Treatment of Schizophrenia and Comorbid Substance Use Disorder
Treatment of Schizophrenia and Comorbid Substance Use Disorder
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DOI：
10.2174/1568007024606230
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发表时间：
2002-01-01
影响因子：
3
通讯作者：
Rawlins, Kimberly
中科院分区：
文献类型：
--
作者：
Green, Alan, I;Salomon, Melinda S.;Rawlins, Kimberly
共病的酒精和物质使用障碍通常发生在精神分裂症患者中，并有助于精神分裂症的发病率。这些共病疾病大大增加了精神分裂症给患者、家庭和整个精神卫生系统带来的经济成本和情感损失。虽然一些研究人员认为精神分裂症患者滥用酒精和其他物质的情况增多的原因与精神分裂症阴性症状的“自我药疗”或典型抗精神病药物对锥体外系系统的影响有关，我们已经提出了一种神经生物学制剂，表明酒精或其他物质可以暂时纠正精神分裂症患者多巴胺介导的中皮质边缘通路的功能障碍，与大脑奖赏回路有关的通路该公式进一步表明，酒精或其他物质通过改善富含多巴胺的中皮质边缘通路的“信号检测”能力来瞬时增强该回路的功能。精神分裂症患者共病物质使用障碍的治疗涉及谨慎使用旨在促进项目参与和提高禁欲可能性的心理社会方法。虽然典型的抗精神病药物不会限制共病物质的使用，实际上可能会使其恶化，但初步数据表明，新型抗精神病药物氯氮平可能具有显着减少精神分裂症患者酒精和其他物质使用的不寻常能力。目前尚不清楚其他新型抗精神病药物是否具有氯氮平限制酒精和物质滥用的能力。我们提出，氯氮平在这一人群中的作用可能与其广泛的药理学作用有关，包括其对多巴胺D2受体的相对较弱的阻滞作用，以及对多巴胺能5-HT 2受体和去甲肾上腺素能α 1和α 2受体的强效阻滞作用。目前正在精神分裂症和共病患者中研究用于酒精和物质使用障碍（不含精神分裂症）药物治疗的其他药物。
Comorbid alcohol and substance use disorders occur commonly among patients with schizophrenia and contribute to the morbidity of schizophrenia. These comorbid disorders add greatly to the financial costs and emotional toll that schizophrenia places on patients, families and the entire mental health system. While the basis for the increased abuse of alcohol and other substances in patients with schizophrenia have been linked by some investigators to "self-medication" of negative symptoms of schizophrenia or extrapyramidal system effects of typical antipsychotics, we have presented a neurobiologic formulation suggesting that alcohol or other substances may transiently correct a dysfunction of the dopamine-mediated mesocorticolimbic pathways in patients with schizophrenia - pathways linked to brain reward circuits. This formulation further suggests that alcohol or other substances serve to transiently enhance the functioning of this circuit by improving the "signal detection" capability of the dopamine-rich mesocorticolimbic pathways. Treatment of comorbid substance use disorder in patients with schizophrenia involves careful use of psychosocial approaches aimed at fostering program participation and at enhancing the likelihood of abstinence. While the typical antipsychotics do not limit the comorbid substance use, and may actually worsen it, preliminary data suggest the novel antipsychotic clozapine may have the unusual ability to dramatically decrease alcohol and other substance use in patients with schizophrenia. It is not clear whether other novel antipsychotics share this ability of clozapine to limit alcohol and substance abuse. We have proposed that the effect of clozapine in this population may relate to its broad pharmacological effects, including its relatively weak blockade of the dopamine D2 receptor and its potent blockade of the serotonergic 5-HT2 receptor and the noradrenergic alpha 1 and alpha 2 receptors. Studies of other agents, employed in the pharmacotherapy of alcohol and substance use disorders without schizophrenia, are currently underway in patients with schizophrenia and comorbid disorders.