Meister K, Burlon M, Rietschel L, Gouzoulis-Mayfrank E, Bock T, Lambert M
Psychosen-Ersterkennungs- und Behandlungsprojekt, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätskrankenhaus Hamburg-Eppendorf.
Fortschr Neurol Psychiatr. 2010 Feb;78(2):81-9. doi: 10.1055/s-0028-1109978. Epub 2010 Feb 9.
Epidemiological studies suggest that 20 % to 50 % of patients with schizophrenia have a lifetime comorbid substance use disorder (SUD). In first-episode psychosis this prevalence is even higher and varies between 20 % and 75 % with cannabis being the most widely used illicit drug. These difficult to treat patients usually have a worse prognosis as compared with non-substance abusing schizophrenic patients. Despite multiple theories proposed such as the self medication hypothesis, common or bidirectional factor models or genetic vulnerability, there is no consensus on the aetiology of increased rates of substance use in people with psychosis which is important to treat these patients. The dually diagnosed population is a heterogeneous group and it is likely that different models may explain comorbidity in different subgroups. The present review part one gives an overview on prevalence and explanation models for dual diagnosis psychosis and substance use with focus in adolescent and young adult populations, the second part reviews the clinical course for both disorders and current psychosocial treatment options.
流行病学研究表明，20%至50%的精神分裂症患者一生中共患物质使用障碍（SUD）。在首发精神病患者中，这一患病率甚至更高，在20%至75%之间，大麻是使用最广泛的非法药物。与不滥用物质的精神分裂症患者相比，这些难以治疗的患者通常预后更差。尽管提出了多种理论，如自我用药假说、共同或双向因素模型或遗传易感性，但对于精神病患者物质使用率增加的病因尚无共识，而这对于治疗这些患者很重要。双重诊断人群是一个异质性群体，不同的模型可能解释不同亚组中的共病情况。本综述的第一部分概述了双相诊断精神病和物质使用的患病率及解释模型，重点关注青少年和青年人群体，第二部分回顾了这两种疾病的临床病程以及当前的心理社会治疗选择。
