Guía de práctica clínica para el tratamiento farmacológico y psicológico de los pacientes adultos con un trastorno del espectro esquizofrénico y un diagnóstico comórbido de trastorno por uso de sustancias

Autores/as

  • Belen Arranz CIBERSAM. Universitat de Barcelona
  • Marina Garriga Hospital Clínic. Universitat de Barcelona
  • Miquel Bernardo Hospital Clínic. Universitat de Barcelona
  • Ana Gonzalez-Pinto Hospital Universitario. CIBERSAM
  • Manuel Arrojo EOXI
  • Marta Torrens INAD
  • Judith Tirado-Muñoz INAD
  • Francina Fonseca INAD
  • Pilar A. Saiz Universidad de Oviedo. CIBERSAM. ISPA. SESPA
  • Gerardo Florez Complejo Hospitalario de Ourense. CIBERSAM
  • Jose Manuel Goikolea Hospital Clínic. Universitat de Barcelona
  • Iñaki Zorrilla OSI. CIBERSAM
  • Ruth Cunill CIBERSAM. Universitat de Barcelona
  • Xavi Castells Universitat de Girona
  • Elisardo Becoña Universidad de Santiago de Compostela
  • Ana Lopez Universidad de Santiago de Compostela
  • Luis San CIBERSAM. Universitat de Barcelona

DOI:

https://doi.org/10.20882/adicciones.1504

Palabras clave:

Esquizofrenia, consumo de sustancias, comórbido, patología dual, antipsicótico, cannabis, cocaína, alcohol, nicotina.

Resumen

Aunque el correcto diagnóstico y manejo de los pacientes con esquizofrenia y un diagnóstico comórbido de trastorno por uso de sustancias (TUS) determinaría una disminución de la morbilidad y mortalidad en estos pacientes, el desarrollo de estrategias terapéuticas eficientes es todavía una asignatura pendiente. Presentamos recomendaciones sobre el manejo farmacológico y psicológico de estos pacientes siguiendo la estructura PICO (Paciente-Intervención-Comparación-Outcome/resultados). Realizamos una evaluación de la calidad de los estudios y un resumen de la evidencia para cada pregunta siguiendo las recomendaciones del grupo de trabajo GRADE («Grading of Recommendations, Assessment, Development and Evaluation»). Nuestros resultados sugieren: 1) En pacientes con esquizofrenia y trastorno por consumo de cannabis, no es posible recomendar un fármaco antipsicótico sobre otro (entre olanzapina, risperidona o haloperidol) para mejorar los síntomas psicóticos, reducir el consumo de cannabis o mejorar las variables pragmáticas (recomendación débil). No se puede recomendar la clozapina para reducir el consumo de cannabis (recomendación débil). 2) En pacientes con esquizofrenia y trastorno por consumo de cocaína, recomendamos haloperidol sobre olanzapina para reducir el craving (recomendación moderada) y olanzapina sobre haloperidol para mejorar los efectos secundarios motores en estos pacientes (recomendación moderada). 3) En pacientes con esquizofrenia y trastorno por consumo de alcohol, mientras que se recomienda naltrexona para reducir el consumo de alcohol (en términos de reducción del craving de alcohol) (recomendación débil), no hay evidencia suficiente para hacer ninguna recomendación sobre el uso de acamprosato como adyuvante (recomendación débil). 4) En pacientes con esquizofrenia y trastorno por consumo de nicotina, se recomiendan bupropión y vareniclina adyuvantes para reducir el consumo y la abstinencia de nicotina (recomendación fuerte/moderada). 5) En pacientes con esquizofrenia y trastorno por policonsumo, se recomiendan antipsicóticos de segunda generación sobre los de primera generación y olanzapina sobre otros antipsicóticos de segunda generación para mejorar los síntomas psicóticos (recomendación moderada/débil). 

Biografía del autor/a

Belen Arranz, CIBERSAM. Universitat de Barcelona

Parc Sanitari Sant Joan de Deu, CIBERSAM. Universitat de Barcelona, Barcelona. Spain.

Marina Garriga, Hospital Clínic. Universitat de Barcelona

Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer. Universitat de Barcelona, Barcelona. Spain.

Miquel Bernardo, Hospital Clínic. Universitat de Barcelona

Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer. Universitat de Barcelona, Barcelona. Spain.

Ana Gonzalez-Pinto, Hospital Universitario. CIBERSAM

Instituto de Investigación Sanitaria BIOARABA, OSI Araba, Hospital Universitario. CIBERSAM, Vitoria. Spain.

Manuel Arrojo, EOXI

Servicio de Psiquiatría. EOXI de Santiago de Compostela. Spain.

Marta Torrens, INAD

Institut de Neuropsiquiatria i Addiccions (INAD). Parc de Salut Mar, RTA, Barcelona. Spain.

Judith Tirado-Muñoz, INAD

Institut de Neuropsiquiatria i Addiccions (INAD). Parc de Salut Mar, RTA, Barcelona. Spain.

Francina Fonseca, INAD

Institut de Neuropsiquiatria i Addiccions (INAD). Parc de Salut Mar, RTA, Barcelona. Spain.

Pilar A. Saiz, Universidad de Oviedo. CIBERSAM. ISPA. SESPA

Universidad de Oviedo, CIBERSAM, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Servicio de Salud del Principado de Asturias (SESPA), Oviedo. Spain.

Gerardo Florez, Complejo Hospitalario de Ourense. CIBERSAM

Unidad de Conductas Adictivas, Complejo Hospitalario de Ourense. CIBERSAM, Ourense. Spain.

Jose Manuel Goikolea, Hospital Clínic. Universitat de Barcelona

Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer. Universitat de Barcelona, Barcelona. Spain.

Iñaki Zorrilla, OSI. CIBERSAM

Instituto de Investigación Sanitaria BIOARABA, OSI Araba, Hospital Universitario. CIBERSAM, Vitoria. Spain.

Ruth Cunill, CIBERSAM. Universitat de Barcelona

Parc Sanitari Sant Joan de Deu, CIBERSAM. Universitat de Barcelona, Barcelona. Spain.

Xavi Castells, Universitat de Girona

Grupo de investigación TransLab, Departamento de Ciencias Médicas. Universitat de Girona. Spain.

Elisardo Becoña, Universidad de Santiago de Compostela

Unidad de Tabaquismo y Trastornos Adictivos, Facultad de Psicología. Univ. de Santiago de Compostela. Spain.

Ana Lopez, Universidad de Santiago de Compostela

Unidad de Tabaquismo y Trastornos Adictivos, Facultad de Psicología. Univ. de Santiago de Compostela. Spain.

Luis San, CIBERSAM. Universitat de Barcelona

Parc Sanitari Sant Joan de Deu, CIBERSAM. Universitat de Barcelona, Barcelona. Spain.

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Publicado

2021-03-11

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