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Adicción y esquizofrenia
Published online by Cambridge University Press: 12 May 2020
Resumen
Estudios epidemiológicos en la población general y estudios basados en la evaluación clínica de poblaciones esquizofrénicas han revelado un alto grado de solapamiento entre la esquizofrenia y los trastornos adictivos. El abuso de sustancias psicoactivas (incluido el alcohol) a lo largo de la vida es tan frecuente (50%) que la posibilidad de un vínculo específico surge inevitablemente. Se han propuesto diversas hipótesis para explicar la elevada comorbilidad entre la esquizofrenia y la adicción: 1) Se ha desarrollado la hipótesis social-ambiental, pero los estudios han proporcionado datos escasos para validarla. 2) La posible vulnerabilidad biológica compartida entre la esquizofrenia y las adicciones llevó a los investigadores a explorar los determinantes genéticos comunes y a estudiar la implicación de los sistemas dopaminérgico y opioide en la etiología tanto de la esquizofrenia como del abuso y la dependencia de drogas psicoactivas. 3) Por último, la teoría de la automedicación propone que los esquizofrénicos pueden intentar contrarrestar el déficit asociado a sus trastornos’ utilizando las sustancias que toman o su conducta de tipo dependiente para afrontar sus problemas emocionales. El perfil clínico de los adictos esquizofrénicos parece mostrar algunos rasgos distintivos, como el alto nivel de comorbilidad depresiva y una dependencia muy alta de la nicotina y el alcohol, con un pronóstico muy malo. Estos pacientes son difíciles de manejar; la posibilidad de interacciones farmacológicas entre las sustancias que toman y la medicación neuroléptica requiere prudencia, y su cumplimiento también es malo. Los trastornos adictivos en esquizofrénicos son en la actualidad un tema de investigación activa del que se pretende que conduzca a identificar tratamientos específicos. La identificación temprana de trastornos adictivos en los esquizofrénicos debería hacer posible limitar su desarrollo y mejorar el pronóstico.
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