Short-term Naloxone Administration in Schizophrenic and Manic Patients

Pickar, David; Vartanian, Felix; Bunney, William E.; Maier, Hans P.; Gastpar, Markus; Prakash, Rudra; Bb, Sethi; Lideman, R.P.; Belyaev, B S; Tsutsulkovskaja, Mella V. A.; Jungkunz, G.; Nedopil, Norbert; Verhoeven, W.M.A.; Praag, Herman van

doi:10.1001/archpsyc.1982.04290030047009

Cited by 104 publications

(30 citation statements)

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“…These decreases in Bunney-Hamburg psychosis ratings and the BPRS thinking disturbance score extend the previous findings of Pickar and colleagues that short term opioid system blockade decreases positive symp toms of psychosis (Pickar et al 1981a(Pickar et al , 1981b(Pickar et al , 1982c.…”

Section: Discussionsupporting

confidence: 84%

“…The results of treatment studies using naloxone have been incon clusive (see Bissette et al 1986;Pickar et al 1989). Opi ate antagonists were ineffective when used as the sole treatment for schizophrenia; however, when used as an adjuvant; brief trials of naloxone decreased positive symptoms of psychosis (Bissette et al 1986;Pickar et al 1981aPickar et al , 1981bPickar et al , 1982c. Unfortunately, the World Health Organization (WHO) international collaborative repeated-dose naloxone augmentation trial could not confIrm the results of these single-dose studies (Pickar et al 1989).…”

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confidence: 99%

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Beneficial Effects of Nalmefene Augmentation in Neuroleptic-Stabilized Schizophrenic Patients

Rapaport

Wolkowitz

Kelsoe

et al. 1993

Neuropsychopharmacol

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Section: Discussionsupporting

confidence: 84%

mentioning

confidence: 99%

Beneficial Effects of Nalmefene Augmentation in Neuroleptic-Stabilized Schizophrenic Patients

Rapaport

Wolkowitz

Kelsoe

et al. 1993

Neuropsychopharmacol

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“…On the whole, they were safe and well tolerated and resulted in significant improvements of various aspects of schizophrenic symtomatology such as positive and deficit symptoms, polydipsia, alcoholism, and tardive dyskinesia in some (Watson et al, 1978;Lehmann et al, 1979;Berger et al, 1981;Nishikawa et al, 1994a, b;Marchesi et al, 1995;Petrakis et al, 2004;Wonodi et al, 2004), but not all (Volavka et al, 1977;Pickar et al, 1982) participants.…”

Section: Opioid Antagonists May Improve Hedonic Deficits In Patients mentioning

confidence: 97%

Food Intake and Reward Mechanisms in Patients with Schizophrenia: Implications for Metabolic Disturbances and Treatment with Second-Generation Antipsychotic Agents

Elman

Borsook

Lukas

2006

Neuropsychopharmacol

133

142

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Obesity is highly prevalent among patients with schizophrenia and is associated with detrimental health consequences. Although excessive consumption of fast food and pharmacotherapy with such second-generation antipsychotic agents (SGAs) as clozapine and olanzapine has been implicated in the schizophrenia/obesity comorbidity, the pathophysiology of this link remains unclear. Here, we propose a mechanism based on brain reward function, a relevant etiologic factor in both schizophrenia and overeating. A comprehensive literature search on neurobiology of schizophrenia and of eating behavior was performed. The collected articles were critically reviewed and relevant data were extracted and summarized within four key areas: (1) energy homeostasis, (2) food reward and hedonics, (3) reward function in schizophrenia, and (4) metabolic effects of the SGAs. A mesolimbic hyperdopaminergic state may render motivational/incentive reward system insensitive to low salience/palatability food. This, together with poor cognitive control from hypofunctional prefrontal cortex and enhanced hedonic impact of food, owing to exaggerated opioidergic drive (clinically manifested as pain insensitivity), may underlie unhealthy eating habits in patients with schizophrenia. Treatment with SGAs purportedly improves dopamine-mediated reward aspects, but at the cost of increased appetite and worsened or at least not improved opiodergic capacity. These effects can further deteriorate eating patterns. Pathophysiological and therapeutic implications of these insights need further validation via prospective clinical trials and neuroimaging studies. INTRODUCTIONObesity has reached pandemic proportions and it is rapidly surpassing smoking as a number one killer in the industrialized world (Sturm, 2002;Skidmore and Yarnell, 2004). Its annual cost to the American society is staggering, and is estimated to be around $117 billion owing to related illnesses and loss of productivity (National Institute of Diabetes and Digestive and Kidney Diseases, 2005).In schizophrenia, obesity is twice as prevalent as in the general public, afflicting over half this patient population (Allison et al, 1999a;Dixon et al, 2000; American Diabetes Association, 2004;Marder et al, 2004;Wirshing, 2004). Besides negative psychosocial impacts (distorted selfesteem and societal stigmatization) and medications noncompliance, schizophrenics appear to be particularly susceptible to the detrimental medical sequelae of obesity such as the 'Metabolic Syndrome', which is a cluster of cardiovascular risk factors, including abdominal adiposity, insulin resistance, impaired, glucose tolerance, dyslipidemia, and hypertension (McKee et al, 1986;Mukherjee et al, 1996;Brown et al, 2000;Haupt and Newcomer, 2002;Ryan and Thakore, 2002;Ryan et al, 2003;Holt et al, 2004;Kohen, 2004;Marder et al, 2004;Lieberman et al, 2005).Excessive body weight gain (BWG) could be attributed to a constellation of endocrine, molecular, genetic, demographic, and lifestyle-related factors. Provided that a common tra...

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“…Naltrexone and another opioid antagonist, naloxone, have either shown no worsening of the symptoms associated with schizophrenia or a modest therapeutic improvement in psychotic symptoms (Pickar et al 1982;Sernyak et al 1998). A few pilot studies have evaluated naltrexone in dually diagnosed patients.…”

Section: Introductionmentioning

confidence: 99%

Naltrexone augmentation of neuroleptic treatment in alcohol abusing patients with schizophrenia

et al. 2003

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Short-term Naloxone Administration in Schizophrenic and Manic Patients

Cited by 104 publications

References 55 publications

Beneficial Effects of Nalmefene Augmentation in Neuroleptic-Stabilized Schizophrenic Patients

Beneficial Effects of Nalmefene Augmentation in Neuroleptic-Stabilized Schizophrenic Patients

Food Intake and Reward Mechanisms in Patients with Schizophrenia: Implications for Metabolic Disturbances and Treatment with Second-Generation Antipsychotic Agents

Naltrexone augmentation of neuroleptic treatment in alcohol abusing patients with schizophrenia

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