Soyka M
Psychiatrische Klinik, Universität München.
Fortschr Neurol Psychiatr. 1994 Mar;62(3):71-87. doi: 10.1055/s-2007-996658.
The scientific discussion on the interrelationship of "alcoholism and psychosis" has been dominated by nosological problems for years. Alcohol hallucinosis, a comparatively rare psychosis in chronic alcoholism, can mimic the symptomatology of paranoid schizophrenia. The clinical features (vivid acoustic hallucinations and fear) are often inconclusive, as, unlike other organic psychoses, alcohol hallucinosis does not entail clouding of sensorium and disorientation. On the one hand follow-up studies suggest that alcohol hallucinosis in some cases can take a chronic schizophrenia-like course. Especially in these cases differential diagnosis between both conditions can be difficult. On the other hand a number of recent clinical studies suggest high prevalence rates for substance and esp. alcohol abuse and dependence in schizophrenics. Different approaches account for limitations in comparing the results. In most of the studies prevalence estimates for alcohol abuse and dependence range from 12-43%. In some highly selected clinical populations even higher prevalence estimates have been reported. Epidemiological studies such as the "Epidemiological Catchment Area Study" equally are in support of an appr. 4-fold increased risk for alcoholism in schizophrenics. Schizophrenics with alcohol abuse differ from non-abusing schizophrenics in a variety of clinical symptoms and features. With respect to psychopathological symptomatology schizophrenics with an additional alcohol abuse or dependence show more "positive", psychotic and less "negative" symptoms. Some findings suggest that in comparison with other schizophrenics, dual diagnosis schizophrenics may be superior in terms of a better premorbid functioning. However, during course of illness higher (re-) hospitalization rates and higher rates of suicide attempts have been reported; likewise, aggressivity and delinquency have been encountered. In this review clinical and diagnostic questions concerning the interrelationship between alcoholism and schizophrenic psychosis are discussed and some principles of psychopharmacotherapy in dual diagnosis schizophrenics are outlined.
多年来，关于“酒精中毒与精神病”相互关系的科学讨论一直受疾病分类学问题主导。酒精性幻觉症是慢性酒精中毒中一种相对罕见的精神病，可模仿偏执型精神分裂症的症状学。其临床特征（生动的幻听和恐惧）往往不具决定性，因为与其他器质性精神病不同，酒精性幻觉症不会导致意识模糊和定向障碍。一方面，随访研究表明，酒精性幻觉症在某些情况下可能呈现慢性精神分裂症样病程。尤其是在这些病例中，两种病症的鉴别诊断可能很困难。另一方面，近期的一些临床研究表明，精神分裂症患者中物质尤其是酒精滥用和依赖的患病率很高。不同的研究方法导致结果比较存在局限性。在大多数研究中，酒精滥用和依赖的患病率估计在12%至43%之间。在一些经过高度挑选的临床人群中，甚至报告了更高的患病率估计值。诸如“流行病学集水区研究”这样的流行病学研究同样支持精神分裂症患者患酒精中毒的风险大约增加4倍。有酒精滥用问题的精神分裂症患者在各种临床症状和特征上与无酒精滥用问题的精神分裂症患者不同。在精神病理症状学方面，同时存在酒精滥用或依赖的精神分裂症患者表现出更多“阳性”、精神病性症状，而“阴性”症状较少。一些研究结果表明，与其他精神分裂症患者相比，双重诊断的精神分裂症患者在病前功能较好方面可能更具优势。然而，在病程中，报告显示其（再）住院率较高且自杀未遂率较高；同样，也存在攻击性和犯罪行为。在本综述中，讨论了关于酒精中毒与精神分裂症性精神病之间相互关系的临床和诊断问题，并概述了双重诊断精神分裂症患者的一些心理药物治疗原则。
