Substance Use Disorder Comorbidity in Schizophrenia

Abstract

Use of alcohol and other substances are commonly observed among patients with a diagnosis of schizophrenia. Despite this common comorbidity, there have been very few studies which do not take alcohol/substance use as an exclusion criterion. Thus we have very limited data on this specific area. A number of theories have been developed to explain these high comorbidity rates. Typical antipsychotic medications decreases alcohol or substance use in general, but this is valid only for a limited extend in patients with schizophrenia. On the other hand atypical antipsychotics, particularly clozapine plays an active role in that respect. Recently, we can see lots of new adjunctive medications formulated for the treatment of alcoholism, but only one of them (naltrexone) has thus far been carefully studied and tested in relation with these patients with schizophrenia. It is not reasonable to consider that pharmacological approaches may alone provide us with optimal results in these patients. Ultimately, it should be intended to have a well-balanced psychosocial treatment programs including also psychotherapetical inputs.

Keywords

• Schizophrenia, alcohol-substance use disorder, dual diagnosis.

Şizofrenide Madde Kullanım Bozuklukları Eş Tanısı

Öz

Şizofreni tanısı alan hastalarda alkol ve madde kullanımı yaygındır. Şizofrenide alkol madde kullanım bozuklukları sıklığı yüksek olmasına rağmen yapılan tüm çalışmalarda madde kullanım ektanısının dışlanması bu alandaki verilerin çok kısıtlı olmasına yol açmıştır. Yüksek eştanılılığın açıklanmasında pek çok teori öne atılmıştır. Tipik antipsikotik ilaçların şizofreni tanılı hastalarda alkol ve madde kullanımına etkileri sınırlıdır. Atipik antipsikotik ilaçların özellikle klozapin kullanımının etkinliği gösterilmiştir. Literatüre baktığımızda, alkol kötüye kullanımı tedavisinde pek çok yeni ajan ortaya çıkmışsa da, sadece bir tanesinin (naltrekson) şizofreni tanılı hastalarda kullanımına dair çalışmalar mevcuttur. Bu hasta populasyonunda, farmakolojik yaklaşımların tek başına en uygun fayda getireceğini düşünmek doğru bir yaklaşım olmaz. Psikoterapinin de içerisinde bulunduğu, iyi koordine edilmiş bir tedavi planı mutlak hedef olmalıdır.

Anahtar Kelimeler

• Şizofreni, alkol-madde kullanım bozukluğu, eştanılılık

Kaynakça

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