Dual Pathology: Craving and Drug Abuse in Patients On Paliperidone

Abstract

INTRODUCTION: patients with dual pathology have worse clinical evolution and worse therapeutic response. The repeated administration of substances sensitizes the dopaminergic systemwith downregulation of the reward circuit. When the drug use stops, the exposureto stimuli produces a dopamine increase and craving appears. AIMS: to prove usefulness of paliperidone in dual pathology for craving andfor drug abuse.MATERIALS AND METHODS: 18 patients diagnosed with dual pathology. They were treated with paliperidone and all of them were interviewed about craving andsubstance use. RESULTS: 4 groups: Cannabis (5%). Cannabis and cocaine (16.66%). Cannabis andother two or more substances (16.66%). Cocaine and alcohol (16.66%). All ofthem were diagnosed of dual pathology: induced psychotic disorder (33.33%),personality disorder (27.77%), conduct disorder (16.66%), paranoid schizophrenia (11.11%), bipolar disorder (5.55%), and dysmorphic disorder(5.55%). 38.89% achieved abstinence. 50% reduced significantly substance use.77.78% verbalized a decrease in craving.DISCUSSION: cannabis disables the gabaergic interneurons, which stop inhibiting the dopaminergic neurons and a large amount of dopamine is released from the accumbens nucleus. Cocaine increases dopamine and 5-HT levels on thebrain. Paliperidone presents an affinity for D2 and 5TH2a receptors, so this might explain the results, because it blocks the enhancer effect, which contributes to the craving decrease and to the drug withdrawal. CONCLUSIONS: paliperidone seems to be a good choice in dual pathologydue to the improvement on craving and drug abuse