Introduction Les troubles de la personnalité appartenant au groupe B du DSM-V, notamment les troubles de la personnalité limite et antisociale, sont associés à des taux élevés de problèmes liés à l’utilisation d’une substance. Les mécanismes qui pourraient expliquer cette relation demeurent cependant mal compris. Le craving a par ailleurs récemment été reconnu comme étant une composante majeure des troubles liés à l’utilisation d’une substance. Le but de cet article est donc d’effectuer une recension des écrits afin d’explorer la possibilité que le craving explique en partie cette comorbidité fréquente chez les personnes atteintes de troubles de la personnalité limite ou antisociale.Méthode Revue critique de la littérature.Résultats Un nombre limité d’études suggèrent une association positive entre la présence de troubles de la personnalité et le craving. Par ailleurs, les personnes atteintes de ces troubles répondent différemment aux médicaments qui réduisent ce symptôme, lorsque comparées à des sujets normaux. Alors qu’un nombre réduit d’études ont porté directement sur le craving et les troubles de la personnalité, plusieurs ont exploré l’association entre certains traits de tempérament et le craving. La corrélation entre l’impulsivité, les affects négatifs et le craving pourrait potentiellement expliquer la prévalence élevée et la sévérité des troubles liés à l’usage de substances chez les personnes atteintes d’un trouble de la personnalité limite ou antisociale.Conclusion Ces résultats suggèrent que certains traits de personnalité seraient liés au craving et pourraient servir de cibles intéressantes pour prévenir, évaluer et gérer les troubles comorbides liés à l’utilisation de substances.Background Cluster-B personality disorders (DSM-V), particularly borderline and antisocial personality disorders, are associated with high rates of substance use disorder. However, the mechanisms underlying this relationship have yet to be fully understood. Craving has recently been identified as an important component of substance use disorder. The purpose of this article is therefore to review the current literature and explore whether craving could be implicated as an underlying mechanism of comorbid substance use disorder in antisocial and borderline personality disorders.Method Critical review of the literature.Results Emerging evidence indicates that there is in fact an association between craving and personality disorders. Patients afflicted with the latter, incidentally, respond differently to anti-craving medication when compared to normal subjects. While a limited number of studies have directly assessed craving in patients with personality disorders, a growing number have looked at the association between craving and specific personality traits. The correlation between impulsivity, negative affect and craving seems like a plausible explanation for the high prevalence and severity of substance use disorder in subjects with antisocial or borderline personality disorders.Conclusion These findings suggest that specif...
measured by lost workdays in the past 12 months. An ordered logistic regression was used to determine the impact of financial access on patients' out-of-pocket costs (less than $2,000, $2,000 -4,999, $5,000 or more). In addition, a negative binomial regression was implemented to estimate the impact on productivity loss caused by financial access barriers. Results: A total of 8,818 and 22,338 cancer survivors were identified out of 717,513 respondents for assessing the impact on productivity loss and out-of-pocket-costs, respectively. The financial access barrier was associated with increased productivity loss compared to those without barriers, [IRR= 1.16, (95% CI: 1.00 to 1.35, P=0.045)]. Not surprisingly, increased financial barriers were associated with higher patients' out-of-pocket costs, [OR= 1.56, (95% CI: 1.73 to 1.80, P =0.007)]. Conclusions: Cancer survivors with financial access barriers are more likely to lose productivity and pay a higher level of out-of-pocket costs, suggesting inequality in health care access can further exacerbate the societal burden of cancer in addition to direct medical costs.
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