Schizophrenia and Comorbid Substance Use Disorder: Effects of Antipsychotics
J Clin Psychiatry 2005;66(suppl 6):21-26
© Copyright 2014 Physicians Postgraduate Press, Inc.
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The rate of comorbid substance use disorder in patients with schizophrenia is 3 times higher than
that in the general population. Men with schizophrenia appear to be particularly vulnerable to substance
use disorders. Substances commonly abused in patients with schizophrenia include alcohol,
cannabis, and cocaine. Although the basis of comorbidity is unclear, a number of theories have been
proposed, including the possibility of a deficiency in the dopamine-mediated mesocorticolimbic brain
reward circuit. Data suggest that substance abuse may complicate and worsen the course of schizophrenia.
Early intervention with appropriate pharmacotherapy may prove beneficial and potentially
improve the long-term course of the disorder. Conventional antipsychotics have not been overly useful
in this patient population, but some atypical antipsychotics have been shown to reduce the use of
alcohol, cannabis, cocaine, and tobacco in patients with schizophrenia. Further research is required,
but early evidence suggests that at least some atypical antipsychotics may prove to be therapeutically
effective in the treatment of patients with schizophrenia and comorbid substance use disorder.