Destoop Marianne, Docx Lise, Morrens Manuel, Dom Geert
Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, 2610 Antwerp, Belgium.
Multiversum, Provinciesteenweg 408, 2530 Boechout, Belgium.
J Clin Med. 2021 Feb 6;10(4):616. doi: 10.3390/jcm10040616.
Substance use disorders (SUD) are highly prevalent among psychotic patients and are associated with poorer clinical and functional outcomes. Effective interventions for this clinical population are scarce and challenging. Contingency management (CM) is one of the most evidence-based treatments for SUD's, however, a meta-analysis of the effect of CM in patients with a dual diagnosis of psychotic disorder and SUD has not been performed.
We searched PubMed and PsycINFO databases up to December 2020.
Five controlled trials involving 892 patients were included. CM is effective on abstinence rates, measured by the number of self-reported days of using after intervention (95% CI -0.98 to -0.06) and by the number of negative breath or urine samples after intervention (OR 2.13; 95% CI 0.97 to 4.69) and follow-up (OR 1.47; 95% CI 1.04 to 2.08).
Our meta-analysis shows a potential effect of CM on abstinence for patients with SUD and (severe) psychotic disorders, although the number of studies is limited. Additional longitudinal studies are needed to confirm the sustained effectivity of CM and give support for a larger clinical implementation of CM within services targeting these vulnerable co-morbid patients.
物质使用障碍（SUD）在精神病患者中高度普遍，且与较差的临床和功能结局相关。针对这一临床群体的有效干预措施稀缺且具有挑战性。应急管理（CM）是治疗SUD最具循证依据的方法之一，然而，尚未对CM在患有精神病性障碍和SUD双重诊断患者中的效果进行荟萃分析。
我们检索了截至2020年12月的PubMed和PsycINFO数据库。
纳入了五项涉及892名患者的对照试验。CM在戒断率方面有效，通过干预后自我报告的使用天数（95%CI -0.98至-0.06）以及干预后阴性呼气或尿液样本数量（OR 2.13；95%CI 0.97至4.69）和随访（OR 1.47；95%CI 1.04至2.08）来衡量。
我们的荟萃分析表明，尽管研究数量有限，但CM对患有SUD和（重度）精神病性障碍的患者在戒断方面有潜在效果。需要更多纵向研究来证实CM的持续有效性，并支持在针对这些脆弱的共病患者的服务中更大规模地临床应用CM。
