Moggi Franz
1 Universitätsklinik für Psychiatrie und Psychotherapie, Universität Bern.
Ther Umsch. 2018 Jun;75(1):37-43. doi: 10.1024/0040-5930/a000964.
Epidemiology, etiology and treatment of patients with psychosis and co-morbid substance use disorder Abstract. More than 25 years ago, when the research on the efficacy of treatments for patients with a comorbidity of psychosis and substance use disorder has been systematically started, some authors described the treatment of these patients as a "mission impossible". Approximately half of all individuals with schizophrenia develop substance use disorders in the course of their life; about one third of them a comorbid alcohol use disorder and about one quarter a comorbid substance use disorder with other addictive substances. There is no universally valid aetiology model to explain the relationship between psychosis and addiction. Contrary to expectations, the self-medication model was not empirically confirmed, while the psychological affect regulation model, the vulnerability-stress model of a specific sensitivity to addictive substances given a predisposition of psychosis, or the neurobiological common factor model of a dysfunction of dopamine regulation in the mesocorticolimbic reward system that predispose to primary substance use disorder found some empirical support. Research on the psychosocial-psychotherapeutic and pharmacological treatment of patients with psychosis and addiction are so heterogeneous in terms of characteristics of patients, disorders, treatments, settings and outcomes that hardly two comparable studies can be found. Thus, it is hardly possible to make scientifically based statements on the efficacy and effectiveness of therapies. Integrative treatment programs are promising, which combine psycho- and pharmacotherapeutic interventions for the treatment of psychotic and substance use disorders in a coherent manner and which can be flexibly adapted to the individual patient's needs. Such treatments are carried out at the same time, in the same setting and by the same treatment providers and practioners. Successful integrative treatment programs usually include motivational interventions, cognitive-behavioral interventions specific to schizophrenia and addiction, interventions that may reduce the substance use such as relapse prevention, contingency management and / or family interventions. These interventions are best combined with second-generation antipsychotics, if necessary with medication to reduce substance use. Although no "mission impossible" treating patients with psychosis and addiction remains a complex challenge for research and practice.
精神病与共病物质使用障碍患者的流行病学、病因及治疗 摘要。25多年前，当对精神病与物质使用障碍共病患者的治疗效果研究系统开展时，一些作者将这些患者的治疗描述为“不可能完成的任务”。在所有精神分裂症患者中，约有一半在其一生中会出现物质使用障碍；其中约三分之一共病酒精使用障碍，约四分之一共病使用其他成瘾物质的物质使用障碍。目前尚无普遍适用的病因模型来解释精神病与成瘾之间的关系。与预期相反，自我用药模型未得到实证证实，而心理情感调节模型、在精神病易感性基础上对成瘾物质具有特定敏感性的脆弱性-应激模型，或中脑皮质边缘奖赏系统多巴胺调节功能障碍导致原发性物质使用障碍的神经生物学共同因素模型得到了一些实证支持。关于精神病与成瘾患者的心理社会-心理治疗及药物治疗的研究，在患者特征、疾病、治疗、环境和结果方面差异极大，几乎找不到两项可比的研究。因此，很难就治疗的疗效和有效性做出基于科学的陈述。综合治疗方案很有前景，它将心理和药物治疗干预以连贯的方式结合起来，用于治疗精神病和物质使用障碍，并且可以灵活地根据个体患者的需求进行调整。此类治疗由相同的治疗提供者和从业者在同一环境中同时进行。成功的综合治疗方案通常包括动机干预、针对精神分裂症和成瘾的认知行为干预、可能减少物质使用的干预措施，如预防复发、权变管理和/或家庭干预。这些干预措施最好与第二代抗精神病药物联合使用，必要时可使用减少物质使用的药物。虽然治疗精神病与成瘾患者并非“不可能完成的任务”，但对研究和实践而言仍是一项复杂的挑战。
