PHARMACOTHERAPY FOR SCHIZOPHRENIC DRUG USERS

滥用可卡因在精神分裂症患者中很常见。 实际上 流行病学集水区研究发现，16.7%的可卡因成瘾者 有精神分裂症的共病诊断（比值比为13），47% 的精神分裂症患者有终生的物质使用障碍。 这些 个人对传统药物滥用和精神疾病的反应很差 治疗。 有很大的临床和研究需要发展 创新的和明确的精神药理学治疗， 解决精神病和药物滥用问题的人口 问题 这项拨款申请旨在评估药物治疗， 精神分裂的可卡因滥用者，并提出开始与12周的两倍 一项盲法试验，比较马吲哚与安慰剂的疗效。 所有患者 将继续服用精神分裂症的抗精神病药物 还有， 患者将被随机分配至日间医院（25小时/周） 或强化门诊计划（12小时/周）。 这两个双 诊断程序强调团体治疗，但也包括个别病例 管理和家庭参与。 核心心理治疗方法 该计划是双重诊断复发预防（DDRP），包括 改良药物滥用复发预防和精神病社会 技能培训（精神症状和药物管理）。 后 在为期12周的临床试验中，患者将在3岁时重新评估， 六个月的后续会议。 这项拨款的具体目的是 是： 1. 马吲哚缓释片改善物质代谢的疗效观察 精神分裂症可卡因滥用者的滥用治疗结果 2. 比较两个社会心理水平的相对疗效 治疗（包括成本效益）。 3. 按性别分层并评估治疗结果的差异。 4. 评估治疗疗效的预测因素，包括可卡因的严重程度 精神分裂症和抑郁症的阴性症状。

Cocaine abuse is common among schizophrenics. In fact, the Epidemiological Catchment Area study found that 16.7% of cocaine addicts had a comorbid diagnosis of schizophrenia (odds ration of 13), and 47% of schizophrenics have a lifetime substance use disorder. These individuals respond poorly to traditional drug abuse and psychiatric treatments. There exists a great clinical and research need to develop innovative and well defined psychopharmacological treatments for this population which address both the psychiatric and substance abuse problems. This grant application proposes to evaluate pharmacotherapies for schizophrenic cocaine abusers and proposes to begin with a 12 week double blind trial comparing adjunctive mazindol versus placebo. All patients will be maintained on neuroleptic medication for schizophrenia. Also, patients will be randomized to either a day hospital (25 hours / week) or an intensive outpatient program (12 hours / week). Both of these dual diagnosis programs emphasize group therapy, but include individual case management and family participation. The core psychotherapy approach for the program is Dual Diagnosis Relapse Prevention (DDRP) which consists of modified substance abuse relapse prevention and psychiatric social skills training (psychiatric symptom and medication management). After the 12 week clinical trial, patients will be re-evaluated at three and six month follow-up sessions. The specific aims of this grant proposal are to: 1. Determine the efficacy of adjunctive mazindol in improving substance abuse treatment outcomes in schizophrenic cocaine abusers. 2. Compare the relative efficacy of the two levels of psychosocial treatment (including cost-effectiveness). 3. Stratify by gender and assess differences in treatment outcome. 4. Assess predictors of treatment efficacy including severity of cocaine usage, negative symptoms of schizophrenia and depression.