Scheller-Gilkey Geraldine, Woolwine Bobbi J, Cooper Ilene, Gay Olumuyiwa, Moynes Kelly A, Miller Andrew H
Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia 30335, USA.
Am J Drug Alcohol Abuse. 2003 Aug;29(3):553-66. doi: 10.1081/ada-120023458.
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.
大量研究记录了被诊断为精神分裂症的个体中药物滥用的高患病率及其毁灭性后果。关于这些疾病之间高共病率的一个突出理论是，精神分裂症中的药物滥用是一种自我治疗精神症状（包括阴性症状和抑郁）以及副作用（包括锥体外系反应）的尝试。与此观点一致的是，新型抗精神病药物已被证明可以减轻阴性和抑郁症状，同时引发锥体外系反应的倾向较低，与精神分裂症患者药物滥用的减少有关。为了进一步探索自我治疗假说与非典型抗精神病药物减少药物滥用的机制之间的关系，我们比较了有药物滥用史的精神分裂症患者，他们分别接受传统抗精神病药物（n = 35）或非典型抗精神病药物（n = 35）治疗。还对没有药物滥用史、接受传统抗精神病药物（n = 23）与非典型抗精神病药物（n = 29）治疗的精神分裂症患者进行了研究。评估包括阳性和阴性症状量表、汉密尔顿抑郁评定量表、辛普森 - 安格斯量表和异常不自主运动量表。与传统药物相比，非典型抗精神病药物与药物使用水平（主要是酒精）的降低有关。然而，有趣的是，在有药物滥用问题的患者中，接受传统药物与非典型药物治疗的患者在阳性或阴性症状、抑郁或锥体外系反应方面没有显著差异。这些数据表明，与症状和副作用自我治疗相关的理论似乎无法解释在使用非典型与传统抗精神病药物治疗的精神分裂症患者中发现的药物使用率差异。
