Extrapyramidal symptoms in substance abusers with and without schizophrenia and in nonabusing patients with schizophrenia

Zhornitsky, Simon; Stip, Émmanuel; Pampoulova, Tania; Rizkallah, Élie; Lipp, Olivier; Bentaleb, Lahcen Aït; Chiasson, Jean-Pierre; Potvin, Stéphane

doi:10.1002/mds.23227

Cited by 22 publications

(12 citation statements)

References 59 publications

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“…This is consistent with evidence suggesting that negative symptoms are relatively unique to schizophrenia (Zhornitsky et al, 2010a). By contrast, we found that depressive symptoms were nearly twice as high in DD and over one and a half times higher in SUD compared to SCZ patients.…”

Section: Discussionsupporting

confidence: 92%

“…Compounding these problems is the nearly 50% lifetime prevalence of substance use disorder (SUD) associated with schizophrenia (Regier et al, 1990). In non-psychotic individuals, substance use is associated with neurological and psychiatric symptoms (Mauri et al, 2007; Zhornitsky et al, 2010a). In schizophrenia patients, substance use has a negative impact on the course of the pathology.…”

Section: Introductionmentioning

confidence: 99%

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

Zhornitsky¹,

Stip²,

Desfossés³

et al. 2011

Front. Psychiatry

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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

Zhornitsky¹,

Stip²,

Desfossés³

et al. 2011

Front. Psychiatry

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“…Among FEP patients, a recent 2-year followup study found that 24% of individuals abused either alcohol or drugs at baseline and 72% of substance abusers, and 31% of nonabusers had experienced at least one occasion of involuntary hospitalization [69]. In general, studies suggest that compared to nonabusing patients, dual diagnosis schizophrenia patients have more psychiatric symptoms and EPS [70], they are more frequently hospitalized, suicidal, impulsive and violent, homeless, and unemployed, and they have more legal and health problems [71, 72]. Moreover, substance use is commonly associated with poor adherence to antipsychotic treatment, and, naturally, LAIs are commonly recommended as for improving adherence in psychosis patients with comorbid SUDs [14, 31, 73].…”

Section: Lais For Sudsmentioning

confidence: 99%

Oral versus Long-Acting Injectable Antipsychotics in the Treatment of Schizophrenia and Special Populations at Risk for Treatment Nonadherence: A Systematic Review

Zhornitsky

Stip

2012

Schizophrenia Research and Treatment

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Long-acting injectable antipsychotics (LAIs) should offer better efficacy and tolerability, compared to oral antipsychotics due to improved adherence and more stable pharmacokinetics. However, data on LAIs has been mixed, with some studies finding that they are more effective and tolerable than oral antipsychotics, and others finding the contrary. One possibility for the disparate results may be that some studies administered different antipsychotics in the oral and injectable form. The present systematic review examined the efficacy and tolerability of LAIs versus their oral equivalents in randomized and naturalistic studies. In addition, it examined the impact of LAIs on special populations such as patients with first-episode psychosis, substance use disorders, and a history of violence or on involuntary outpatient commitment. Randomized studies suggest that not all LAIs are the same; for example, long-acting risperidone may be associated with equal or less side effects than oral risperidone, whereas fluphenazine decanoate and enanthate may be associated with equal or more side effects than oral fluphenazine. They also suggest that LAIs reduce risk of relapse versus oral antipsychotics in schizophrenia outpatients when combined with quality psychosocial interventions. For their part, naturalistic studies point to a larger magnitude of benefit for LAIs, relative to their oral equivalents particularly among first-episode patients.

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“…They also suggested that these agents are not effective in treating stimulant dependence and may aggravate the condition in some cases. (14) Another study to determine whether quetiapine plus naltrexone is more effective than naltrexone alone for the treatment of alcohol-dependent patients, a double-blind, randomized clinical trial where eligible alcohol-dependent patients were randomized to receive naltrexone (50mg/day) plus quetiapine (25-200mg/day) or naltrexone (50mg/day) plus placebo for 12 weeks, and afterwards patients received naltrexone alone during 4 additional weeks, it was found that there were no statistically significant differences for any primary drinking outcomes between treatment groups. Both regimens were well tolerated.…”

Section: Introductionmentioning

confidence: 99%

A Double - Blind, Placebo - Controlled, Randomized Study Comparing Quetiapine With Placebo, Along With Oral Naltrexone, in the Treatment of Opioid Dependent Patients

Chalana¹,

Sachdeva²,

Kundal³

et al. 2015

jemds

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AIM:The aim of the study is to compare quetiapine with placebo along with oral naltrexone in the treatment of opioid dependent patients. We conducted the study as opioid dependence is steadily increasing in this area and more research is needed to prevent relapse after opioid detoxification. SETTINGS AND DESIGN: It is a double blind placebo controlled , randomized study that was conducted in department of psychiatry, de addiction unit (Sri Guru Ram Das Institute of Medical Sciences & Research, Sri Amritsar) over one year time period. All the patients who were taken in the study had a confirmed diagnosis of opioid dependence as per ICD 10 criteria. MATERIAL AND METHOD: It is a double blind, placebo controlled, randomized study. A total of 217 subjects were admitted over year, out of which 164 were screened as 53 subjects refused to participate. Out of 164 randomization of 152 patient was done and two groups (1&2) were made. . During detoxification, opioids were given to both groups and stopped after 1-2 weeks. Then all patients were started on Naltrexone 50 mg/day. Group 1 (n=73) received naltrexone (50mg/day) plus quetiapine (50-200mg/day), while group 2 (n=79) received naltrexone (50mg/day) plus placebo (multivitamin) for next 26 weeks. Our primary efficacy measures were relapse rate and percent days of abstinence. Two groups were compared with the help of percentage method and independent t test done. RESULTS: Relapse rate in placebo group was almost twice to that of Quetiapine group. In group 1, 24 subjects (32.87%) had relapsed by the end of 6 months as compared to 56 subjects (70.88%) in group 2. Percent days of abstinence in Quetiapine group were significantly higher as compared to placebo group. DISCUSSION: Our study shows significant advantages in using Quetiapine along with Naltrexone to decrease relapse rate and increase percent days of abstinence after inpatient detoxification.

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Extrapyramidal symptoms in substance abusers with and without schizophrenia and in nonabusing patients with schizophrenia

Cited by 22 publications

References 59 publications

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

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

Oral versus Long-Acting Injectable Antipsychotics in the Treatment of Schizophrenia and Special Populations at Risk for Treatment Nonadherence: A Systematic Review

A Double - Blind, Placebo - Controlled, Randomized Study Comparing Quetiapine With Placebo, Along With Oral Naltrexone, in the Treatment of Opioid Dependent Patients

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