Shorter Daryl, Hsieh John, Kosten Thomas R
Michael E. DeBakey V.A. Medical Center, Mental Health Care Line, Houston, Texas.
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.
Am J Addict. 2015 Dec;24(8):705-12. doi: 10.1111/ajad.12306. Epub 2015 Nov 20.
Post-traumatic Stress Disorder (PTSD) and substance use disorders (SUD) frequently co-occur, and their combination can increase poor health outcomes as well as mortality.
Using PUBMED and the list of references from key publications, this review article covered the epidemiology, neurobiology and pharmacotherapy of PTSD with comorbid alcohol, opiate, and cannabis use disorders. These SUD represent two with and one without FDA approved pharmacotherapies.
SUD is two to three times more likely among individuals with lifetime PTSD, and suicide, which is made more likely by both of these disorders, appears to be additively increased by having this comorbidity of SUD and PTSD. The shared neurobiological features of these two illnesses include amygdalar hyperactivity with hippocampal, medial prefrontal and anterior cingulate cortex dysfunction. Medications for comorbid PTSD and SUD include the PTSD treatment sertraline, often used in combination with anticonvulsants, antipsychotics, and adrenergic blockers. When PTSD is comorbid with alcohol use disorder (AUD), naltrexone, acamprosate or disulfiram may be combined with PTSD treatments. Disulfiram alone may treat both PTSD and AUD. For PTSD combined with opiate use disorder methadone or buprenorphine are most commonly used with sertraline. Marijuana use has been considered by some to be a treatment for PTSD, but no FDA treatment for this addiction is approved. Pregabalin and D-cycloserine are two innovations in pharmacotherapy for PTSD and SUD.
Comorbid PTSD and SUD amplifies their lethality and treatment complexity. Although they share important neurobiology, these patients uncommonly respond to a single pharmacotherapy such as sertraline or disulfiram and more typically require medication combinations and consideration of the specific type of SUD.
创伤后应激障碍（PTSD）与物质使用障碍（SUD）经常同时出现，二者并存会增加不良健康后果以及死亡率。
通过使用PUBMED以及关键出版物的参考文献列表，这篇综述文章涵盖了共病酒精、阿片类药物和大麻使用障碍的PTSD的流行病学、神经生物学和药物治疗。这些物质使用障碍中，两种有FDA批准的药物治疗，一种没有。
终生患有PTSD的个体出现物质使用障碍的可能性要高出两到三倍，而这两种障碍都会增加自杀可能性，PTSD与物质使用障碍并存似乎会使自杀可能性成倍增加。这两种疾病共有的神经生物学特征包括杏仁核过度活跃以及海马体、内侧前额叶和前扣带回皮质功能障碍。用于治疗PTSD与物质使用障碍共病的药物包括治疗PTSD的舍曲林，该药常与抗惊厥药、抗精神病药和肾上腺素能阻滞剂联合使用。当PTSD与酒精使用障碍（AUD）共病时，纳曲酮、阿坎酸或双硫仑可与PTSD治疗药物联合使用。单独使用双硫仑可能对PTSD和AUD都有效。对于PTSD合并阿片类药物使用障碍，美沙酮或丁丙诺啡最常与舍曲林联合使用。一些人认为使用大麻是治疗PTSD的一种方法，但FDA尚未批准针对这种成瘾的治疗方法。普瑞巴林和D - 环丝氨酸是PTSD和物质使用障碍药物治疗方面的两项创新。
PTSD与物质使用障碍共病会增加其致死率和治疗复杂性。尽管它们有重要的共同神经生物学特征，但这些患者很少对单一药物治疗（如舍曲林或双硫仑）有反应，通常更需要联合用药，并考虑物质使用障碍的具体类型。
