Evolution of Substance use, Neurological and Psychiatric Symptoms in Schizophrenia and Substance use Disorder Patients: A 12-Week, Pilot, Case–Control Trial with Quetiapine

Abstract

Neurological and psychiatric symptoms are consequences of substance abuse in schizophrenia and non-schizophrenia patients. The present case–control study examined changes in substance abuse/dependence, and neurological and psychiatric symptoms in substance abusers with [dual diagnosis (DD) group, n = 26] and without schizophrenia [substance use disorder (SUD) group, n = 24] and in non-abusing schizophrenia patients (SCZ group, n = 23) undergoing 12-week treatment with the atypical antipsychotic, quetiapine. Neurological and psychiatric symptoms were evaluated with the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, the Extrapyramidal Symptoms Rating Scale, and the Barnes Akathisia Rating Scale. At endpoint, DD and SCZ patients were receiving significantly higher doses of quetiapine (mean = 554 and 478 mg/day, respectively), relative to SUD patients (mean = 150 mg/day). We found that SUD patients showed greater improvement in weekly dollars spent on alcohol and drugs and SUD severity, compared to DD patients. At endpoint, there was no significant difference in dollars spent, but DD patients still had a higher mean SUD severity. Interestingly, DD patients had significantly higher parkinsonism and depression than SCZ patients at baseline and endpoint. On the other hand, we found that SUD patients had significantly more akathisia at baseline, improved more than SCZ patients, and this was related to cannabis abuse/dependence. Finally, SUD patients improved more in Positive and Negative Syndrome Scale positive scores than DD and SCZ patients. Taken together, our results provide evidence for increased vulnerability to the adverse effects of alcohol and drugs in schizophrenia patients. They also suggest that substance abuse/withdrawal may mimic some symptoms of schizophrenia. Future studies will need to determine the role quetiapine played in these improvements.

Is the Deficit in Pain Inhibition in Fibromyalgia Influenced by Sleep Impairments?

“…The HAM-D rates the severity of symptoms observed in depression such as change in mood, insomnia, agitation and weight loss. The HAM-D was administered by a nurse trained by SP, who has vast experience in administration of psychiatric interviews for research purposes [ 29 - 34 ].…”

“…This interview-type questionnaire provides measures of overall anxiety, psychological distress (psychic anxiety), and physical complaints related to anxiety (somatic anxiety). The HAM-A was administered by a nurse trained by SP, who has vast experience in the administration of psychiatric interviews for research purposes [ 29 - 34 ].…”

Plasma Endocannabinoid Alterations in Individuals with Substance Use Disorder are Dependent on the “Mirror Effect” of Schizophrenia

“…In SCZ and SUD patients, psychiatric symptoms (positive, negative, and depressive) significantly improved during treatment ( p  < 0.05; for more information, see Zhornitsky et al, 2011). …”

“…On baseline, SCZ and SUD patients had similar positive symptoms [SCZ: 17.4 (4.4); SUD: 16.2 (5.1); F  = 3.2; p  = 0.08]; SCZ patients had more negative symptoms than SUD patients [SCZ: 16.9 (4.7); SUD: 13.6 (4.7); F  = 7.2; p  = 0.01]; and SUD patients had more depressive symptoms than SCZ patients [SCZ: 3.6 (4.4); SUD: 6.8 (4.4); F  = 8.4; p  = 0.005; Zhornitsky et al, 2011]. In SCZ and SUD patients, psychiatric symptoms (positive, negative, and depressive) significantly improved during treatment ( p  < 0.05; for more information, see Zhornitsky et al, 2011).…”

Is it time to consider comorbid substance abuse as a new indication for antipsychotic drug development?

“…On the other hand, one study reported that olanzapine was no better than first-generation antipsychotics in the treatment of comorbid drug abuse (Noordsy et al, 2001). Limited information is available about quetiapine or aripiprazole (Brown et al, 2002; Potvin et al, 2008; Zhornitsky et al, 2011). Once more, most of the available information has been generated from case reports, uncontrolled or small controlled studies using different or mixed target substances, making it difficult to reach firm conclusions or provide an adequate basis for comparative analysis.…”