Risperidone versus other antipsychotics for people with severe mental illness and co-occurring substance misuse

Abstract

There is not sufficient good-quality evidence available to determine the effects of risperidone compared with other antipsychotics in people with a dual diagnosis. Few trials compared risperidone with first-generation agents, leading to limited applicability to settings where access to second-generation agents is limited, such as in low- and middle-income countries. Moreover, heterogeneity in trial design and measurement of outcomes precluded the use of many trials in our analyses. Future trials in this area need to be sufficiently powered but also need to conform to consistent methods in study population selection, use of measurement scales, definition of outcomes, and measures to counter risk of bias. Investigators should adhere to CONSORT guidelines in the reporting of results.

Dual diagnosis: A systematic review of the organization of community health services

“…DD around the world is an underestimated disorder, under-diagnosed and often poorly treated (Temmingh et al, 2018) and therefore it is essential to pay more attention to the recognition of this comorbidity. As far as diagnosis is concerned, it is evident from the literature review that this is still a gray area with much room for discussion (Todd et al, 2004) that can hinder the development of a rationale for treatment and care.…”

“…Since the late 1980s, the international literature has shown that comorbid alcohol and/or other SUDs are highly prevalent in people suffering from severe mental illness (Carrà et al, 2015). Also, the most recent Cochrane review indicates that up to 75% of people with a serious mental illness are DD (Temmingh et al, 2018) and it is recognized that 64%–88% of adolescents with SUDs have at least one, and often more than one, comorbid psychiatric problems (Brewer et al, 2017).…”

The Unhappy Mental Health Triad: Comorbid Severe Mental Illnesses, Personality Disorders, and Substance Use Disorders in Prison Populations

“…The triad was present in 11% of the adolescent men and 14% of the adolescent women in juvenile detention. The three diagnostic groups juxtaposed in our study usually require different treatment approaches: SMIs often need repeat psychiatric evaluations and medication (18). PDs may respond to dialectic behavioral therapies and often require long term psychotherapy (35).…”

“…Especially, the co-occurrence of disorders across those diagnostic groups may pose additional challenges for treatment planning and integration (17) and for prognosis, whereas comorbid disorders within specific diagnostic groups can often be treated using one single approach and thus are less relevant for treatment planning. Focusing among the axis one disorders on the severe disorders and treating them as a group is pragmatic and in line with international research on interventions for co-occurring mental health and substance use disorders in general (18,19) and in prison populations (16). Individuals with antisocial PD may differ from those with borderline PD regarding the criminal profiles: whereas people with antisocial PD tend to show more instrumental violence, people with borderline PD commit more often emotional violence as a result from impulsivity (20).…”

Severe mental illness and health service utilisation for nonpsychiatric medical disorders: A systematic review and meta-analysis

“…Significant increases in levels of obesity, metabolic syndrome, diabetes, cardiovascular disease, viral disease, respiratory tract disease, and musculoskeletal disease are seen alongside SMI, and illness severity is usually more pronounced in these patients [ 9 ]. Increased morbidity in SMI patients is largely down to a higher prevalence of modifiable risk factors [ 92 ], such as smoking [ 93 ], obesity [ 94 ], and alcohol and substance misuse [ 95 ]. Additionally, SMI is associated with physiological changes known to impact upon physical health.…”