Relationship of clinical symptoms and substance use in schizophrenia patients on conventional versus atypical antipsychotics.
Relationship of clinical symptoms and substance use in schizophrenia patients on conventional versus atypical antipsychotics.
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精神分裂症患者传统与非典型抗精神病药物的临床症状和物质使用的关系。
DOI：
10.1081/ada-120023458
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
Miller,AndrewH
中科院分区：
文献类型：
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作者：
Scheller-Gilkey,Geraldine;Woolwine,BobbiJ;Cooper,Ilene;Gay,Olumuyiwa;Moynes,KellyA;Miller,AndrewH
大量的研究记录了被诊断为精神分裂症的个体中药物滥用的高流行率和破坏性后果。这些疾病之间的高共病率的一个突出理论是精神分裂症中的物质滥用是试图自我消除精神症状，包括阴性症状和抑郁症以及副作用，包括锥体外系反应（EPR）。与这一观点相一致的是，新型抗精神病药物已被证明可以减少阴性和抑郁症状，同时表现出较低的导致EPR的倾向，与精神分裂症患者药物滥用的减少有关。为了进一步探讨自我药疗假说，因为它与非典型抗精神病药物减少物质滥用的机制有关，我们比较了有物质滥用史的精神分裂症患者接受常规（n = 35）或非典型（n = 35）抗精神病药物治疗。还对无药物滥用史的精神分裂症患者进行了检查，这些患者接受常规（n = 23）与非典型抗精神病药物（n = 29）。评估包括阳性和阴性症状量表、汉密尔顿抑郁量表、Alfresson-Angus和异常不自主运动量表。与常规药物相比，非典型抗精神病药物与物质使用（主要是酒精）水平降低相关。然而，有趣的是，在药物滥用患者中，常规药物与非典型药物的患者在阳性或阴性症状、抑郁或EPR方面没有显著差异。这些数据表明，与症状和副作用的自我药疗相关的理论似乎不能解释精神分裂症患者使用非典型抗精神病药物与传统抗精神病药物的物质使用率差异。
A large body of research documents the high prevalence and devastating consequences of substance abuse among individuals diagnosed with schizophrenia. One prominent theory of the high rate of comorbidity between these disorders is that substance abuse in schizophrenia is an attempt to self‐medicate psychiatric symptoms including negative symptoms and depression as well as side effects including extrapyramidal reactions (EPR). Consistent with this notion, novel antipsychotic medications, which have been shown to reduce negative and depressive symptoms while exhibiting a lower propensity to cause EPR, have been associated with reduced substance abuse in patients with schizophrenia. To further explore the self‐medication hypothesis as it relates to the mechanism by which atypical antipsychotics reduce substance abuse, we compared schizophrenia patients with a history of substance abuse medicated with either conventional (n = 35) or atypical (n = 35) antipsychotics. Patients with schizophrenia who did not have a history of substance abuse who were on conventional (n = 23) vs. atypical antipsychotics (n = 29) were also examined. Assessments included the Positive and Negative Symptom Scale, Hamilton Rating Scale for Depression, Simpson–Angus, and Abnormal Involuntary Movement Scale. Compared with conventional medications, atypical antipsychotic drugs were associated with reduced levels of substance use (primarily alcohol). Interestingly, however, in substance‐abusing patients there were no significant differences between patients on conventional vs. atypical agents with respect to positive or negative symptoms, depression, or EPR. These data suggest that theories related to self‐medication of symptoms and side effects do not appear to account for the difference in rates of substance use found in schizophrenia patients on atypical vs. conventional antipsychotic medications.