Roth Robert M, Brunette Mary F, Green Alan I
Department of Psychiatry, Dartmouth Medical School/DHMC, Lebanon, NH 03756, USA.
Curr Psychiatry Rep. 2005 Aug;7(4):283-91. doi: 10.1007/s11920-005-0082-8.
Substance use disorders (SUDs) are highly prevalent and are associated with poor outcomes among individuals with schizophrenia. Integrating treatments for both disorders improves outcomes. Numerous individual pharmacologic and psychosocial treatments have shown effectiveness at reducing substance use in individuals with a primary diagnosis of schizophrenia and co-occurring substance use disorders. Of these treatments, medications such as certain atypical antipsychotics and naltrexone, and psychosocial treatments such as contingency management, seem to be particularly promising. The development and evaluation of psychopharmacologic and psychosocial treatments for SUDs in schizophrenia would benefit from a better understanding of the neurobiological mechanisms underlying the effectiveness of such treatments. Several theories have been put forth to explain the heightened risk for SUDs in schizophrenia. Of these, brain reward circuitry dysfunction, hypothesized to be etiologically important in SUDs, may be an especially salient target for treatments aimed at the reduction of substance use in patients with schizophrenia. We review current pharmacologic and psychosocial treatments for SUDs in schizophrenia, and theoretical mechanisms underlying the increased risk for SUDs in this population. We propose that effective treatments may in part work through the modulation of brain reward circuitry dysfunction.
物质使用障碍（SUDs）在精神分裂症患者中极为普遍，且与不良预后相关。对这两种疾病进行综合治疗可改善预后。许多针对单一疾病的药物治疗和心理社会治疗已显示出在减少初次诊断为精神分裂症且同时患有物质使用障碍的个体的物质使用方面的有效性。在这些治疗方法中，某些非典型抗精神病药物和纳曲酮等药物，以及应急管理等心理社会治疗方法，似乎特别有前景。对精神分裂症患者物质使用障碍的精神药理学和心理社会治疗的开发与评估，将受益于对这些治疗有效性背后神经生物学机制的更好理解。已经提出了几种理论来解释精神分裂症患者物质使用障碍风险增加的原因。其中，大脑奖赏回路功能障碍被认为在物质使用障碍的病因学中具有重要意义，可能是旨在减少精神分裂症患者物质使用的治疗的一个特别突出的靶点。我们综述了目前针对精神分裂症患者物质使用障碍的药物治疗和心理社会治疗，以及该人群物质使用障碍风险增加的潜在理论机制。我们提出，有效的治疗可能部分通过调节大脑奖赏回路功能障碍来发挥作用。
