Green Alan I, Tohen Mauricio F, Hamer Robert M, Strakowski Stephen M, Lieberman Jeffrey A, Glick Ira, Clark W Scott
Commonwealth Research Center and the Massachusetts Mental Health Center, Harvard Medical School, 74 Fenwood Road, Boston, MA 02115, USA.
Schizophr Res. 2004 Feb 1;66(2-3):125-35. doi: 10.1016/j.schres.2003.08.001.
Co-occurring substance use disorders, mostly involving alcohol, cannabis or cocaine, occur commonly in patients with schizophrenia and are associated with increased morbidity and mortality. Available but limited data suggest that substance use disorders (especially cannabis use disorders) may also be common in first-episode patients and appear linked to a poor outcome in these patients. Strategies to curtail substance use form an important dimension of the treatment program for both first-episode and chronic patients. We report on rates of co-occurring substance use disorders in patients within their first episode of schizophrenia-related psychosis from a multicenter, international treatment trial of olanzapine vs. haloperidol.
The study involved 262 patients (of 263 who were randomized and who returned for a post-randomization evaluation) within their first episode of psychosis (schizophrenia, schizoaffective disorder or schizophreniform disorder) recruited from 14 academic medical centers in North America and Western Europe. Patients with a history of substance dependence within 1 month prior to entry were excluded.
Of this sample, 97 (37%) had a lifetime diagnosis of substance use disorder (SUD); of these 74 (28% of the total) had a lifetime cannabis use disorder (CUD) and 54 (21%) had a lifetime diagnosis of alcohol use disorder (AUD). Patients with SUD were more likely to be men. Those with CUD had a lower age of onset than those without. Patients with SUD had more positive symptoms and fewer negative symptoms than those without SUD, and they had a longer duration of untreated psychosis. The 12-week response data indicated that 27% of patients with SUD were responders compared to 35% of those without SUD. Patients with AUD were less likely to respond to olanzapine than those without AUD.
These data suggest that first-episode patients are quite likely to have comorbid substance use disorders, and that the presence of these disorders may negatively influence response to antipsychotic medications, both typical and atypical antipsychotics, over the first 12 weeks of treatment.
物质使用障碍与精神分裂症常同时出现，主要涉及酒精、大麻或可卡因，这在精神分裂症患者中很常见，且与发病率和死亡率增加相关。现有但有限的数据表明，物质使用障碍（尤其是大麻使用障碍）在首发患者中也可能很常见，并且似乎与这些患者的不良预后有关。减少物质使用的策略是首发患者和慢性患者治疗方案的一个重要方面。我们报告了在一项奥氮平与氟哌啶醇的多中心国际治疗试验中，首发精神分裂症相关精神病患者中物质使用障碍共病的发生率。
该研究纳入了从北美和西欧的14个学术医学中心招募的262例（随机分组的263例患者中有262例返回进行随机化后评估）首发精神病（精神分裂症、分裂情感性障碍或精神分裂症样障碍）患者。入组前1个月内有物质依赖史的患者被排除。
在这个样本中，97例（37%）有终生物质使用障碍（SUD）诊断；其中74例（占总数的28%）有终生大麻使用障碍（CUD），54例（21%）有终生酒精使用障碍（AUD）诊断。有SUD的患者更可能是男性。有CUD的患者起病年龄比没有CUD的患者低。有SUD的患者比没有SUD的患者有更多的阳性症状和更少的阴性症状，且未治疗精神病的持续时间更长。12周的反应数据表明，有SUD的患者中有27%有反应，而没有SUD的患者中有35%有反应。有AUD的患者对奥氮平的反应比没有AUD的患者少。
这些数据表明，首发患者很可能有共病的物质使用障碍，并且这些障碍的存在可能在治疗的前12周对典型和非典型抗精神病药物的反应产生负面影响。
