治疗伴有精神障碍的物质滥用患者。
Treatment of substance abusing patients with comorbid psychiatric disorders.
机构信息
The Center for Psychiatric and Chemical Dependency Services, University of Pittsburgh Medical Center, Pittsburgh, PA 15213-2593, USA.
出版信息
Addict Behav. 2012 Jan;37(1):11-24. doi: 10.1016/j.addbeh.2011.09.010. Epub 2011 Sep 14.
OBJECTIVE
To update clinicians on the latest in evidence-based treatments for substance use disorders (SUD) and non-substance use disorders among adults and suggest how these treatments can be combined into an evidence-based process that enhances treatment effectiveness in comorbid patients.
METHOD
Articles were extracted from Pubmed using the search terms "dual diagnosis," "comorbidity" and "co-occurring" and were reviewed for evidence of effectiveness for pharmacologic and psychotherapeutic treatments of comorbidity.
RESULTS
Twenty-four research reviews and 43 research trials were reviewed. The preponderance of the evidence suggests that antidepressants prescribed to improve substance-related symptoms among patients with mood and anxiety disorders are either not highly effective or involve risk due to high side-effect profiles or toxicity. Second generation antipsychotics are more effective for treatment of schizophrenia and comorbid substance abuse and current evidence suggests clozapine, olanzapine and risperidone are among the best. Clozapine appears to be the most effective of the antipsychotics for reducing alcohol, cocaine and cannabis abuse among patients with schizophrenia. Motivational interviewing has robust support as a highly effective psychotherapy for establishing a therapeutic alliance. This finding is critical since retention in treatment is essential for maintaining effectiveness. Highly structured therapy programs that integrate intensive outpatient treatments, case management services and behavioral therapies such as Contingency Management (CM) are most effective for treatment of severe comorbid conditions.
CONCLUSIONS
Creative combinations of psychotherapies, behavioral and pharmacological interventions offer the most effective treatment for comorbidity. Intensity of treatment must be increased for severe comorbid conditions such as the schizophrenia/cannabis dependence comorbidity due to the limitations of pharmacological treatments.
目的
向临床医生介绍成人物质使用障碍（SUD）和非物质使用障碍的最新循证治疗方法，并提出如何将这些治疗方法结合到一个循证治疗过程中，从而提高共病患者的治疗效果。
方法
使用“双重诊断”、“共病”和“共病”等术语从 Pubmed 中提取文章，并对其进行了药物治疗和心理治疗共病有效性的证据进行了审查。
结果
共审查了 24 项研究综述和 43 项研究试验。大量证据表明，为改善心境和焦虑障碍患者的物质相关症状而开的抗抑郁药要么效果不佳，要么由于副作用高或毒性大而存在风险。第二代抗精神病药对治疗精神分裂症和共病物质滥用更有效，目前的证据表明氯氮平、奥氮平和利培酮是其中最好的药物。氯氮平似乎是治疗精神分裂症患者酒精、可卡因和大麻滥用最有效的抗精神病药。动机访谈作为一种建立治疗联盟的高效心理治疗方法，具有强大的支持。这一发现至关重要，因为保留治疗对保持疗效至关重要。高度结构化的治疗方案，整合强化门诊治疗、病例管理服务和行为疗法，如条件强化（CM），对严重共病的治疗最有效。
结论
心理治疗、行为和药物干预的创造性组合为共病提供了最有效的治疗方法。由于药物治疗的局限性，对于严重的共病情况，如精神分裂症/大麻依赖共病，必须增加治疗强度。
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