PHARMACOTHERAPY OF SCHIZOPHRENIA-PATIENTS WITH COMORBID SUBSTANCE-ABUSE

Substance abuse worsens the course of schizophrenia and significantly impairs the relationship between the patient and the health care team, Recent advances in laboratory studies of substance abuse and the phar macology of schizophrenia open up new possibilities for pharmacotherap y of substance abuse in schizophrenia patients, D-1 dopaminergic recep tor agonists may directly block the drive for stimulant use, D-2 dopam inergic receptor antagonists may indirectly block the drive for stimul ant and nicotine use,while opioid antagonists appear to reduce the dri ve to use alcohol, New generations of neuroleptics with serotonin (5-H T2) receptor antagonism and/or 5-HT1A agonist activity may reduce subs tance abuse in schizophrenia patients who self-medicate negative sympt oms or neuroleptic side effects, Pharmacotherapy efficacy may be enhan ced by adding contingency management, social skills training, and othe r manualized programs, Tables are provided of potentially useful medic ations, Preliminary results are presented of cocaine-abusing schizophr enia patients treated with desipramine and traditional neuroleptics.