Belen Arranz, Marina Garriga, Miquel Bernardo, Ana González-Pinto, Manuel Arrojo, Marta Torrens, Judith Tirado-Muñoz, Francina Fonseca, Pilar A Sáiz, Gerardo Flórez, Jose Manuel Goikolea, Iñaki Zorrilla, Ruth Cunill, Xavi Castells, Elisardo Becoña, Ana López, Luis San
{"title":"成人精神分裂症谱系障碍伴合并症药物使用的药理学和心理管理临床实践指南。","authors":"Belen Arranz, Marina Garriga, Miquel Bernardo, Ana González-Pinto, Manuel Arrojo, Marta Torrens, Judith Tirado-Muñoz, Francina Fonseca, Pilar A Sáiz, Gerardo Flórez, Jose Manuel Goikolea, Iñaki Zorrilla, Ruth Cunill, Xavi Castells, Elisardo Becoña, Ana López, Luis San","doi":"10.20882/adicciones.1504","DOIUrl":null,"url":null,"abstract":"<p><p>Although correct diagnosis and management of patients with schizophrenia and a comorbid substance use disorder (SUD) would determine a decrease in morbidity and mortality in these patients, development of efficient therapeutic strategies is still pending. We present recommendations on the pharmacological and psychological management of these patients following the 'PICO' structure (Patient-Intervention-Comparison-Outcomes). Evaluation of the quality of studies and summary of the evidence for each question was performed following the recommendations of the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) working group. Our results suggest: 1) In patients with schizophrenia and cannabis use disorder, it is not possible to recommend one antipsychotic drug over another (between olanzapine, risperidone or haloperidol) for improving psychotic symptoms, reducing cannabis use, or improving pragmatic variables (weak recommendation). Clozapine cannot be recommended to reduce cannabis use (weak recommendation). 2) In patients with schizophrenia and cocaine use disorder we recommend haloperidol over olanzapine to reduce craving (moderate recommendation), and olanzapine over haloperidol to improve motor side effects in these patients (moderate recommendation). 3) In patients with schizophrenia and alcohol use disorder while naltrexone is recommended to reduce alcohol use (in terms of reducing alcohol craving) (weak recommendation), there is insufficient evidence to make any recommendation on the use of adjuvant acamprosate (weak recommendation). 4) In patients with schizophrenia and nicotine use disorder, adjuvant bupropion and varenicline are recommended for reducing nicotine use and nicotine abstinence (strong/moderate recommendation). 5) In patients with schizophrenia and polydrug use disorder, second-generation over first-generation antipsychotic drugs and olanzapine over other second-generation antipsychotics are recommended to improve psychotic symptoms (moderate/weak recommendation).</p>","PeriodicalId":55560,"journal":{"name":"Adicciones","volume":"34 2","pages":"110-127"},"PeriodicalIF":2.2000,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"Clinical practice guideline on pharmacological and psychological management of adult patients with schizophrenia spectrum disorders and a comorbid substance use.\",\"authors\":\"Belen Arranz, Marina Garriga, Miquel Bernardo, Ana González-Pinto, Manuel Arrojo, Marta Torrens, Judith Tirado-Muñoz, Francina Fonseca, Pilar A Sáiz, Gerardo Flórez, Jose Manuel Goikolea, Iñaki Zorrilla, Ruth Cunill, Xavi Castells, Elisardo Becoña, Ana López, Luis San\",\"doi\":\"10.20882/adicciones.1504\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Although correct diagnosis and management of patients with schizophrenia and a comorbid substance use disorder (SUD) would determine a decrease in morbidity and mortality in these patients, development of efficient therapeutic strategies is still pending. 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Clozapine cannot be recommended to reduce cannabis use (weak recommendation). 2) In patients with schizophrenia and cocaine use disorder we recommend haloperidol over olanzapine to reduce craving (moderate recommendation), and olanzapine over haloperidol to improve motor side effects in these patients (moderate recommendation). 3) In patients with schizophrenia and alcohol use disorder while naltrexone is recommended to reduce alcohol use (in terms of reducing alcohol craving) (weak recommendation), there is insufficient evidence to make any recommendation on the use of adjuvant acamprosate (weak recommendation). 4) In patients with schizophrenia and nicotine use disorder, adjuvant bupropion and varenicline are recommended for reducing nicotine use and nicotine abstinence (strong/moderate recommendation). 5) In patients with schizophrenia and polydrug use disorder, second-generation over first-generation antipsychotic drugs and olanzapine over other second-generation antipsychotics are recommended to improve psychotic symptoms (moderate/weak recommendation).</p>\",\"PeriodicalId\":55560,\"journal\":{\"name\":\"Adicciones\",\"volume\":\"34 2\",\"pages\":\"110-127\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2022-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Adicciones\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.20882/adicciones.1504\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"SUBSTANCE ABUSE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Adicciones","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.20882/adicciones.1504","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SUBSTANCE ABUSE","Score":null,"Total":0}
Clinical practice guideline on pharmacological and psychological management of adult patients with schizophrenia spectrum disorders and a comorbid substance use.
Although correct diagnosis and management of patients with schizophrenia and a comorbid substance use disorder (SUD) would determine a decrease in morbidity and mortality in these patients, development of efficient therapeutic strategies is still pending. We present recommendations on the pharmacological and psychological management of these patients following the 'PICO' structure (Patient-Intervention-Comparison-Outcomes). Evaluation of the quality of studies and summary of the evidence for each question was performed following the recommendations of the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) working group. Our results suggest: 1) In patients with schizophrenia and cannabis use disorder, it is not possible to recommend one antipsychotic drug over another (between olanzapine, risperidone or haloperidol) for improving psychotic symptoms, reducing cannabis use, or improving pragmatic variables (weak recommendation). Clozapine cannot be recommended to reduce cannabis use (weak recommendation). 2) In patients with schizophrenia and cocaine use disorder we recommend haloperidol over olanzapine to reduce craving (moderate recommendation), and olanzapine over haloperidol to improve motor side effects in these patients (moderate recommendation). 3) In patients with schizophrenia and alcohol use disorder while naltrexone is recommended to reduce alcohol use (in terms of reducing alcohol craving) (weak recommendation), there is insufficient evidence to make any recommendation on the use of adjuvant acamprosate (weak recommendation). 4) In patients with schizophrenia and nicotine use disorder, adjuvant bupropion and varenicline are recommended for reducing nicotine use and nicotine abstinence (strong/moderate recommendation). 5) In patients with schizophrenia and polydrug use disorder, second-generation over first-generation antipsychotic drugs and olanzapine over other second-generation antipsychotics are recommended to improve psychotic symptoms (moderate/weak recommendation).
期刊介绍:
Adicciones publica artículos originales sobre el tratamiento, la prevención, estudios básicos y descriptivos en el campo de las adicciones, como son las drogas ilegales, el alcohol, el tabaco o cualquier otra adicción, procedentes de distintas disciplinas (medicina, psicología, investigación básica, investigación social, etc.). Todos los artículos son seleccionados después de pasar un proceso de revisión anónimo hecho por expertos en ese tema.