P.3.b.001 Pharmacological management of alcohol dependence in chronic schizophrenia

Vasile, D.; Vasiliu, O.; Mangalagiu, A.G.; Petrescu, B.M.; Sopterean, G.A.; Bratu, R.E.

doi:10.1016/s0924-977x(13)70679-5

Cited by 4 publications

(14 citation statements)

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“…38,44 Further evidence suggests that naltrexone may be effective in reduction of drinks per week 44 and the number of drinks per drinking day. 44 While studies indicate that the effect of disulfiram is approximately equivalent to that of naltrexone, fitting with the wider literature on the topic, naltrexone is shown to be better tolerated in patients suffering from comorbid alcohol use and psychotic disorders, 38,42,43 though mild side effects have been reported. 45 In the one study that tested for such an effect, combining these treatments did not offer any advantage, though it did produce more side effects than found in the administration of either drug alone.…”

Section: Discussionmentioning

confidence: 91%

“…The studies included in this review have several limitations. The majority of studies had participants stabilized on antipsychotic medications, 38,39,[41][42][43][44][45][46] putatively impacting dopaminergic reward systems, though it enhances the transferability of the findings.…”

Section: Methodology Design and Limitationsmentioning

confidence: 99%

“…52 Concurrent psychosocial ordinary care was not possible to control for in several works, 38,40,41,44 though studies with no such interventions still observed significant drinking reductions. 39,43,45,46 A total of 87% of the participants were male; women have been traditionally under-represented in this field 53 but appreciation for sex-specific differences has increased, 54,55 albeit that the general literature suggests men and women do not differ in their response to naltrexone. 56 Three studies utilized samples from the Veterans Administration in the USA, 39,41 with military personnel shown to often have differing personality traits from the general population, [57][58][59][60] and results were not stratified by ethnicity.…”

Section: Methodology Design and Limitationsmentioning

confidence: 99%

“…63 Overall, the literature is notable for its small size, with several of the studies coming from a single research team. One study was a retrospective chart review, 46 four studies [42][43][44][45] were open-label trials, and three were randomized controlled trials. 38,40,41 The inclusion of a retrospective chart review yields weak evidence, as the intervention was not controlled, nor were specific drinking measures allowed to be taken.…”

Section: Methodology Design and Limitationsmentioning

confidence: 99%

“…Due to the varied designs adopted, three outcome groupings have been utilized. Naltrexone's effects on drinking behaviour were compared: with placebo in four studies [38][39][40][41] ; with another pharmaceutical agent in four studies 39,[41][42][43] ; and against baseline drinking behaviour in three studies, one of which utilized the long-acting injectable form of the medication. [44][45][46] Naltrexone versus placebo All four studies 16,38,39,41 showed significant superiority of naltrexone over placebo, though the placebo groups did show improvement in comparison to baseline drinking behaviour.…”

Section: Drinking Outcomesmentioning

confidence: 99%

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Naltrexone efficacy in treating alcohol-use disorder in individuals with comorbid psychosis: a systematic review

Sawicka

Tracy²

2017

Therapeutic Advances in Psychopharmacology

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Background: Psychotic illnesses, such as schizophrenia, are typically enduring and disabling conditions, impacting individual, family, and societal outcomes. Individuals with these face greater vulnerabilities in developing alcohol-use disorder (AUD). Furthermore, the nature of psychoses, often manifesting with paranoia, cognitive impairment, a lack of insight, suboptimal treatment adherence, and stigma from others, means that they can pose unique treatment challenges when these two conditions comorbidly occur. These challenges mean that the standard literature on the effectiveness of the opioid antagonist naltrexone in AUD does not necessarily translate to this vulnerable population. Methods: Following PRISMA guidelines, we herein systematically reviewed the evidence for naltrexone in individuals with both psychosis and AUD. Overall, there is a paucity of research in this important area, with only nine reports meeting search criteria, only four of which were randomized control trials. Studies compared naltrexone with: placebo, another pharmaceutical agent, or upon changes to baseline drinking behaviour. One study evaluated the long-acting injectable formulation of this drug. Results: Most studies, including the methodologically more robust ones, supported naltrexone's effectiveness over placebo in terms of reduction in drinking days and numbers of drinks consumed on such days in this cohort. Work comparing naltrexone to other pharmaceutical interventions showed approximate equivalence with disulfiram, and modest superiority over acamprosate. Conclusions: On this limited evidence base, this review endorses the use of naltrexone as both safe and effective in those with both psychotic illnesses and AUD. Several key issues remain to be elucidated. Critically, study designs meant that they were limited to individuals with good engagement with services, and levels of adherence were attained that are unlikely to be replicated in this cohort in real-world settings. Finally, effects of specific psychosis symptomatology, not least paranoia and insight, upon naltrexone use, and the reverse directional potential of 'double dysphoria' from an opioid antagonist remain largely unexplored.

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Section: Discussionmentioning

confidence: 91%

Section: Methodology Design and Limitationsmentioning

confidence: 99%

Section: Methodology Design and Limitationsmentioning

confidence: 99%

Section: Methodology Design and Limitationsmentioning

confidence: 99%

Section: Drinking Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

Naltrexone efficacy in treating alcohol-use disorder in individuals with comorbid psychosis: a systematic review

Sawicka

Tracy²

2017

Therapeutic Advances in Psychopharmacology

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Opioid antagonists are associated with a reduction in the symptoms of schizophrenia: a meta-analysis of controlled trials

Clark

Snellenberg

Lawson

et al. 2020

Neuropsychopharmacol.

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Current treatments for the symptoms of schizophrenia are only effective for positive symptoms in some individuals, and have considerable side effects that impact compliance. Thus, there is a need to investigate the efficacy of other compounds in treating both positive and negative symptoms. We conducted a meta-analysis of English language placebo-controlled clinical trials of naloxone, naltrexone, nalmefene, and buprenorphine in patients with schizophrenia to determine whether opioid antagonists have therapeutic efficacy on positive, negative, total, or general symptoms. We searched online databases Ovid Medline and PsychINFO, PubMed, EMBASE, Scopus, Cochrane library/CENTRAL, Web of Science, and Google Scholar from 1970 through February 2019. Following PRISMA guidelines, Hedges g was calculated for each study. Primary study outcomes were the within-subject change on any symptom assessment scale for positive, negative, total, or general symptoms of schizophrenia between active drug and placebo conditions. Thirty studies were included with 434 total patients. We found a significant effect of all drugs on all scales combined with both a standard random effects model: (g = 0.26; P = 0.02; k = 22; CI = 0.03–0.49) and a more inclusive bootstrap model: (g = 0.26; P = 0.0002; k = 30; CI = 0.11–0.51) and a significant effect on total scales with the bootstrap model (g = 0.25288; P = 0.015; k = 19; CI = 0.04–0.35). We also observed a significant effect of all drugs on all positive scales combined with both the random effects (g = 0.33; P = 0.015; k = 17; CI = 0.07–0.60) and bootstrap models (g = 0.32; P < 0.0001; k = 21; CI = 0.13–1.38). This evidence provides support for further testing in randomized clinical trials of a new class of non-D2-receptor drugs, based on opioid mechanisms, for the treatment of positive and negative symptoms of schizophrenia.

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Pharmacological Treatment of Alcohol use Disorder in Patients with Psychotic Disorders: A Systematic Review

Rosenstand

Nielsen

Skøt

et al. 2024

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Background: Patients with psychotic disorders (PD) often have comorbid alcohol use dis- order (AUD), which is typically treated pharmacologically. Up till now, no systematic review has ex- amined the effectiveness and safety of AUD treatment in PD patients. Objectives: This study aimed to systematically review the literature on (1) the effects of pharmacolog- ical treatments for AUD on drinking outcomes, (2) the side effects of the drugs, and (3) the effects of polypharmacy in patients with comorbid AUD and PD. Methods: Bibliographic searches were conducted in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO. At least two reviewers extracted the data, assessed the risk of bi- as, and performed the qualitative synthesis of the collected evidence. Results: Twelve eligible studies were identified, half being randomized controlled trials (RCTs). Three studies examined disulfiram, nine naltrexone, two acamprosate, and one nalmefene by comparing the effects of treatment to placebo, baseline, or other pharmacological agents. Disulfiram and naltrexone were shown to reduce alcohol intake. Regarding acamprosate, the findings were mixed. Nalmefene decreased alcohol intake. All pharmacological agents appeared safe to use as AUD mono- therapy, but cardiac events were reported when combining naltrexone and disulfiram. Nine studies had a high risk of bias, and three had some other concerns. Conclusion: The studies provide tentative support for the use of naltrexone and disulfiram in this population, although combinations of pharmacological AUD treatments and other polypharmacy remain unexplored. The studies had high adherence rates that are hardly replicable in real-world settings. Thus, the findings need to be confirmed in larger RCTs with longer follow-ups for high-quality efficacy and effectiveness.

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P.3.b.001 Pharmacological management of alcohol dependence in chronic schizophrenia

Cited by 4 publications

References 0 publications

Naltrexone efficacy in treating alcohol-use disorder in individuals with comorbid psychosis: a systematic review

Naltrexone efficacy in treating alcohol-use disorder in individuals with comorbid psychosis: a systematic review

Opioid antagonists are associated with a reduction in the symptoms of schizophrenia: a meta-analysis of controlled trials

Pharmacological Treatment of Alcohol use Disorder in Patients with Psychotic Disorders: A Systematic Review

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