psychiatryПСИХИАТРИЯPsychiatry (Moscow) (Psikhiatriya)1683-83192618-6667FSBSI “The Mental Health Research Centre”; LLC «Publisher «MIA»10.30629/2618-6667-2025-23-2-110-121psychiatry-1352Research ArticleНАУЧНЫЕ ОБЗОРЫSCIENTIFIC REVIEWSВозможности рациональной терапии антипсихотиками пациентов с шизофренией и коморбидной зависимостью от психоактивных веществThe Possibilities of Rational Antipsychotic Therapy in Patients with Schizophrenia and Comorbid Substance Dependencehttps://orcid.org/0000-0001-7148-4485АсадуллинА. Р.AsadullinA. R.

Азат Раилевич Асадуллин, доктор медицинских наук, доцент, профессор кафедры психиатрии, наркологии и психотерапии

Уфа

Azat R. Asadullin, Dr. Sci. (Med.), Docent, Professor, Department of Psychiatry, Narcology and Psychotherapy, Bashkir State Medical University

Ufa

droar@yandex.ruhttps://orcid.org/0000-0003-4516-3324ГасенкоК. А.GasenkoK. A.

Ксения Александровна Гасенко, врач-психиатр, заведующая отделением психосоциальной реабилитации №24

Омск

Kseniia A. Gasenko, psychiatrist, Head of 24th psychosocial rehabilitation unit

Omsk

ksenia.gasenko@yandex.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Башкирский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияBashkir State Medical UniversityRussian FederationБУЗОО «КПБ им. Н.Н. Солодникова»РоссияOmsk Regional Psychiatric Hospital named after N.N. SolodnikovRussian Federation202522062025232110121Copyright © Асадуллин А.Р., Гасенко К.А., 20252025Асадуллин А.Р., Гасенко К.А.Asadullin A.R., Gasenko K.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.journalpsychiatry.com/jour/article/view/1352

Обоснование: злоупотребление психоактивными веществами (ПАВ) широко распространено среди пациентов, страдающих шизофренией. Выбор тактики лечения пациента с двойным диагнозом представляет значительные трудности для клинициста за счет особенностей взаимовлияния двух заболеваний, худшей переносимости психофармакотерапии, низкого комплаенса. Цель исследования: проанализировать данные литературы, посвященной патогенезу развития коморбидных расстройств вследствие употребления ПАВ у пациентов, страдающих шизофренией, и современным стратегиям их лечения антипсихотиками с кратким обзором механизмов сочетанного действия препаратов. Материалы и методы: по ключевым сло вам «шизофрения», «зависимость от алкоголя», «коморбидность» «антипсихотическая терапия», “schizophrenia”, “alcohol use disorder”, “SUD”, “comorbidity”, “antipsychotic drugs” проведен поиск научных публикаций в базах Google Scholar, ELibrary.ru, Scopus, PubMed и составлен нарративный обзор литературы. Заключение: существуют различные теории, призванные объяснить механизм формирования коморбидной зависимости у пациентов, страдающих шизофренией. Современные исследования предполагают нейробиологическую общность этих расстройств, что и определяет терапевтическую стратегию в отношении данной группы больных. Анализ научных публикаций позволяет сделать вывод о перспективности применения эффективности антипсихотиков 3-го поколения в лечении коморбидных расстройств, что может стать объектом дальнейших клинических исследований.

Background: substance abuse disorder is widespread among schizophrenic patients. The choice of treatment strategy for a patient with a dual diagnosis presents significant difficulties for the clinician due to the peculiarities of the mutual influence of the two diseases, worse tolerance of psychopharmacotherapy, and low compliance. The aim of review was to analyze the scientific publications on the pathogenesis of comorbid substance use disorders in schizophrenic patients and current strategies of their treatment with antipsychotics considering drug interactions. Materials and Methods: a narrative review of scientific publications was compiled using available sources in the literature, including a search using combinations of keywords «шизофрения», «зависимость от алкоголя», «коморбидность» «антипсихотическая терапия», “schizophrenia”, “alcohol use disorder”, “SUD”, “comorbidity”, “antipsychotic drugs” in Google Scholar, ELibrary.ru, Scopus, PubMed databases. Conclusion: there are various theories designed to explain the mechanism of comorbid addiction formation in patients suffering from schizophrenia. One way or another at present, the common neurobiological basis of these disorders is no doubt, that determines the therapeutic strategy for this group of patients. The available publications shows promising prospects for the effectiveness of 3rd generation antipsychotics in the treatment of comorbid disorders, but further researches are needed.

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The authors declare that there are no conflicts of interest present.