Pharmacological treatment of substance-abusing schizophrenic patients

This article reviews special clinical dilemmas inherent in the differential pharmacotherapy of patients with the dual diagnoses of schizophrenia and substance abuse. The author discusses the role of neuroleptic medications in treating the psychotic diathesis, preventing recurrences of schizophrenic symptomatology, counteracting psychotic exacerbations engendered by abused substances, and potentially generating side effects such as akinesia and akathisia that patients may attempt to "self-medicate" with substances of abuse. Also addressed are the potential adjunctive roles of antiparkinsonian medications, tricyclic antidepressants, and benzodiazepines in appropriately selected cases, as well as pharmacokinetic and pharmacodynamic interactions of psychotropic medications and substances of abuse. Throughout the course of these psychopharmacological strategies, the value of psychosocial interventions geared to recognizing and compensating for specific schizophrenic vulnerabilities should be emphasized, as substance abuse is addressed in the context of a complication in the course of schizophrenia.