Department of Veterans Affairs (VA) Boston Healthcare System, Brockton Division.
Harvard South Shore Psychiatry Residency Program, Brockton.
Curr Opin Psychiatry. 2020 May;33(3):219-224. doi: 10.1097/YCO.0000000000000593.
To summarize the current literature regarding comorbid schizophrenia and opioid use disorder (OUD).
Epidemiological evidence is unclear on whether patients with schizophrenia have a higher rate of OUD. Patients with OUD have been shown to have a higher risk of developing schizophrenia. However, it is clear that patients with both schizophrenia and OUD are less likely to receive standard of care including medication-assisted treatment (MAT) for opiate use disorder and have worse outcomes compared with patients with schizophrenia who do not abuse opioids. OUD significantly increases the risk of converting patients from prodromal schizophrenia states to schizophrenia or schizoaffective disorder. Shared pathophysiology involving the kappa opioid receptor may help explain the relationships between schizophrenia and OUD. Second-generation antipsychotics, long-acting injectables, and MAT for OUD should be utilized in a dual-diagnosis and treatment approach for patients with schizophrenia and OUD.
Exploration into the relationship between schizophrenia and opiate abuse is still in its infancy and requires a significant amount of future attention to clarify the epidemiology of this comorbidity, neurobiological relationship, shared genetic underpinnings, and possible treatments for both the psychotic symptoms and substance abuse.
总结目前关于精神分裂症合并阿片类使用障碍（OUD）的文献。
关于精神分裂症患者是否有更高的 OUD 发生率，流行病学证据尚不清楚。患有 OUD 的患者患精神分裂症的风险更高。然而，很明显，患有精神分裂症和 OUD 的患者接受包括阿片类药物使用障碍的药物辅助治疗（MAT）在内的标准治疗的可能性较低，并且与未滥用阿片类药物的精神分裂症患者相比，预后更差。OUD 显著增加了患者从前驱期精神分裂症状态转变为精神分裂症或分裂情感障碍的风险。涉及κ阿片受体的共同病理生理学可能有助于解释精神分裂症和 OUD 之间的关系。第二代抗精神病药、长效注射剂和 OUD 的 MAT 应在精神分裂症和 OUD 患者的双重诊断和治疗方法中使用。
探索精神分裂症和阿片类药物滥用之间的关系仍处于起步阶段，需要大量未来的关注来阐明这种合并症的流行病学、神经生物学关系、共同的遗传基础，以及对精神病症状和物质滥用的可能治疗方法。
