesis of heroin addiction or codependence per se, and is probably linked to the presence of familial depression in comorbidity with the addictive disorder.     

立体定向手术治疗海洛因依赖的远期随访分析

目的评估立体定向毁损术治疗海洛因依赖的手术疗效,分析术后复吸原因。方法回顾性分析接受脑立体定向术的154例海洛因成瘾者的临床资料,采用症状自评量表对病人精神卫生状况进行调查随访。结果随访154例,时间5~6年,其中复吸52例(33.8%,复吸组),未复吸102例(66.2%,未复吸组)。复吸组术后躯体化、强迫症状、敌对、偏执、精神病性等因子明显高于未复吸组和国内常模(均P<0.05)。结论立体定向手术是海洛因依赖的安全有效的治疗方法。强迫症状和人格障碍的改善是消除心理依赖的基础及手术戒毒治疗成功的重要因素;精神病性和躯体化是复吸的主要原因。     

Addiction and personality

Within the field of substance abuse, it is now widely admitted that the addictive personality does not exist. No one personality type is predisposed to addiction. The predisposition to drug dependence involves many different factors: psychological, social, familial, biological. None of these factors can be the sole determinant of drug dependence. Keeping that in mind, it is of interest to review the recent data on the relationship between personality traits or disorders and opiate and cocaine dependence. Using DSM and ICD categorical assessment, no single personality disorder emerged, instead a range of personality disorders has been evaluated in opiate and cocaine dependent subjects. Every type of personality disorders (PD) existed but cluster BPD were the most common (especially antisocial personality disorder in opiate addicts). However, it is noteworthy that a large minority to a majority of subjects did not display any king of PD. The implication of these results is that antisocial PD is probably over-diagnosed in drug dependence clinical settings. The studies reviewed failed to demonstrate that personality disorders were strong predictors of outcome in opiate or cocaine dependence. However, opiate dependent PD subjects entering treatment had more severe problems and lower retention rate than non PD subjects. But the amount of improvement was not significantly different between PD subjects and non PD subjects. This demonstrated that substance dependent PD patients could benefit from treatment whose intensity and duration must be adjusted. There is good support for the idea that Sensation Seeking trait is a vulnerability factor to substance abuse. But after dependence develops, sensation seeking is probably irrelevant to continued use of the drugs. This break between the psychopathology of vulnerability of substance abuse and the psychopathology of dependence raises the question of the existence of dramatically different factors involved in both phases of addiction.     

Patterns of comorbidity in panic disorder and major depression: findings from a nonreferred sample

Previous findings in referred adult samples document major depression as having important moderating effects on the patterns of comorbidity for panic disorder and major depression. This study evaluated whether these patterns of comorbidity are moderated by referral bias. Panic disorder (PD) and major depression (MD) were used to predict the risk for comorbid psychiatric disorders and functional outcomes using data from a large sample of adults who had not been ascertained on the basis of clinical referral (N=1,031). Participants were comprehensively assessed with structured diagnostic interview methodology to evaluate childhood and adult comorbid psychiatric disorders. PD increased the risk for anxiety disorders, independently of MD. MD increased the risk for mania, antisocial personality disorder, psychoactive substance use disorder, disruptive behavior disorders, overanxious disorder, social phobia, and generalized anxiety disorder, independently of PD. These results extend to nonreferred samples' previously reported findings documenting that MD has important moderating effects on patterns of comorbidity for PD and indicate that patterns of comorbidity for PD are not due to referral bias.     

Comorbidity of panic and somatization disorder: A genetic-epidemiological approach

Although recent diagnostic systems support the distinctiveness of panic disorder (PD) and somatization disorder, a high level of comorbidity of these two diagnoses has been reported, indicating a need for investigations with external validators. One hundred fifty-nine outpatients with DSM-III-R PD and 76 surgical controls were screened for lifetime presence of DSM-III-R somatization disorder, and the risks for some types of psychiatric disorders in their families were computed. In our sample, 23% of women and 5% of men with PD also had DSM-III-R somatization disorder. Women patients with PD plus somatization disorder did not differ from women with PD only in age at onset of panic, agoraphobia, childhood history of separation anxiety, or lifetime diagnoses of other disorders. Familial risks for PD, PD-agoraphobia, and alcohol dependence were significantly higher for families of women with PD and women with PD plus somatization disorder than for controls. The familial risks for antisocial personality (ASP) disorder (a familial indicator for the somatization disorder spectrum of liability, phenomenologically independent from both PD and somatization disorder) were significantly higher for families of women with PD plus somatization disorder than for families of women with PD only or for controls. Application of DSM-IV criteria for somatization disorder substantially decreased the comorbidity with PD. Our data suggest that somatization disorder is not simply a form of PD, and that the two disorders may coexist in the same subject without sharing a common genetic diathesis. Compared with DSM-III-R, DSM-IV criteria for somatization disorder appear to be simpler in structure and of less complicated application.     

Factors differentiating personality-disordered individuals with and without a history of unipolar mood disorder

The relationship between mood disorders and personality disorders has been of longstanding interest to clinicians. Despite theoretical reasons to do so, virtually no studies have examined factors that discriminate personality-disordered subjects with a history of mood disorder (PD/HMD) from personality-disordered subjects without a history of mood disorder (PD). This study examined demographic variables, patterns of comorbidity, measures of life functioning, personality traits, and early life experiences differentiating PD/HMD (n = 83) from PD (n = 214). Diagnoses were assigned using structured clinical interviews and a best-estimate procedure. The results suggest that subjects with borderline personality disorder are more likely to have a life history of mood disorder than are subjects with other personality disorders. In addition, PD/HMDs are more likely to receive a diagnosis of anxiety disorder or alcoholism, to have lower Global Assessment of Functioning (GAF) scores, and to have sought treatment than PDs. On self-report measures of personality, PD/HMDs endorse higher levels of trait anxiety and affective lability (e.g., Harm Avoidance, Neuroticism) than do PDs. PD/HMDs are also more likely to report childhood physical and emotional abuse than are PDs, and to describe their parents as using affectionless control. No differences were found between Axis II clusters as a function of mood disorder history. The discussion suggests a potential model in which early environmental stress interacts with constitutional vulnerabilities to put individuals at an increased risk for both mood and anxiety disorders as well as personality disorders.