Green Alan I
Department of Psychiatry, Dartmouth Medical School/DHMC, One Medical Center Drive, Lebanon, NH 03756-0001, USA.
Neurotox Res. 2007 Jan;11(1):33-40. doi: 10.1007/BF03033480.
Substance use disorder (SUD) occurs commonly in patients with schizophrenia and is associated with a poor outcome. Despite this common co-morbid occurrence (and its negative impact on the course of schizophrenia), there have been very few studies assessing pharmacological strategies for optimal treatment of these patients. A number of theories have been advanced to help explain the high rate of substance use disorder in patients with schizophrenia. Our group has suggested that the brain reward circuit dysfunction model, which may incorporate aspects of all of these models, may help direct research aimed at developing new pharmacological treatments for patients with schizophrenia and co-occurring SUD. Although typical antipsychotic medications appear to be of limited value in these patients, emerging, but preliminary, data suggest that the atypical antipsychotics, particularly clozapine, may be particularly helpful. The role of adjunctive medications, such as those medications that have recently been shown to be useful for the treatment of alcoholism, may have a role in the treatment of these patients, although only naltrexone has, thusfar, been carefully tested in these comorbid patients. Further studies are indicated to assess the role of novel pharmacologic treatment strategies for these patients. Ultimately, any medication given to these patients will need to be prescribed within psychosocial treatment programs aimed at assisting these patients in limiting and ultimately ceasing substance use.
物质使用障碍（SUD）在精神分裂症患者中很常见，且与不良预后相关。尽管这种共病情况很常见（且对精神分裂症病程有负面影响），但评估针对这些患者的最佳治疗的药理学策略的研究却很少。已经提出了一些理论来帮助解释精神分裂症患者中物质使用障碍的高发生率。我们小组认为，大脑奖赏回路功能障碍模型可能综合了所有这些模型的各个方面，有助于指导旨在为精神分裂症合并SUD患者开发新的药物治疗的研究。虽然典型抗精神病药物在这些患者中似乎价值有限，但新出现的初步数据表明，非典型抗精神病药物，尤其是氯氮平，可能特别有帮助。辅助药物的作用，例如最近已被证明对治疗酒精中毒有用的那些药物，可能在这些患者的治疗中发挥作用，尽管到目前为止，只有纳曲酮在这些共病患者中经过了仔细测试。需要进一步研究来评估新型药物治疗策略对这些患者的作用。最终，给予这些患者的任何药物都需要在旨在帮助这些患者限制并最终停止物质使用的心理社会治疗方案中开具。
