Protocols of dual diagnosis intervention in schizophrenia

Objective: To review the existing literature on the psychopharmacological and psychotherapeutic treatment of patients with both schizophrenia and a substance use disorder (SUD). Methods: Selective review of the literature. PubMed search until November 2010. Results: Patients with psychotic disorders also frequently have SUDs. To attempt to explain their high coexistence there are different hypotheses, such as self-medication or the drug induction theories of chronic psychosis. Pathogenesis mechanisms are unknown. Patients may use substances to control or minimize symptoms such as hallucinations or anxiety, for the management of negative emotional states, to counteract negative symptoms and as a means of integration into a group. The diagnosis is complicated. It is important to correctly identify these patients because they have a more severe psychopathology, a more violent social behavior, and have more comorbidity with other medical diseases (such as human immunodeficiency virus or hepatitis C virus), which worsens the prognosis. The knowledge of the clinical characteristics and needs of these patients should enable suitable treatment programs to be developed. Conclusions: Substance abuse worsens the course and prognosis of schizophrenia and makes the psychopharmacological treatment and psychotherapeutic approach more difficult. Dual psychotics are characterized by low adherence to treatment and poor linkage to health facilities. Therefore, the integrated treatment model, in which the same therapeutic team jointly addresses schizophrenia and SUD, is offered as a therapeutic option of choice in managing these patients. Copyright © 2011 by Lippincott Williams & Wilkins.