Department of Neuropsychology, Institute of Cognitive Neuroscience, Ruhr-University Bochum, Bochum, Germany.
Psychiatry Clin Neurosci. 2013 Sep;67(6):367-83. doi: 10.1111/pcn.12072. Epub 2013 Jul 25.
Although individuals with schizophrenia show a lifetime prevalence of 50% for suffering from a comorbid substance use disorder, substance abuse usually represents an exclusion criterion for studies on schizophrenia. This implies that surprisingly little is known about a large group of patients who are particularly difficult to treat. The aim of the present work is to provide a brief and non-exhaustive overview of the current knowledgebase about neurobiological and cognitive underpinnings for dual diagnosis schizophrenia patients. Studies published within the last 20 years were considered using computerized search engines. The focus was on nicotine, caffeine, alcohol, cannabis and cocaine being among the most common substances of abuse. All drugs of abuse target dopaminergic, glutamatergic and GABAergic transmission which are also involved in the pathophysiology of schizophrenia. Current literature suggests that neurocognitive function might beless disrupted in substance-abusing compared to non-abusing schizophrenia patients, but in particular the neuroimaging database on this topic is sparse. Detrimental effects on brain structure and function were shown for patients for whom alcohol is the main substance of abuse. It is as yet unclear whether this finding might be an artifact of age differences of patient subgroups with different substance abuse patterns. More research is warranted on the specific neurocognitive underpinnings of schizophrenia patients abusing distinct psychoactive substances. Treatment programs might either benefit from preserved cognitive function as a resource or specifically target cognitive impairment in different subgroups of addicted schizophrenia patients.
尽管精神分裂症患者一生中出现共病物质使用障碍的患病率为 50%，但物质滥用通常是精神分裂症研究的排除标准。这意味着，对于那些特别难以治疗的大量患者，人们知之甚少。本研究旨在简要而全面地概述目前关于精神分裂症共病患者的神经生物学和认知基础的知识基础。使用计算机搜索引擎考虑了过去 20 年内发表的研究。重点是尼古丁、咖啡因、酒精、大麻和可卡因，它们是最常见的滥用物质之一。所有滥用药物都针对多巴胺能、谷氨酸能和 GABA 能传递，这些传递也与精神分裂症的病理生理学有关。目前的文献表明，与非滥用精神分裂症患者相比，物质滥用患者的神经认知功能可能较少受到干扰，但特别是关于这一主题的神经影像学数据库非常匮乏。对于主要滥用酒精的患者，其大脑结构和功能受到损害。目前尚不清楚这一发现是否是不同物质滥用模式的患者亚组因年龄差异而导致的人为因素。需要对滥用不同精神活性物质的精神分裂症患者的特定神经认知基础进行更多研究。治疗方案可能受益于认知功能作为资源的保留，或者针对不同亚组的成瘾精神分裂症患者的认知障碍进行具体靶向治疗。
