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首页> 外文期刊>The journal of clinical psychiatry >Treatment of schizophrenia and comorbid substance abuse: pharmacologic approaches.
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Treatment of schizophrenia and comorbid substance abuse: pharmacologic approaches.

机译：精神分裂症和合并症的治疗：药理学方法。

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Co-occurring substance use disorder is common among patients with schizophrenia, and its presence greatly worsens the course of schizophrenia. A number of theories have been introduced to explain the increased rate of substance use disorder in these patients. These theories include the notion that substance use could trigger psychotic symptoms in vulnerable individuals and the idea that the substances are used to self-medicate symptoms of schizophrenia. Our group and others have advanced a neurobiological hypothesis to explain this comorbidity-that a mesocorticolimbic brain reward circuit underlies the substance use disorder in patients with schizophrenia. Treatment of substance use disorder in these patients is best done with integrated treatment programs that combine psychosocial interventions with pharmacotherapy. Recent data suggest that the atypical antipsychotic clozapine and perhaps other atypical agents may lessen substance use in patients with schizophrenia. My colleagues and I have proposed that clozapine's effect in these patients may be related to its ability to decrease the brain reward circuit dysfunction. Research is continuing on the use of atypical antipsychotics in patients with schizophrenia and comorbid substance abuse. The adjunctive use of naltrexone or other agents also may be helpful. Further research on the optimal pharmacologic approach to patients with dual diagnosis is needed.
机译：并发物质使用障碍在精神分裂症患者中很常见，并且它的存在大大加剧了精神分裂症的病程。引入了许多理论来解释这些患者中药物使用障碍的发生率增加。这些理论包括以下概念：滥用毒品可能会在易受伤害的个人中引发精神病性症状;以及滥用毒品用于自我治疗精神分裂症症状的想法。我们的小组和其他小组提出了一种神经生物学的假说来解释这种合并症-精神分裂症患者的中药皮质醇溶性大脑奖励回路是物质使用障碍的基础。在这些患者中，药物滥用的治疗最好是将心理社会干预措施与药物治疗相结合的综合治疗方案来完成。最新数据表明，非典型抗精神病药物氯氮平和其他非典型药物可能会减少精神分裂症患者的药物使用。我和我的同事已经提出，氯氮平对这些患者的作用可能与其降低大脑奖赏回路功能障碍的能力有关。精神分裂症和合并症药物滥用患者使用非典型抗精神病药的研究仍在继续。纳曲酮或其他药物的辅助使用也可能会有帮助。需要对双重诊断患者的最佳药理方法进行进一步研究。

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