ALCOHOLISM AS COMORBID CONDITION OF DEPRESSION

Uvod i cilj: Istraživanje je provedeno na Klinici za psihijatriju KBC-a Split u razdoblju od 01.01.2015. do 30.09.2015. godine. Cilj istraživanja u ovom radu je utvrditi broj ili udio bolesnika s istovremeno prisutnim alkoholizmom i depresijom te utvrditi broj bolesnika kod kojih je primarno bila prisutna depresija, a alkoholizam se razvio kasnije (kao komorbiditetno stanje) odnosno utvrditi broj bolesnika kod kojih je kao primarna bolest prisutan alkoholizam, a depresija se razvila kasnije kao posljedica alkoholizma (sekundarna depresija). Glavne mjere ishoda su pokušaj evidentiranja udjela primarne i sekundarne dijagnoze u uzorku pomoću dobnih podataka i odnosa broja bolesnika prema spolu, zatim povezati mogućnost utjecaja dodatnih komorbidnih stanja s primarnom dijagnozom te brojem hospitalizacija. Ispitanici i metode: Ispitanici su bolesnici s istovremeno prisutnim simptomima depresije i alkoholizma čija je anamneza uzeta u razmatranje. Stanje bolesnika je dijagnosticirano prema Međunarodnoj klasifikaciji bolesti (MKB-10), te je proveden standardni psihijatrijski intervju o osobnom stanju i životnom okruženju bolesnika. Ukupno je evidentirano 36 bolesnika (26 muškaraca i 10 žena). Za istraživanje je provedena analiza bolničkih otpusnih pisama osoba liječenih u navedenom razdoblju te psihički status čime su prikupljeni podaci o: spolu, dobi, ostalim psihičkim poremećajima (poput PTSP-a) te broju hospitalizacija. Rezultati: Omjer broja muških bolesnika u odnosu prema ženskim bolesnicima u uzorku je statistički značajan i iznosi 2,6:1. Prema dobnoj strukturi ukupno najveći broj bolesnika nalazimo u dobnoj skupini između 51 i 60 godina. Prosječna životna dob u uzorku bolesnika bez obzira na spol iznosi 54 godine, između muškaraca i žena u uzorku nema statistički značajne razlike u životnoj dobi. Frekvencija muških bolesnika je više rasprostranjena kroz srednje dobne skupine, frekvencija bolesnica u mlađoj i starijoj dobnoj skupini. Ukupno je 23 ispitanika oba spola imalo drugo komorbidno stanje, što iznosi 63,89% ispitivanog uzorka. Od ukupnog broja ispitivanog uzorka evidentirano je 10 muškaraca s dijagnozom PTSP-a kao komorbidnog stanja uz dijagnosticiranu depresiju i alkoholizam. Ukupni omjer svih promatranih komorbidnih poremećaja između spolova iznosi 4,75:1. Razlike između spolova nisu se pokazale statistički značajnima što ukazuje na visoku učestalost komorbidnih stanja bez obzira na spol. Broj hospitalizacija je evidentiran kroz dvije skupine: 1-2 hospitalizacije i višekratne hospitalizacije (>2). Podatci pokazuju kako se u ovakvom uzorku više od 90% svih bolesnika hospitalizira. Izrazita su višekratna hospitaliziranja muškaraca. Zaključak: U Klinici za psihijatriju KBC-a Split u razdoblju od 01.01.2015. do 30.09.2015. godine je ukupno kod 36 bolesnika utvrđena istovremena prisutnost simptoma depresije i alkoholizma. U uzorku je značajno veći broj muškaraca u odnosu na žene, a ujedno i viša relativna frekvencija bolesnika (muških) u srednjoj životnoj dobi. Prevalencija muškaraca može biti uvjetovana prevalencijom primarnog alkoholizma unutar uzorka. Depresija unutar uzorka bi stoga imala veći udio u sekundarnoj dijagnozi, a relativna frekvencija bolesnica u mlađoj i starijoj životnoj dobi moguće korespondira s takvom pretpostavkom. Prosječna životna dob u uzorku bolesnika bez obzira na spol se može povezati istodobno s progresijom alkoholne ovisnosti oko srednje životne dobi, kao i većoj zastupljenosti depresije u srednjoj i starijoj životnoj dobi. Većina bolesnika u uzorku je izložena raznim komorbidnim stanjima što može ukazivati na korespondenciju primarne dijagnoze s komorbidnim stanjima. Ovo je osobito značajno za muškarce kod kojih značajan udio boluje od PTSP-a. Veći broj bolesnika s višekratnom hospitalizacijom kod muškaraca može biti uvjetovan njihovim većim komorbiditetom unutar ispitivane grupe. Prema podatcima iz otpusnih pisama statističkom analizom nije moguće utvrditi primarnu dijagnozu psihičkog oboljenja pojedinog bolesnika/-ce te se ne može ustanoviti točan broj ili udio komorbiditetnih stanja alkoholizma i depresije u promatranom uzorku, već je u radu donešena opća pretpostavka kojom se obuvaća stanje grupe koju čine bolesnici s dijagnosticiranim stanjem alkoholizma i depresije u određenom razdoblju trajanja ovog istraživanja.
Introduction and aim: Location of research was the Psychiatric Clinic at the Clinical Hospital Centre Split from 01/01/2015 to 30/09/2015. The aim of research in this paper is to determine the prevalence of comorbid conditions among patients who simultaneously suffer from alcohol abuse and depression as well as to determine the number of patients who suffered from depression which eventually developed to substance (alcohol) abuse (as a comorbid condition) or the number of patients suffering from alcohol abuse developing depression as a consequence of alcoholism (secondary depression). Primary outcome measures were to attempt to record the share of primary and secondary diagnoses in the operated group by using data on age and relation between the number of patients and gender, followed by the aim to see how additional comorbidities influence with primary diagnosis and repeated hospitalization. Examinees and methods: Examinees are patients with symptoms of depression and alcoholism occurring simultaneously and their medical history has been taken into consideration. The condition of patients has been diagnosed according to the International Classification of Diseases (ICD-10) and a standard psychiatric interview involving patient's personal and environmental circumstances was also conducted. In total, 36 patients were examined (26 men and 10 women). Organization of research included an analysis of medical history of patients treated during the period concerned by use discharging notes and their mental status also, on the basis of which are gathered data for this research paper: gender, age, other mental disorders (such as PTSD) and the parameter such as the number of hospitalizations. Results: The male: female ratio of patients was 2.6:1. When it comes to age structure, the majority of patients belong to the 51 - 60 age group. The average lifespan in the operated group regardless of gender is 54 and there is no statistically relevant difference in age between men and women. The frequency of male patients is more significant in the middle age groups. Twenty three male patients in total with a secondary comorbid condition, which makes 63.89% of the operated group. Out of the total number of examinees, ten men were diagnosed with PTSD, being a comorbid condition, along with depression and alcoholism. Total ratio of all examined comorbid disorders between genders is 4.75:1. Differences with regards to gender showed statistically irrelevant which indicates high prevalence of comorbidity regardless of gender. The number of hospitalizations has been recorded in two groups: 1 – 2 hospitalizations and repeated hospitalizations (>2). According to data, more than this 90% of patients in this operated group are hospitalized, male patients being more often readmissioned to the hospital than female. Conclusions: The research conducted in the Psychiatric Clinic at the Clinical Hospital Centre Split from 01/01/2015 to 30/09/2015 determined that 36 patients showed symptoms of depression and alcohol abuse simultaneously. Male patients significantly outnumber female patients in the operated group and have higher relative frequencies around middle-age group. Prevalence of male patients could be in relation to the prevalence of the primary alcoholics within the operated group. Therefore, depression is more likely to appear secondary to diagnosis in this operated group and the relative frequencies of female patients around young- and old-age group may correspond with that assumption. The average lifespan of the patients regardless of gender can be related both to the progression of alcohol abuse around middle-age and depression around young- and old-age group, respectively. Most patients in the operated group are exposed to a comorbid condition which may indicate the co-occurence of primary diagnosis with a comorbid condition. This is especially the case for males, many of which suffer from PTSD. A majority of the male patients who undergo recurrent admissions could be in relation with higher rate of male comorbidity inside the operating group. Medical history of the patients does not provide data on the exact number and ratio of alcohol abuse as a comorbid depression inside the operating group and it is neither possible to determine which of the two psychiatric disorders is a primary diagnose due to statistical analysis. So general assumption has been brought which covers state group consisting of patients with a diagnosed condition of depression and alcoholism in a given period of this study.