Price Scott A, Brahm Nancy C
Department of Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Tulsa, Oklahoma.
J Pediatr Pharmacol Ther. 2011 Oct;16(4):226-36. doi: 10.5863/1551-6776-16.4.226.
A diagnosis of schizophrenia requires development of a pharmacotherapy regimen that balances many factors in the therapeutic decision-making process. Patient age and the presence or absence of comorbid chemical dependency represent two factors. Comorbid chemical dependency can have a profound impact on the successful treatment of schizophrenia, making patients with dual diagnoses of schizophrenia and chemical dependence a uniquely challenging population. There is little information regarding treatment of schizophrenia and chemical dependence in the pediatric population. Existing data from pediatric and adult populations may facilitate a well-guided and knowledgeable approach to treating pediatric dual diagnosis patients.
A review of the literature for medication trials evaluating antipsychotic medication used to treat schizophrenia in childhood and adolescence as well as antipsychotic use in the treatment of the dual diagnoses of schizophrenia and chemical dependence was done. Databases for Ovid MEDLINE, PubMed, and PsycInfo were searched using the terms "addiction," "adolescence," "childhood," "dual diagnosis," "schizophrenia," and "substance abuse." Results were limited to English-language articles.
Seven articles were identified related to psychotic disorders and substance abuse in pediatric populations. Psychosis measurement instruments included the Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale, and Clinical Global Impression. Mean improvements were insignificant in most cases. Medication trials included clozapine, olanzapine, risperidone, and molindone. Trial safety concerns included metabolic effects, increased prolactin levels, and akathisia. One study with random assignment to olanzapine was discontinued early because of substantial weight gain without evidence of superior efficacy. Clozapine treatment was associated with more adverse drug events.
There is a great need for more research and use of available data to develop safe and effective treatment guidelines for childhood and adolescent dual diagnosis patients. When appropriate decisions are made regarding treatment of patients with comorbid schizophrenia and chemical dependence, both conditions may benefit with increased remission.
精神分裂症的诊断需要制定一种药物治疗方案，该方案要在治疗决策过程中平衡诸多因素。患者年龄以及是否存在共病的化学物质依赖是其中两个因素。共病的化学物质依赖会对精神分裂症的成功治疗产生深远影响，使得同时患有精神分裂症和化学物质依赖的患者成为极具挑战性的特殊群体。关于儿科人群中精神分裂症和化学物质依赖的治疗信息很少。来自儿科和成人人群的现有数据可能有助于采用精心指导且知识渊博的方法来治疗儿科双重诊断患者。
对评估用于治疗儿童和青少年精神分裂症的抗精神病药物以及用于治疗精神分裂症和化学物质依赖双重诊断的抗精神病药物使用情况的药物试验文献进行了综述。使用“成瘾”“青少年”“儿童”“双重诊断”“精神分裂症”和“药物滥用”等术语搜索了Ovid MEDLINE、PubMed和PsycInfo数据库。结果仅限于英文文章。
确定了7篇与儿科人群中的精神障碍和药物滥用相关的文章。精神病测量工具包括简明精神病评定量表、阳性和阴性症状量表以及临床总体印象量表。在大多数情况下，平均改善并不显著。药物试验包括氯氮平、奥氮平、利培酮和吗茚酮。试验的安全性问题包括代谢影响、催乳素水平升高和静坐不能。一项随机分配使用奥氮平的研究因体重显著增加且无疗效更佳的证据而提前终止。氯氮平治疗与更多药物不良事件相关。
非常需要开展更多研究并利用现有数据来制定针对儿童和青少年双重诊断患者的安全有效治疗指南。当对同时患有精神分裂症和化学物质依赖的患者做出适当的治疗决策时，两种病症都可能因缓解率提高而受益。
