Pharmacotherapy of patients with schizophrenia and substance abuse

Abstract

Background : Comorbid substance-use disorder in schizophrenia patients is associated with poor clinical and functional outcome. Objective : To provide evidence-based pharmacological treatment recommendations to improve the disease course of this patient group. Methods : A comprehensive systematic review of the pharmacological studies in this subgroup of patients was performed and the available studies were discussed from the standpoint of evidence-based medicine. Results/conclusion : Slight advantages were found for second-generation antipsychotic agents over conventional antipsychotics with regard to improvement of distinct psychopathological symptoms, reduced craving, and greater reduction of substance use; these findings are mainly derived from open studies or case series. Additional treatment with antidepressants, depending on the patient's psychopathology, as well as with anti-craving agents should be considered.

Canadian Schizophrenia Guidelines: Schizophrenia and Other Psychotic Disorders with Coexisting Substance Use Disorders

“…However, the use of second-generation instead of firstgeneration antipsychotic medications may be preferred due to greater tolerability of second-generation antipsychotic medications and potentially decreased likelihood for developing extrapyramidal side effects in persons with substance use disorders (Grade: Low). [47][48][49][50] In the same vein, there is some evidence to suggest a potential preferred role of secondgeneration long-acting injectable (LAI) antipsychotic medications over first-generation LAIs, 51 but evidence for differences in substance use outcomes or psychotic symptoms with the use of second-generation LAIs compared with oral second-generation antipsychotic medications has not been demonstrated. 52,53 The benefits from using secondgeneration antipsychotic medications may be greater for those who discontinue illicit substance use compared with those who continue to use, according to a secondary analysis of data from the Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE).…”

“…[17][18][19] Currently, the 3 medications indicated for use in persons with alcohol use disorders are naltrexone, acamprosate and disulfiram; the best evidence is for naltrexone and acamprosate in persons without coexisting psychiatric disorders. 58 Although the NICE guidelines do not directly comment on known pharmacotherapies for alcohol use disorders in persons with schizophrenia and coexisting substance use disorders, there is some evidence of efficacy for naltrexone (Grade: Moderate, 2 double-blind RCTs, 2 open studies), 47,48,59 limited evidence for disulfiram (Grade: Low, 2 open-label retrospective studies) 47,48,59 and no current evidence for acamprosate (1 double-blind RCT, placebo ¼ acamprosate). 47,48,59 Pharmacotherapy for the treatment of cocaine use disorder is limited, with there being no currently indicated agents for cocaine use disorder despite multiple treatment trials.…”

Protocols of Dual Diagnosis Intervention in Schizophrenia

“…Some may have antidepressant effects (lamotrigine) and others antimanic effects (valproate, carbamazepine, or oxcarbazepine). 136 Furthermore, antiepileptic drugs may be useful in special circumstances, such as the regulation of impulsivity and craving added to its effect as mood stabilizer, modulating the phenomenon of relapse in consumption and therefore, the conse- …”

Multiple Species Metabolism of PHA-568487, A Selective α7 Nicotinic Acetylcholine Receptor Agonist

“…Current drug therapy for schizophrenia includes atypical antipsychotic agents, such as risperidone and aripiprazole. In addition, the standard of care antipsychotics are associated with a range of harmful side-effects [5]. In addition, the standard of care antipsychotics are associated with a range of harmful side-effects [5].…”