Horsfall Jan, Cleary Michelle, Hunt Glenn E, Walter Garry
Research Unit, Sydney South West Area Health Service, Concord Centre for Mental Health, Concord Hospital, New South Wales 2139, Australia.
Harv Rev Psychiatry. 2009;17(1):24-34. doi: 10.1080/10673220902724599.
Considerable research documents the health consequences of psychosis and co-occurring substance use disorders. Results of randomized controlled trials assessing the effectiveness of psychosocial interventions for persons with dual diagnoses are equivocal but encouraging. Many studies are hampered by small, heterogeneous samples, high attrition rates, short follow-up periods, and unclear description of treatment components. The treatments available for this group of patients (which can be tailored to individual needs) include motivational interviewing, cognitive-behavioral therapy, contingency management, relapse prevention, case management, and skills training. Regardless of whether services follow integrated or parallel models, they should be well coordinated, take a team approach, be multidisciplinary, have specialist-trained personnel (including 24-hour access), include a range of program types, and provide for long-term follow-up. Interventions for substance reduction may need to be further developed and adapted for people with serious mental illnesses. Further quality trials in this area will contribute to the growing body of data of effective interventions.
大量研究记录了精神病与并发物质使用障碍对健康的影响。评估针对双重诊断患者的心理社会干预效果的随机对照试验结果并不明确，但令人鼓舞。许多研究因样本量小、样本异质性高、损耗率高、随访期短以及治疗成分描述不清而受到阻碍。针对这类患者的可用治疗方法（可根据个体需求进行调整）包括动机访谈、认知行为疗法、应急管理、预防复发、病例管理和技能培训。无论服务采用综合模式还是并行模式，都应进行良好协调，采用团队方法，具备多学科性质，拥有经过专业培训的人员（包括提供24小时服务），包括一系列项目类型，并提供长期随访。减少物质使用的干预措施可能需要进一步开发并适用于患有严重精神疾病的人群。该领域的进一步高质量试验将为有效干预措施的不断增长的数据做出贡献。
