Alcohol and other drugs of abuse are commonly used by persons with schizophrenia and contribute to the overall morbidity of the disorder. Standard, or typical, antipsychotic drugs do not limit such substance use and may even render it more likely. However, preliminary data from our group and others suggest that the atypical antipsychotic clozapine may decrease substance use in this population. While recognizing the likelihood that substance use decreases negative symptoms (as well as extrapyramidal symptoms) in persons with schizophrenia, we hypothesize that the biological basis of substance use relates to a "reward-deficiency syndrome" secondary to dysfunctional dopamine-mediated mesocorticolimbic neurons in these individuals. We further suggest that clozapine's beneficial effect in patients with comorbid schizophrenia and substance use disorders may relate to its presumed ability to ameliorate the deficits in both the mesocortical and mesolimbic dopaminergic neuronal projections through its various actions on dopaminergic, serotonergic, and particularly noradrenergic neurons.

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Objective: Functional impairments are debilitating concomitants of psychotic disorders and are present early in the illness course and, commonly, prior to psychosis onset. The factors affecting social and role functioning in early psychosis (EP) following treatment are unclear. We evaluated whether six months of participation in the PREP R , Boston, EP treatment program, part of a public-academic community mental health center, was related to improvements in social and role functioning and whether premorbid adjustment in adolescence, baseline neurocognition, and depression symptoms predicted functional improvement. Method:The Global Functioning Social and Role scales, MATRICS neurocognitive battery, and Calgary Depression Scale were assessed at baseline and six months during naturalistic treatment, while premorbid adjustment was measured at baseline. All participants were psychotic disorder patients in PREP R (n = 46 with social functioning and 47 with role functioning measures at both time points).Results: Large improvements were observed in role functioning (d = 0.84) and medium to large improvements were observed in social functioning (d = 0.70). Models consisting of adolescent premorbid adjustment and change in depression symptoms predicted social and role functioning change, whereas neuropsychological functioning did not. Conclusions:Substantial improvements in social and role functioning were observed among this sample participating in a recovery-based EP program. The impact of clinical factors on social and role functioning was highlighted. Further studies of premorbid adjustment in adolescence and the treatment of depression in EP programs in controlled treatment trials are needed to confirm these findings.

Purpose: The current study evaluates the demographic, clinical, and neurocognitive characteristics of a recruited FEP research sample, a research control group, and a FEP clinic sample that were assessed and treated within the same center and time period. Methods: This study utilized data collected through an observational study and a retrospective chart review. Samples were ascertained in the Longitudinal Assessment and Monitoring of Clinical

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The current study highlights the role of premorbid adjustment and changes in coping and neurocognition as factors influencing treatment satisfaction. Future research designs might be able to more specifically ascertain causal relationships between patient characteristics, treatment components, client satisfaction and clinical effects.

Objectives: Previous research regarding the impact of olanzapine on substance use in patients with schizophrenia is mixed, and no data address its impact on alcohol use disorders. This retrospective study compared the effect of olanzapine to the effect of clozapine, an agent associated Mary F. Brunette, Christopher O'Keefe, and Alan I. Green are affiliated with the Department of Psychiatry, Dartmouth Medical School, White River Junction, VA. Brunette et al. 345 with improvements in alcohol use disorders in patients with schizophrenia, and to the effect of typical antipsychotic medications, which have not been associated with improvements in alcohol use disorders in these patients. We hypothesized that patients taking olanzapine would be more likely to become abstinent than those treated with typical antipsychotics but less likely to become abstinent than patients treated with clozapine. Methods: Data were collected by chart review. Results: Olanzapine treatment was more likely to be associated with abstinence than treatment with typical antipsychotics (chi-square = 4.22, df = 1, p = .040) and less likely to be associated with abstinence than clozapine treatment (chi-square = 13.02, df = 1, p = .0001). The majority of patients in the three medication groups were deemed improved in their psychiatric status. Conclusions: While these results should be interpreted with caution, the analyses reported here suggest that olanzapine may be more helpful for the treatment of alcohol disorders in patients with schizophrenia spectrum disorders than typical antipsychotics, but the impact appears to be small compared to the impact of clozapine, which seems more promising. This retrospective study adds to a growing literature suggesting that clozapine may be particularly helpful for the treatment of alcohol disorders in patients with schizophrenia.