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精神分裂症并发物质使用障碍：流行病学、发病机制、临床表现和诊断

Authors
E Cabrina Campbell, MD
Stanley N Caroff, MD
Stephan C Mann, MD, DLFAPA
Section Editors
Andrew J Saxon, MD
Stephen Marder, MD
Deputy Editor
Richard Hermann, MD
Translators
段艳平, 住院医师

引言

精神分裂症和成瘾都是慢性疾病，伴有严重并发症和结局，以及给个人和社会造成经济负担。两种疾病都会导致治疗依从性较差，且当两者同时存在时，结局更差。

精神分裂症的一些症状与酒精或其他药物的中毒、长期使用和戒断症状相重叠。家族史和症状的时间关系能有助于区别仅有物质使用障碍(substance use disorder, SUD)的患者和精神分裂症并发SUD的患者。

《精神疾病诊断与统计手册》第4版修订版(the Diagnostic and Statistical Manual of Mental Disorders Ⅳ-text revision, DSM-Ⅳ-TR)中的精神病学诊断(物质滥用和物质依赖)，已经被DSM-5中的单一诊断(SUD)所取代[1]。尽管DSM-Ⅳ和DSM-5界定的疾病并不完全对应，但物质依赖大约相当于SUD的中度至重度亚型，而物质滥用与SUD的轻度亚型相似。

精神分裂症和SUD的流行病学、发病机制、临床表现、病程、评估和诊断将在此介绍。精神分裂症并发SUD患者的治疗将单独介绍。单发精神分裂症和单发SUD患者的流行病学、发病机制、临床表现、病程、评估、诊断和治疗也将单独讨论。 (参见“精神分裂症并发物质使用障碍的治疗”和“精神分裂症：流行病学与发病机制”和“精神分裂症的药物治疗：急性期与维持期治疗”和“精神分裂症：临床表现、病程、评估及诊断”和“精神分裂症药物治疗：副作用的处理”和“精神分裂症的心理社会干预”和“阿片类物质使用障碍：流行病学、药理学、临床表现、病程、筛查、评估和诊断”和“大麻使用障碍：临床特征及诊断”和“酒精使用障碍：流行病学、发病机制、临床表现、不良后果和诊断”和“成人可卡因使用障碍：流行病学、药理学、临床表现、医疗后果和诊断”)

流行病学

在美国，精神分裂症患者出现DSM-Ⅳ-TR中物质滥用和物质依赖的终生患病率范围估计为47%-59%，相比而言，一般人群的患病率为16%[2,3]。高共病率也见于国际范围内(例如，在澳大利亚、瑞士、意大利、德国及英格兰)[4]。存在这些共病的许多患者使用两种或以上成瘾物质。 (参见“精神分裂症：流行病学与发病机制”)

             

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Literature review current through: 2017-06 . | This topic last updated: 2016-03-29.
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