酒精使用障碍的药物治疗(201706郭中孟)

Essentially the DSM criteria require: (A) the presence of prominent hallucinations or delusions, (B) evidence from the history, physical examination or laboratory findings that the symptoms developed within or during a month of alcohol intoxication or withdrawal. The symptoms are (C) not better accounted for by a psychotic disorder that is not substanceinduced (e.g.symptoms precede substance use) and (D) do not exclusively occur during the course of a delirium.
However, these figures did not exclude patients experiencing psychotic symptoms associated with alcoholwithdrawal delirium. It is estimated that AIPD patients represent a minority (33.1 %) of the group of patients experiencing psychotic symptoms associated with alcohol dependence (the rest being mostly associated with alcohol withdrawal delirium) (Soyka et al. 1988).
Epidemiology
Whereas the lifetime risk for alcohol dependence is 10–15 % (males) and 3–5 % (females) (Schuckit 2005), only 2–3 % of such patients had psychotic symptoms (Victor and Adams 1953).
The sex ratios in patients with AIPD and alcohol-withdrawal delirium were similar (male/female: 3.64– 3.68:1 respectively) (Soyka et al. 1988).
The German study excluded patients with other substance abuse, whilst the Finnish study included comorbid lifetime substance use (20 %) and other psychiatric disorders (76 %).
The prevalence of AIPD in alcohol dependent patients varied between 0.4 % and 0.7 % (inpatients, Germany) (Soyka 2008a), 4 % (inpatients, lifetime, Finland) (Perälä et al. 2010) and 12.36 % (Nepal) (Sedain 2013). A lifetime prevalence of 0.41 % was reported in the general population (Perälä et al. 2010).
Early descriptions of a distinct psychotic syndrome associated with excessive alcohol use were based on case-studies and clinical observation. Bleuler (1916) termed the condition alcoholic hallucinosis.
No significant demographic differences (age, education, marital status and employment) were found between male alcoholic patients with and without a history of psychosis (Tsuang et al. 1994).
Overestimation of AIPD prevalence may therefore be possible in the Finnish study, as these comorbid disorders may also be associated with psychotic features.
Alcohol-withdrawal delirium was included in the alcohol-induced psychotic syndrome (AIPS) group and 13 % of AIPD patients developed a primary psychosis.
DSM 5 stipulates that the period of onset should be “during or soon” after intoxication or withdrawal of alcohol and that the disturbance should cause clinical significant distress or impairment.
AIPS was associated with a high mortality rate (37 % over 8 years) (Perälä et al. 2010), and “AIPD” (including patients with delirium tremens) was also identified as a risk factor for premature death (Mattisson et al. 2011).
The age of onset of alcoholism reported in AIPD varied between 21.4 (Jordaan et al. 2009), and 29.1 years (Tsuang et al. 1994) with the latter study showing a significantly younger age of onset of alcoholism for AIPD patients than their non-psychotic male counterparts. The mean age of onset of psychosis was significantly later in AIPD (36.2 and 37.4 years) compared to schizophrenia (24.8 and 32.8 years) (Jordaan et al. 2009 and Soyka 1990).
Follow-up studies on patient groupsappeared from around the 1950’s and described the features of what is currently known as: Alcohol-induced Psychotic Disorder (AIPD) (APA, DSM-IV-TR 2000; DSM-5, 2013), or Psychotic Disorder due to the use of Alcohol (WHO ICD-10 1993).
Histories of higher (Tsuang et al. 1994) and lower (Jordaan et al. 2009) levels of alcohol consumption in AIPD compared to uncomplicated alcohol dependent patients were reported in studies with varying methodologies. Higher rates of other drug use in AIPD compared to uncomplicated alcohol dependence were also reported (Tsuang et al. 1994).
Underreporting of AIPD is however also possible because some patients may receive other diagnoses eg. “dual diagnosis”, alcohol-withdrawal delirium etc. or may not seek treatment because of favourable outcome (Soyka 2008a; Perälä et al. 2010; Kumar and Bankole 2010).
酒精使用障碍的药物治疗进展
Medication for Alcohol Use Disorders
交流提纲
概述
酒精使用障碍（alcohol use disorder， AUD） 酒精依赖 酒精戒断反应 酒精所致精神病 酒精所致人格改变 酒精所致智能障碍
The association between alcohol use and psychosis was documented as early as 1847 by Marcel. He was credited for differentiating the disorder from delirium tremens (Johansson 1961).
Psychotic manifestations may also occur in other general medical or neurological disorders associated with alcohol dependence(Greenberg and Lee 2001).
Initial studies on groups of patients did not compare patients with other diagnostic groups (Benedetti 1952; Burton Bradley 1958; Victor and Hope 1958). Conclusions were based on clinical observations Fra Baidu biblioteknd follow-up studies over variable periods of time. From the 1960’s studies adopted a more systematic research approach (Glass 1989a).
Kraepelin (1913) and other authors also reported a distinct psychotic syndrome associated with alcoholism that differed from delirium tremens (alcohol withdrawal with delirium), Wernicke’s encephalopathy, Korsakoff’s psychosis and alcohol-induced dementia (Glass 1989a).