Effectiveness of atypical antipsychotics for substance use in schizophrenia patients.
ABSTRACT This study examined the influence of medication class (atypical antipsychotic, typical antipsychotic and no medication) and compliance on substance use outcomes for schizophrenia patients in the community.
N=362 adults with schizophrenia-spectrum disorder were followed for 3 years in a naturalistic study with structured interviews at 6-month intervals. Multivariable time-series analysis was performed using propensity-score adjustment for selection to medication class.
Participants who were compliant with atypical antipsychotic medications for 90 days or more during each 6-month period were significantly less likely to use substances during the next 6-month period than patients who were compliant with typical antipsychotics or those who were not prescribed either type of medication for at least 90 days.
Atypical antipsychotics may offer an advantage in reducing substance use among schizophrenia patients. For patients to benefit from atypical antipsychotics, treatment should focus on enhancing compliance and integrating substance use treatment.
- SourceAvailable from: Gianna Sepede[Show abstract] [Hide abstract]
ABSTRACT: Background: Substance Use Disorders (SUDs) are common among patients with schizophrenia and dramatically worsen their outcome. In the last years, the use of Atypical Antipsychotics (AAPs) in dual diagnosis has become an encouraging clinical strategy. Aim of the present paper is to provide a systematic literature review on efficacy and safety of AAPs use in schizophrenic patients with comorbid SUD. Methods: We searched PubMed to identify original studies pertaining the use of AAPs in treating dual-diagnosed schizophrenic patients. Results: We found 12 papers that met our inclusion/exclusion criteria: five randomized clinical trials, two open label trials and five observational studies. 1432 schizophrenic patients, 905 of them with a comorbid SUD, were involved. Olanzapine, Risperidone and Clozapine were the most prescribed AAPs; alcohol, cannabis and cocaine the most frequent substances of abuse. None of the selected studies was placebo-controlled: AAPs were compared to Typical Antipsychotics (TAPs) or one another. AAPs resulted usually, but not always, more efficacious than TAPs on substance related problems. In those studies comparing different AAPs, clozapine showed better results than other treatments, whereas no significant differences emerged between risperidone and olanzapine. In terms of safety, AAPs were usually well tolerated. Conclusions: Our review suggests that AAPs, in particular clozapine, olanzapine and risperidone, may be a promising therapeutic option for schizophrenic patients with comorbid SUD. On the other hand, given the limited number of randomized controlled trials and the lack of placebo arms, further studies are needed to better address this point.Journal of Schizophrenia Research. 08/2014; 1(1):1-12.
- [Show abstract] [Hide abstract]
ABSTRACT: Diagnoses of psychiatric diseases do not include criminal behavior. In schizophrenia, a non-negligible subgroup is incarcerated for capital and other crimes. Most studies that compared offender and non-offender patients with schizophrenia have only focused on male patients. With this study, we compared demographic and disease-related characteristics between 35 female incarcerated forensic patients (fSZ) and 35 female inpatients with schizophrenia (SZ). Basic clinical documentation and basic forensic clinical documentation revealed significant clinical and demographic differences between the two groups. Compared to SZ, fSZ were more severely clinically impaired, showing higher rates of comorbid alcohol and substance disorder, more suicide attempts, had more previous hospitalizations, and were younger at disease onset. Regarding demographic variables, fSZ showed a higher rate of unemployment and homelessness and had to rely more often on housing and legal guardianships compared to SZ. These results suggest that female forensic patients with schizophrenia are more severely affected by clinical and non-clinical variables requiring an adapted intervention program. These results may also indicate two developmental trajectories for criminal and non-criminal schizophrenia in females.Psychiatry research. 10/2013;