BACKGROUND It remains unclear if individuals with Tourette syndrome (TS) or chronic tic disorder (CTD) have an elevated risk of subsequent substance misuse. METHODS In this population-based cohort study, we investigated the association between ICD diagnoses of TS/CTD and substance misuse outcomes, accounting for psychiatric comorbidity and familial factors. The cohort included all individuals living in Sweden at any time between January 1, 1973, and December 31, 2013. Substance misuse outcomes were defined as an ICD code of substance use-related disorder or cause of death, or as a substance use-related criminal conviction in the nationwide registers. RESULTS The cohort included 14,277,199 individuals, of whom 7832 had a TS/CTD diagnosis (76.3% men). TS/CTD was associated with an increased risk of any subsequent substance misuse outcomes (adjusted hazard ratio [aHR], 3.11; 95% confidence interval [CI], 2.94-3.29), including alcohol-related disorder (aHR, 3.45; 95% CI, 3.19-3.72), drug-related disorder (aHR, 6.84; 95% CI, 6.32-7.40), substance-related criminal convictions (aHR, 2.56; 95% CI, 2.36-2.77), and substance-related death (aHR, 2.54; 95% CI, 1.83-3.52). Excluding psychiatric comorbidities had little effect on the magnitude of the associations, with the exception of attention-deficit/hyperactivity disorder, which attenuated the risk of any substance misuse outcomes (aHR, 2.00; 95% CI, 1.82-2.19). The risk of any substance misuse outcomes in individuals with TS/CTD was substantially attenuated but remained significant when compared with their unaffected siblings (aHR, 1.74; 95% CI, 1.53-1.97). CONCLUSIONS TS/CTD were associated with various types of subsequent substance misuse outcomes, independently of psychiatric comorbidity and familial factors shared between siblings. Screening for drug and alcohol use should become part of the standard clinical routines, particularly in patients with comorbid attention-deficit/hyperactivity disorder.

中文翻译：

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图雷特综合征和慢性抽动障碍与随后的酒精或药物相关疾病、刑事定罪和死亡风险的关联：一项基于人群的家庭研究

背景 目前尚不清楚患有图雷特综合征 (TS) 或慢性抽动障碍 (CTD) 的个体是否会增加随后滥用药物的风险。方法 在这项基于人群的队列研究中，我们调查了 ICD 诊断出的 TS/CTD 与物质滥用结果之间的关联，同时考虑了精神病合并症和家族因素。该队列包括 1973 年 1 月 1 日至 2013 年 12 月 31 日期间任何时间居住在瑞典的所有个人。 物质滥用结果被定义为物质使用相关疾病或死亡原因的 ICD 代码，或物质使用相关疾病的 ICD 代码。刑事定罪在全国登记册中。结果 该队列包括 14,277,199 人，其中 7832 人诊断为 TS/CTD（76.3% 为男性）。TS/CTD 与任何后续物质滥用结果的风险增加相关（调整后的风险比 [aHR]，3.11；95% 置信区间 [CI]，2.94-3.29），包括酒精相关疾病（aHR，3.45；95% CI，3.19-3.72）、药物相关疾病（aHR，6.84；95% CI，6.32-7.40）、药物相关刑事定罪（aHR，2.56；95% CI，2.36-2.77）和药物相关死亡（ aHR，2.54；95% CI，1.83-3.52）。除了注意力缺陷/多动障碍之外，排除精神共病对关联的程度几乎没有影响，这会降低任何物质滥用结果的风险（aHR，2.00；95% CI，1.82-2.19）。与未受影响的兄弟姐妹相比，TS/CTD 患者出现任何物质滥用结果的风险显着降低，但仍然显着（aHR，1.74；95% CI，1. 53-1.97)。结论 TS/CTD 与各种类型的后续物质滥用结果相关，独立于精神共病和兄弟姐妹之间共享的家族因素。筛查药物和酒精使用应成为标准临床程序的一部分，特别是在合并注意力缺陷/多动障碍的患者中。