Coles Alexandria S, Knezevic Dunja, George Tony P, Correll Christoph U, Kane John M, Castle David
Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto, ON, Canada.
Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Front Psychiatry. 2021 Dec 15;12:808002. doi: 10.3389/fpsyt.2021.808002. eCollection 2021.
Co-occurring substance use disorders (SUDs) among individuals with schizophrenia are a prevalent and complex psychiatric comorbidity, which is associated with increased symptom severity, worsened illness trajectory and high rates of treatment non-adherence. Recent evidence suggests that the use of long-acting injectable (LAI) antipsychotics may provide an effective treatment option for individuals with this dual-diagnosis. A systematic review of the literature was conducted using the databases PubMed, PsychInfo and Google Scholar for English-language studies, investigating the use of LAIs in co-occurring schizophrenia and substance use disorders (SCZ-SUDs). Eight reports [one case study ( = 1), one case series ( = 8), three open-label retrospective studies ( = 75), and three randomized controlled trials ( = 273)] investigated the use of LAI antipsychotics in 357 participants with SCZ-SUDs [alcohol use disorder: 5 studies, = 282; cocaine use disorder: 5 studies, = 85; amphetamine use disorder: 1 study, = 1; cannabis use disorder: 3 studies, = 160; opioid use disorder: 3 studies, = 19; methylenedioxymethamphetamine (MDMA) use disorder: 2 studies, = 9; ketamine use disorder: 1 study, = 4] and were included in this systematic review. Findings indicate significant improvements in substance use related outcomes across 7 of 8 studies, while in 6 of 8 studies, significant improvements in psychopathology-related outcomes were reported. LAI antipsychotics may be an efficacious intervention option for the treatment of SCZ-SUDs. However, varying methodological rigor, generally small sample sizes and heterogeneity of samples, settings, substances of abuse, tested LAIs and comparators, as well as psychosocial cotreatments and level of reported detail across studies requires that these findings be considered preliminary and interpreted with caution. Further research is required to better understand the effects of LAIs among individuals with SCZ-SUDs.
精神分裂症患者中同时存在物质使用障碍（SUDs）是一种普遍且复杂的精神科共病，与症状严重程度增加、疾病轨迹恶化以及高治疗不依从率相关。最近的证据表明，使用长效注射（LAI）抗精神病药物可能为患有这种双重诊断的个体提供一种有效的治疗选择。我们使用PubMed、PsychInfo和谷歌学术数据库对英文研究进行了系统文献综述，调查LAI在精神分裂症和物质使用障碍（SCZ-SUDs）共病中的应用。八项报告[一项病例研究（n = 1）、一项病例系列研究（n = 8）、三项开放标签回顾性研究（n = 75）和三项随机对照试验（n = 273）]调查了357名患有SCZ-SUDs的参与者使用LAI抗精神病药物的情况[酒精使用障碍：5项研究，n = 282；可卡因使用障碍：5项研究，n = 85；苯丙胺使用障碍：1项研究，n = 1；大麻使用障碍：3项研究，n = 160；阿片类物质使用障碍：3项研究，n = 19；亚甲基二氧甲基苯丙胺（摇头丸）使用障碍：2项研究，n = 9；氯胺酮使用障碍：一项研究，n = 4]，并纳入了本系统综述。研究结果表明，八项研究中的七项在物质使用相关结局方面有显著改善，而八项研究中的六项报告了精神病理学相关结局有显著改善。LAI抗精神病药物可能是治疗SCZ-SUDs的一种有效干预选择。然而，研究方法的严谨性各不相同，样本量通常较小，样本、环境、滥用物质、测试的LAI和对照以及心理社会联合治疗存在异质性，以及各研究报告细节的水平，这些都要求将这些结果视为初步结果并谨慎解读。需要进一步研究以更好地了解LAI在患有SCZ-SUDs的个体中的作用。
