Sección de Adicciones y Patología Dual. Servicio de Psiquiatría. Hospital Universitario Vall Hebron. Universitat Autònoma de Barcelona. CIBERSAM. Barcelona (Spain).
Servicio Salud Mental Retiro. Hospital Universitario Gregorio Marañón. Madrid (Spain).
Actas Esp Psiquiatr. 2020 May;48(3):99-105. Epub 2020 May 1.
Patients with psychotic disorders often have substance use disorders and other addictions. The objective of this study was to know the current treatment situation of these patients focusing on clozapine, which was proposed in most consensus as antipsychotic of first choice in this indication.
A survey with 14 questions on aspects related to the treatment and management of the dual disorders was developed, emphasizing the role of clozapine in this disease.
The survey was answered by 199 experts in mental illnesses (90.5% physicians and 9.5% psychologists). A total of 88.4% of experts were able to prescribe clozapine, but the majority (89.4%) administered the drug to patients with resistant schizophrenia without considering a dual disorder. Only 30.8% considered the use of clozapine in patients with dual psychosis. The underutilization of clozapine in these patients was mainly attributed to controls of the pharmacovigilance plan, including frequent leukocyte count (57.1%), and lack of drug education (35.6%). The main measures proposed to increase its use are fewer blood tests (29.3%), more training (27.8%), and fewer administrative problems (25.1%).
In order to improve the treatment of patients with dual psychosis, it is necessary to simplify the therapy and increase the training of professionals in the use of atypical antipsychotics, especially clozapine, designed to be the drug of choice in the main expert consensus.
患有精神病的患者通常有物质使用障碍和其他成瘾问题。本研究的目的是了解这些患者的当前治疗情况，重点是氯氮平，在大多数共识中，它被提议作为该适应证的首选抗精神病药。
我们制定了一项调查，其中包含 14 个与双相障碍治疗和管理相关的问题，强调氯氮平在这种疾病中的作用。
共有 199 名精神疾病专家（90.5%为医生，9.5%为心理学家）回答了这项调查。共有 88.4%的专家能够开氯氮平，但大多数（89.4%）将该药用于治疗耐药性精神分裂症患者，而不考虑双相障碍。只有 30.8%的专家认为在双相精神病患者中使用氯氮平。这些患者中氯氮平的使用率低主要归因于药物警戒计划的控制，包括频繁的白细胞计数（57.1%）和缺乏药物教育（35.6%）。为了提高这些患者的氯氮平使用率，建议采取以下措施：减少化验次数（29.3%）、增加培训（27.8%）和减少行政问题（25.1%）。
为了改善双相精神病患者的治疗，有必要简化治疗方案，增加专业人员使用非典型抗精神病药（特别是氯氮平）的培训，这是主要专家共识中推荐的首选药物。
