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Chiappini S, Cavallotto C, Mosca A, Di Carlo F, Piro T, Giovannetti G, Pasino A, Vicinelli M, Lorenzini C, Di Paolo M, Pepe M, Di Nicola M, Ricci V, Pettorruso M, Martinotti G. Investigating the Effectiveness of Brexpiprazole in Subjects with Schizophrenia Spectrum Illness and Co-Occurring Substance Use Disorder: A Prospective, Multicentric, Real-World Study. Pharmaceuticals (Basel) 2024; 17:535. [PMID: 38675495 PMCID: PMC11053971 DOI: 10.3390/ph17040535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Dual disorders (DDs) involve the coexistence of a substance use disorder (SUD) with another mental illness, often from the psychotic and affective categories. They are quite common in clinical practice and present significant challenges for both diagnosis and treatment. This study explores the effectiveness of brexpiprazole, a third-generation antipsychotic, in an Italian sample of individuals diagnosed with schizophrenia spectrum disorder and a comorbid SUD. METHODS Twenty-four patients, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and enrolled in several Italian hospitals, underwent a psychometric assessment at baseline (T0) and one month (T1) after starting brexpiprazole treatment administered at a mean dosage of 2 mg/day. RESULTS Brexpiprazole demonstrated significant reductions in psychopathological burden (Positive and Negative Syndrome Scale/PANSS total score: p < 0.001). Positive (p = 0.003) and negative (p = 0.028) symptoms, substance cravings (VAS craving: p = 0.039), and aggression (MOAS scale: p = 0.003) were notably reduced. Quality of life improved according to the 36-item Short Form Health Survey (SF-36) subscales (p < 0.005). CONCLUSIONS This study provides initial evidence supporting brexpiprazole's efficacy and safety in this complex patient population, with positive effects not only on psychopathology and quality of life, but also on cravings. Further studies involving larger cohorts of subjects and extended follow-up periods are needed.
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Affiliation(s)
- Stefania Chiappini
- School of Medicine, UniCamillus International Medical School University, Via di S. Alessandro 8, 00131 Rome, Italy;
| | - Clara Cavallotto
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Alessio Mosca
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Francesco Di Carlo
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Tommaso Piro
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Giulia Giovannetti
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Arianna Pasino
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Mariachiara Vicinelli
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Chiara Lorenzini
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Mariapia Di Paolo
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Maria Pepe
- University Polyclinic Foundation “A. Gemelli” IRCCS, Catholic University of the Sacred Heart, 00136 Rome, Italy; (M.P.); (M.D.N.)
| | - Marco Di Nicola
- University Polyclinic Foundation “A. Gemelli” IRCCS, Catholic University of the Sacred Heart, 00136 Rome, Italy; (M.P.); (M.D.N.)
| | - Valerio Ricci
- Department of Psychiatry, “San Luigi Gonzaga” Hospital, University of Turin, 10124 Turin, Italy;
| | - Mauro Pettorruso
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
| | - Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D‘Annunzio, 66100 Chieti, Italy; (A.M.); (F.D.C.); (T.P.); (G.G.); (A.P.); (M.V.); (C.L.); (M.D.P.); (M.P.); (G.M.)
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Francis B, Ganasan VA, Sulaiman ARB. Brexpiprazole Attenuates Aggression, Suicidality and Substance Use in Borderline Personality Disorder: A Case Series. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:283. [PMID: 38399570 PMCID: PMC10890360 DOI: 10.3390/medicina60020283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
Background: Borderline personality disorder (BPD) is a heterogeneous and highly comorbid disorder. Suicidality, aggression and substance abuse are common presentations of BPD. Our case series is the first to highlight the role of brexpiprazole in improving these symptoms in patients with BPD. Case presentation: We describe three cases demonstrating the role of brexpiprazole in improving BPD's prominent features and comorbidities. All cases improved when brexpiprazole was added to their treatment regime. Case 1: A 26-year-old woman who was diagnosed with BPD and cyclothymia, presented to the psychiatric emergency unit with impulsive suicidal behaviour. Case 2: A 43-year-old woman suffering from BPD sought help due to her violent behaviour and emotional dysregulation. Case 3: A 22-year-old woman with underlying attention deficit and hyperactivity disorder, polysubstance use disorder and BPD presented with dysregulated emotions. Conclusions: Our case series provides anecdotal evidence of the potential role of brexpiprazole in attenuating suicidality, aggression and substance abuse in patients with BPD. We postulate that brexpiprazole's high affinity for the 5HT1A/5HT2A receptors, coupled with its low intrinsic effect on the D2/D3 receptor system, is fundamental in its actions to stabilise the aberrant dopaminergic and serotonergic signalling in BPD. Future research should focus on well-designed clinical trials investigating the efficacy of brexpiprazole in patients with BPD.
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Affiliation(s)
- Benedict Francis
- Department of Psychiatry, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Vijay A/L Ganasan
- Department of Psychiatry and Mental Health, Hospital Tuanku Ja’afar, Seremban 70300, Malaysia;
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Lombardozzi G, Trovini G, Amici E, Kotzalidis GD, Perrini F, Giovanetti V, Di Giovanni A, De Filippis S. Brexpiprazole in patients with schizophrenia with or without substance use disorder: an observational study. Front Psychiatry 2023; 14:1321233. [PMID: 38111619 PMCID: PMC10725927 DOI: 10.3389/fpsyt.2023.1321233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/13/2023] [Indexed: 12/20/2023] Open
Abstract
Background Partial dopamine D2 receptor agonists are used for psychotic symptoms in adults with schizophrenia spectrum disorders. Recently, interest surged for partial dopamine D2 receptor agonists in substance use disorders (SUDs). Since it is believed that SUDs decrease the efficacy of pharmacotherapy of underlying psychiatric disorders, we tested the efficacy of the partial D2 agonist brexpiprazole in patients with schizophrenia who were either comorbid with a SUD (SUD group) or not comorbid (non-SUD) to assess treatment response and the effect of brexpiprazole on substance craving in SUD. Methods We included patients with DSM-5/DSM-5-TR schizophrenia (using SCID-5-CV) aged 18-66 years with either comorbid SUD or non-SUD to treat with brexpiprazole 4 mg/day for 6 months during February-October 2022. Patients were assessed with the Clinical Global Impressions-Severity (CGI-S) scale, the 24-item Brief Psychiatric Rating Scale (BPRS), and the Positive And Negative Syndrome Scale (PANSS) at baseline, weekly for the first 2 months and monthly for the next four. Furthermore, we assessed substance craving in SUD with a visual analog scale for craving (VAScrav) at the same timepoints. Results The total sample was 86 (85 analysable) 18- to 64-year-old (mean 39.32 ± 14.09) patients with schizophrenia [51 men (59.3%) and 35 women (40.7%)], of whom 48 SUD (55.8%) (37 men and 11 women) and 38 non-SUD (44.2%) (14 men and 24 women). No serious or persistent adverse events developed over the study period, but one patient dropped out for subjective akathisia. Results indicated the main effects of time with improvements over the course of the study for CGI-S, BPRS, and PANSS in both SUD and non-SUD groups and the entire sample, and for VAScrav in SUD. Brexpiprazole was associated with similar significant improvements in both groups at the 6 month endpoint compared to baseline. Conclusion Treatment with brexpiprazole for 6 months improved psychotic symptoms in patients with schizophrenia, independently from whether they belonged to the SUD or the non-SUD group; hence, SUD comorbidity did not confer treatment resistance to brexpiprazole. Furthermore, in the SUD group, we observed reduced substance craving.
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Affiliation(s)
- Ginevra Lombardozzi
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
| | - Giada Trovini
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
| | - Emanuela Amici
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
| | - Georgios D. Kotzalidis
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
- Centro Lucio Bini, Rome, Italy
| | | | - Valeria Giovanetti
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
| | | | - Sergio De Filippis
- Villa Von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Italy
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Grunze H. The role of the D3 dopamine receptor and its partial agonist cariprazine in patients with schizophrenia and substance use disorder. Expert Opin Pharmacother 2023; 24:1985-1992. [PMID: 37817489 DOI: 10.1080/14656566.2023.2266359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION Comorbidity of substance use disorder (SUD) with schizophrenia, referred to as dual disorder (DD), significantly increases morbidity and mortality compared to schizophrenia alone. A dopaminergic dysregulation seems to be a common pathophysiological basis of the comorbidity. AREAS COVERED This article reports the current evidence on the role of dopamine dysregulations in DD, the pharmacological profile of cariprazine, a partial agonist of D3 and D2 dopamine receptors, and first clinical observations that may support its usefulness in the therapy of DD. PubMed/MEDLINE was searched for the keywords 'cariprazine,' 'schizophrenia,' 'dual disorder,' 'dopamine,' and 'dopamine receptor.' Preclinical and clinical studies, and reviews published in English were retrieved. EXPERT OPINION Although the management of DD remains challenging, and the evidence for pharmacologic treatments is still unsatisfactory, cariprazine may be a candidate medication in DD due to its unique mechanism of action. Preliminary clinical experiences suggest that cariprazine has both antipsychotic and anticraving properties and should be considered early in patients with DD.
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Affiliation(s)
- Heinz Grunze
- Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany
- Department of Psychiatry, Paracelsus Medical University Nuremberg, Nuremberg, Germany
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5
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Nickols JER, Dursun SM, Taylor AMW. Preclinical evidence for the use of the atypical antipsychotic, brexpiprazole, for opioid use disorder. Neuropharmacology 2023; 233:109546. [PMID: 37068603 DOI: 10.1016/j.neuropharm.2023.109546] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/24/2023] [Accepted: 04/12/2023] [Indexed: 04/19/2023]
Abstract
Opioid addiction is characterized by adaptations in the mesolimbic dopamine system that occur during chronic opioid use. Alterations in dopaminergic transmission contribute to pathological drug-seeking behavior and other symptoms associated with opioid withdrawal following drug discontinuation, making drug abstinence challenging and contributing to high rates of relapse among those suffering from substance use disorder. Recently, the use of dopamine partial agonists has been proposed as a potential strategy to restore dopaminergic signalling during drug withdrawal, while avoiding the adverse side effects associated with stronger modulators of dopaminergic transmission. We investigated the effects of the atypical antipsychotic brexpiprazole, which is a partial agonist at dopamine D2 and D3 receptors, in a mouse model of opioid dependence. The development of opioid dependence in mice is characterized by locomotor sensitization, analgesic tolerance, opioid-induced hyperalgesia, and drug-seeking behavior. We set up four paradigms to model the effects of brexpiprazole on each of these adaptations that occur during chronic opioid use in male and female C57BL/6J mice. Concomitant treatment of brexpiprazole during chronic morphine administration attenuated the development of locomotor sensitization. Brexpiprazole treatment abolished morphine place preference and blocked reinstatement of this behavior following extinction. Brexpiprazole treatment did not alter morphine analgesia, nor did it impact the development of morphine tolerance. However, brexpiprazole treatment did prevent the expression of opioid-induced hyperalgesia in a tail-withdrawal assay, while failing to improve somatic withdrawal symptoms. Altogether, these results provide preclinical evidence for the efficacy of brexpiprazole as a modulator of dopamine-dependent behaviors during opioid use and withdrawal.
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Affiliation(s)
| | - Serdar M Dursun
- Department of Psychiatry, University of Alberta, Edmonton, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Anna M W Taylor
- Department of Pharmacology, University of Alberta, Edmonton, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada; Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada.
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Haddad PM, Correll CU. Long-acting antipsychotics in the treatment of schizophrenia: opportunities and challenges. Expert Opin Pharmacother 2023; 24:473-493. [PMID: 36919576 DOI: 10.1080/14656566.2023.2181073] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Maintenance antipsychotic treatment improves multiple outcomes in people with schizophrenia. These benefits are challenged by medication nonadherence, which is a common occurrence. Long-acting injectable antipsychotic (LAI) formulations were developed to reduce nonadherence and thereby improve outcomes. This narrative review is based on a PubMed search (January 2000 - August 2022) for studies on LAI antipsychotics. AREAS COVERED Opportunities and challenges associated with LAIs are reviewed. Advantages, compared to oral antipsychotics (OAs), include improved adherence, reduced relapse and hospitalization risk, delayed and lower relapse risk after stopping treatment, and the ability to differentiate true treatment resistance from 'pseudo'-resistance. Additionally, LAIs are associated with lower all-cause mortality than OAs. LAIs are under-used in many services, partly reflecting negative attitudes, misconceptions, and lack of knowledge among clinicians, patients, and carers. Practical barriers to LAI use include acquisition costs and inadequate service structures to administer/monitor LAI treatment. EXPERT OPINION The education and engagement of clinicians, patients and caregivers can assist more informed decision-making regarding LAIs. Future research regarding LAIs should encompass multiple complementary designs, focus on functionality and recovery outcomes, and include groups at high risk of relapse, including those with comorbid substance use disorders and early in the course of schizophrenia.
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Affiliation(s)
- Peter M Haddad
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK.,Mental Health, Drugs and Alcohol Services (MHDAS), Barwon Health, Geelong, Australia
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
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High Rate of Discontinuation during Long-Acting Injectable Antipsychotic Treatment in Patients with Psychotic Disorders. Biomedicines 2023; 11:biomedicines11020314. [PMID: 36830850 PMCID: PMC9953565 DOI: 10.3390/biomedicines11020314] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 01/24/2023] Open
Abstract
Treatment discontinuation is a major challenge in routine clinical settings. Despite poor adherence to antipsychotic medication, long acting injectable (LAI) formulations are an underutilized option in psychotic disorders. Recently, an earlier and broader use of LAIs has been emphasized. However, few studies have evaluated the factors associated with LAI antipsychotic discontinuation in ordinary clinical practice. The main purpose of the present study was, therefore, to identify the factors associated with LAI discontinuation in a real-world setting. Patients in treatment with LAI antipsychotics were recruited. A Cox regression analysis was applied considering a 12-month follow-up period. Moreover, a Kaplan-Meier survival analysis was applied to compare the single treatment LAI antipsychotic groups in terms of time to discontinuation. Our analysis showed an LAI discontinuation rate at 12 months, corresponding to 28.8%, with olanzapine and aripiprazole having a longer time to discontinuation compared to zuclopenthixol. The results of the present study can help clinicians with their choice of LAI antipsychotic according to patients' characteristics and in a context of precision medicine. Increasing knowledge about factors affecting discontinuation of LAI antipsychotics can improve the prescribing practices of these compounds. Individualized approaches may ameliorate long-term patients' treatment adherence, thus preventing the long-term disability caused by psychotic disorders.
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Margolese HC, Boucher M, Therrien F, Clerzius G. Treatment with aripiprazole once-monthly injectable formulation is effective in improving symptoms and global functioning in schizophrenia with and without comorbid substance use - a post hoc analysis of the ReLiAM study. BMC Psychiatry 2022; 22:773. [PMID: 36482352 PMCID: PMC9733174 DOI: 10.1186/s12888-022-04397-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/16/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND ReLiAM, Real-Life Assessment of Abilify Maintena, was the first reported long-term prospective non-interventional study for patients with schizophrenia treated with aripiprazole once-monthly injectable formulation (AOM) under real-life conditions. ReLiAM's primary aim was to evaluate the evolution of global functional status in patients treated with AOM for 12 months in Canada. METHODS The objective of this post hoc analysis of the ReLiAM study is to investigate the treatment effects of real-life use of AOM over a 1-year period in the subgroup of patients with reported substance use compared with patients without substance use. RESULTS The results of this post hoc analysis demonstrate that treatment with AOM for 12 months in patients with schizophrenia was comparably effective in improving global functioning in subgroups of patients with and without concomitant substance use. CONCLUSIONS These results support the use of AOM for the treatment of schizophrenia in patients with or without concomitant substance use. TRIAL REGISTRATION ClinicalTrials.gov NCT02131415, first posted on May 6, 2014. Overall trial status: Terminated.
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Affiliation(s)
- Howard C. Margolese
- grid.63984.300000 0000 9064 4811Schizophrenia Program, McGill University Health Centre, Montreal, QC Canada ,grid.14709.3b0000 0004 1936 8649Department of Psychiatry, McGill University, Montreal, QC Canada ,grid.63984.300000 0000 9064 4811MUHC, Allan Memorial Institute, 1025 Pine Ave W, Montreal, QC H3A 1A1 Canada
| | - Matthieu Boucher
- Medical Affairs, Otsuka Canada Pharmaceutical Inc, St-Laurent, QC Canada ,grid.14709.3b0000 0004 1936 8649Department of Pharmacology and Therapeutics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC Canada
| | - Francois Therrien
- Medical Affairs, Otsuka Canada Pharmaceutical Inc, St-Laurent, QC Canada
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Fraguas D, Almenta Gallego D, Arques-Egea S, Gómez-Revuelta M, Sánchez-Lafuente CG, Hernández Huerta D, Núñez Arias D, Oda Plasencia-García B, Parro Torres C, Romero-Guillena SL, Ros Cucurul E, Alamo C. Aripiprazole for the treatment of schizophrenia: Recommendations of a panel of Spanish experts on its use in clinical practice. Int J Psychiatry Clin Pract 2022; 27:82-91. [PMID: 35792729 DOI: 10.1080/13651501.2022.2064308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Aripiprazole is an antipsychotic with a partial agonism of dopamine D2 and D3 receptors. This differential mechanism implies a rigorous appraisal of the appropriate therapeutic strategies in certain situations. To answer currently unsolved clinical questions about the use of oral and long-acting injectable (LAI) aripiprazole, we present here an expert consensus from 12 Spanish psychiatrists and a pharmacologist with extensive experience in the use of this antipsychotic. METHODS Through one face-to-face session and online collaboration, we reached consensus and established practical recommendations based on scientific evidence and clinical experience. We classified the available scientific literature according to SIGN system and attributed a level of evidence to each reviewed article. RESULTS The recommendations were divided according to (i) chronological dimension (based on previous treatments, including patients naïve or not to antipsychotic treatment and maintenance regimen), and (ii) dimension related to therapeutic options, comprising switches to aripiprazole and the most used combinations with this antipsychotic. CONCLUSIONS We recommend considering aripiprazole as first treatment option in the early stages of schizophrenia and in patients with affective symptoms and contemplating a switch to aripiprazole LAI in all candidate patients. Importantly, switches from other antipsychotics should consider previous antipsychotic history and exposure to aripiprazole. KEYPOINTSAripiprazole can be considered as first treatment option in early stages of schizophrenia and in patients with significant affective symptoms.Aripiprazole LAI shows better adherence than oral aripiprazole and could be considered in all candidate patients.Before switching to aripiprazole, detailed information about previous antipsychotic history should be gathered.Switch to aripiprazole should be managed differently for aripiprazole naïve and non-naïve patients.Rigorous and controlled studies on antipsychotics in real clinical practice should be carried out.
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Affiliation(s)
- David Fraguas
- Institute of Psychiatry and Mental Health, Hospital Clínico San Carlos, IdISSC, CIBERSAM, School of Medicine (UCM), Madrid, Spain
| | | | - Sergio Arques-Egea
- Paterna's Mental Health Service, Arnau de Vilanova-Lliria University Hospital, Valencia, Spain
| | - Marcos Gómez-Revuelta
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, University of Cantabria, Santander, Spain
| | | | | | | | - Beatriz Oda Plasencia-García
- Department of Psychiatry, Mental Health's Clinical Management Service, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Carlos Parro Torres
- Institute of Psychiatry and Mental Health, Gregorio Marañón University General Hospital, Madrid, Spain
| | | | - Elena Ros Cucurul
- Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Autonomous University of Barcelona, Barcelona, Spain
| | - Cecilio Alamo
- Department of Biomedicine, Alcala de Henares, University, Madrid, Spain
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10
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Martinotti G, Chiappini S, Mosca A, Miuli A, Santovito MC, Pettorruso M, Skryabin V, Sensi SL, Giannantonio MD. Atypical antipsychotic drugs in dual disorders: current evidence and clinical guidelines. Curr Pharm Des 2022; 28:2241-2259. [PMID: 35747956 DOI: 10.2174/1381612828666220623092853] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/15/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Concurrent disorder or dual diagnosis refers to a combination of substance use disorders and mental disorders that occur in the same patient simultaneously. These conditions pose significant clinical and healthcare impacts and are often underdiagnosed, undertreated, and complex to manage. OBJECTIVE We assessed the quality of current pharmacological recommendations for the management of dual diagnosis, particularly by evaluating the use of second-generation antipsychotics (SGA). METHOD A literature search was performed using the PubMed and Scopus databases for publications up to September 21, 2021, without any time restrictions. The following search strings were used: (aripiprazole OR brexpiprazole OR cariprazine OR paliperidone OR risperidone OR quetiapine OR clozapine OR olanzapine) AND (psychosis OR schizophrenia OR schizoaffective) AND ("substance use disorder" OR cocaine OR alcohol OR cannabis OR heroin OR "double diagnosis" OR "dual diagnosis")) NOT (animal OR rat OR mouse) NOT (review or meta-analysis). RESULTS The search produced a final set of 41 articles. Most patients were males and were affected by schizophrenia, with cannabis the most abused substance, followed by alcohol. Aripiprazole was the most used drug, either orally or by long-acting formulations, followed by risperidone with oral and long-acting formulations, clozapine, olanzapine, and quetiapine. CONCLUSION The findings highlight the use of SGA for the treatment of psychotic symptoms in comorbidity with substance use. Future studies on people with dual diagnosis and focused on long-term evaluations are warranted and need to investigate the efficacy of newly introduced molecules, such as partial D2 agonists and long-acting injectable antipsychotics.
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Affiliation(s)
- Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy.,Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK
| | - Stefania Chiappini
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy.,Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK
| | - Alessio Mosca
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
| | - Andrea Miuli
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
| | - Maria Chiara Santovito
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
| | - Mauro Pettorruso
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
| | - Valentin Skryabin
- Moscow Research and Practical Center on Addictions of the Moscow Department of Healthcare, 37/1 Lyublinskaya street, Moscow, Russia
| | - Stefano L Sensi
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
| | - Massimo Di Giannantonio
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
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11
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Llorca PM, Nuss P, Fakra É, Alamome I, Drapier D, Hage WE, Jardri R, Mouchabac S, Rabbani M, Simon N, Vacheron MN, Azorin JM. Place of the partial dopamine receptor agonist aripiprazole in the management of schizophrenia in adults: a Delphi consensus study. BMC Psychiatry 2022; 22:364. [PMID: 35643542 PMCID: PMC9142729 DOI: 10.1186/s12888-022-04008-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/16/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Aripiprazole is a second-generation antipsychotic, efficacious in patients with schizophrenia during acute episodes. Due to its pharmacological profile, aripiprazole may be of interest in patients with specific clinical profiles who have not been studied extensively in randomised clinical trials. OBJECTIVES To capture experience with aripiprazole in everyday psychiatric practice using the Delphi method in order to inform decision-making on the use of aripiprazole for the treatment of patients with schizophrenia in clinical situations where robust evidence from clinical trials is lacking. METHODS The scope of the survey was defined as the management of schizophrenia in adults. A systematic literature review was performed to identify the different clinical situations in which aripiprazole has been studied, and to describe the level of clinical evidence. Clinical profiles to include in the Delphi survey were selected if there was a clear interest in terms of medical need but uncertainty over the efficacy of aripiprazole. For each clinical profile retained, five to seven specific statements were generated and included in a questionnaire. The final 41-item questionnaire was proposed to a panel of 406 French psychiatrists with experience in the treatment of schizophrenia. Panellists rated their level of agreement using a Likert scale. A second round of voting on eleven items was organised to clarify points for which a consensus was not obtained in the first round. RESULTS Five clinical profiles were identified in the literature review (persistent negative symptoms, pregnancy, cognitive dysfunction, addictive comorbidity and clozapine resistance). Sixty-two psychiatrists participated in the first round of the Delphi survey and 33 in the second round. A consensus was obtained for 11 out of 41 items in the first round and for 9/11 items in the second round. According to the panellists' clinical experience, aripiprazole can be used as maintenance treatment for pregnant women, is relevant to preserve cognitive function and can be considered an option in patients with a comorbid addictive disorder or with persistent negative symptoms. CONCLUSION These findings may help physicians in choosing relevant ways to use aripiprazole and highlight areas where more research is needed to widen the evidence base.
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Affiliation(s)
- Pierre-Michel Llorca
- Department of Psychiatry, Clermont-Ferrand University Hospital, Clermont Auvergne University, Clermont-Ferrand, France.
| | - Philippe Nuss
- grid.412370.30000 0004 1937 1100Psychiatry and Medical Psychology Department, Saint-Antoine Hospital, Paris Sorbonne University, Paris, France
| | - Éric Fakra
- grid.412954.f0000 0004 1765 1491University Hospital Psychiatry Group, Saint-Étienne University Hospital, Saint-Étienne, France
| | - Isabelle Alamome
- Department of Psychiatry, Polyclinic of Limoges, Limoges, France
| | - Dominique Drapier
- grid.410368.80000 0001 2191 9284University Hospital Adult Psychiatry Group, Guillaume-Régnier Hospital, University of Rennes 1, Rennes, France
| | - Wissam El Hage
- grid.12366.300000 0001 2182 6141UMR 1253, iBrain, Tours University, Inserm, Tours, France
| | - Renaud Jardri
- grid.410463.40000 0004 0471 8845Lille Neuroscience & Cognition Centre, INSERM U1172, Fontan Hospital, Lille University Hospital, Lille, France
| | - Stéphane Mouchabac
- grid.412370.30000 0004 1937 1100Psychiatry and Medical Psychology Department, Saint-Antoine Hospital, Paris Sorbonne University, Paris, France
| | - Marc Rabbani
- Medical Affairs Department, Lundbeck SAS, Puteaux, France
| | - Nicolas Simon
- grid.464064.40000 0004 0467 0503Department of Clinical Pharmacology, Aix Marseille University, INSERM, SESSTIM, Hospital Sainte Marguerite, CAP, Marseille, IRD France
| | | | - Jean-Michel Azorin
- grid.414438.e0000 0000 9834 707XDepartment of Psychiatry, Sainte Marguerite Hospital, Marseille, France
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12
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Corbo M, Martinotti G, Aguglia A, Salvi V, Amerio A, Calò S, Fusar-Poli L, Serafini G, Signorelli M, Amore M, Mencacci C, Di Sciascio G, Biggio G, Aguglia E, Di Giannantonio M. Long-acting second-generation and oral antipsychotics for substance use disorders and psychotic symptoms: Prescribing attitudes among Italian psychiatrists. Perspect Psychiatr Care 2021; 57:1700-1706. [PMID: 33616260 DOI: 10.1111/ppc.12738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To explore Italian psychiatrists' attitudes toward the off-label use of second generation antipsychotics (SGAs) in patients with substance use disorder and psychotic symptoms. DESIGN AND METHODS A sample of 300 Italian psychiatrists associated with the Italian Society of Neuropsychopharmacology was randomly selected to complete a survey about the off-label prescription of SGAs. FINDINGS Oral aripiprazole (32.7%), olanzapine (30.2%), and quetiapine (25.2%) were considered "appropriate." Long-acting antipsychoticss were generally considered "inappropriate." PRACTICE IMPLICATIONS Our findings reflect a substantial level of uncertainty and a lack of coherent clinical guidance within the realm of dual diagnosis treatment. Therefore, they emphasize the need to develop specific guidelines to improve the management of pharmacotherapy among this population.
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Affiliation(s)
- Mariangela Corbo
- Department of Neuroscience Imaging and Clinical Science, "G. d'Annunzio" University of Chieti, Chieti, Italy
| | - Giovanni Martinotti
- Department of Neuroscience Imaging and Clinical Science, "G. d'Annunzio" University of Chieti, Chieti, Italy.,Department of Pharmacy, Pharmacology and Clinical Science, University of Hertfordshire, Herts, UK
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Virginio Salvi
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Mood Disorders Program, Tufts Medical Center, Boston, Massachusetts, USA
| | - Salvatore Calò
- Department of Mental Health, Local Health Agency, Lecce, Italy
| | - Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatric Clinic University Hospital "Gaspare Rodolico", University of Catania, Catania, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Signorelli
- Department of Clinical and Experimental Medicine, Psychiatric Clinic University Hospital "Gaspare Rodolico", University of Catania, Catania, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudio Mencacci
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Giovanni Biggio
- Department of Life and Environmental Sciences, Institute of Neuroscience, CNR, University of Cagliari, Cagliari, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatric Clinic University Hospital "Gaspare Rodolico", University of Catania, Catania, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience Imaging and Clinical Science, "G. d'Annunzio" University of Chieti, Chieti, Italy
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13
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Olivares JM, González-Pinto A, Páramo M. Predictors of persistence in patients with schizophrenia treated with aripiprazole once-monthly long-acting injection in the Spanish clinical practice: a retrospective, observational study. Eur Psychiatry 2021; 64:e40. [PMID: 33840396 PMCID: PMC8260564 DOI: 10.1192/j.eurpsy.2021.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Poor adherence to antipsychotic drugs is a major problem in schizophrenia management and one of the most important risk factors for relapse and hospitalization. To date, there is little evidence on persistence predictors with long-acting injectable antipsychotics, especially with aripiprazole once-monthly (AOM). This study (NCT03130478) aimed to describe the impact of demographic and clinical characteristics on persistence with AOM treatment in real-world setting. Methods This was an observational, retrospective, non-interventional study that included adult patients with schizophrenia who were initiated on AOM during a schizophrenia-related hospitalization. Data were retrospectively collected from patients’ medical records. The primary variable was persistence with AOM, measured as the number of days from AOM initiation up to all-cause AOM discontinuation during the first six months after treatment index. Results 140 patients were enrolled and 91 fulfilled the selection criteria. Six months after AOM initiation, 65 (71.4%) patients were still receiving AOM treatment, whereas 26 (28.6%) were not. The mean (standard deviation) time to AOM treatment discontinuation in the first six months was 138.1 (6.8) days, with most of the patients discontinuing at the first 28 days. The risk of AOM discontinuation in the first six months increases 1.05-fold annually since schizophrenia diagnosis (p=0.003); moreover, this risk increases 2.86-fold in patients with concomitant schizophrenia medication at AOM initiation compared to patients without concomitant schizophrenia treatments (p=0.02). Conclusions Main factors predicting persistence with AOM treatment at six months in clinical practice are fewer years since schizophrenia diagnosis and not receiving concomitant schizophrenia treatments at AOM initiation.
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Affiliation(s)
- José Manuel Olivares
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | - Mario Páramo
- Complejo Hospitalario Universitario de Santiago Compostela, Santiago de Compostela, Spain
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14
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Peris L, Szerman N. Partial Agonists and Dual Disorders: Focus on Dual Schizophrenia. Front Psychiatry 2021; 12:769623. [PMID: 34975572 PMCID: PMC8716462 DOI: 10.3389/fpsyt.2021.769623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/18/2021] [Indexed: 12/31/2022] Open
Abstract
Dual disorder is a term applied to patients with an addictive disorder and other mental disorder. Epidemiological studies have established that dual disorders are an expectation rather than an exception. They are difficult to diagnose and treat and constitute a huge burden for both patients and their relatives and society. Current treatments are a combination of those needed to treat the addictive disorder with those focused on the co-occurring psychiatric disorder. Focusing specifically on schizophrenia, growing scientific evidence supports the existence of a shared vulnerability for substance use in these patients and those at risk. Various antipsychotics have been found to be useful in the treatment of psychotic symptoms and disorders; however, few effective treatments have been identified until now for substance use disorders in patients with dual schizophrenia. Partial agonism stands as a new pharmacological option available in recent years. Molecules with this kind of action may act as functional agonists or as antagonists, depending on the surrounding levels of the neurotransmitter. Studies have found their efficacy in schizophrenia, addiction, anxiety and depression. Certain partial agonist antipsychotics seem to have a role in the treatment of dual schizophrenia. That could be the case with cariprazine. Because of its higher affinity for dopaminergic D3 receptors compared to D2, a potential to prevent relapse to addiction, added to its antipsychotic efficacy, has been suggested. Here we briefly review current advances and future directions and introduce some personal insights into the role of partial agonists in co-occurring schizophrenia and substance use.
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Affiliation(s)
- Lola Peris
- Centre Neuchâtelois De Psychiatrie, Marin-Epagnier, Switzerland
| | - Nestor Szerman
- Hospital Universitario Gregorio Marañon, Madrid, Spain.,Fundación Patología Dual, WPA Section on Dual Disorders, WADD, Madrid, Spain
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15
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Coles AS, Knezevic D, George TP, Correll CU, Kane JM, Castle D. Long-Acting Injectable Antipsychotic Treatment in Schizophrenia and Co-occurring Substance Use Disorders: A Systematic Review. Front Psychiatry 2021; 12:808002. [PMID: 34975600 PMCID: PMC8715086 DOI: 10.3389/fpsyt.2021.808002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/23/2021] [Indexed: 12/27/2022] Open
Abstract
Objectives: Co-occurring substance use disorders (SUDs) among individuals with schizophrenia are a prevalent and complex psychiatric comorbidity, which is associated with increased symptom severity, worsened illness trajectory and high rates of treatment non-adherence. Recent evidence suggests that the use of long-acting injectable (LAI) antipsychotics may provide an effective treatment option for individuals with this dual-diagnosis. Methods: A systematic review of the literature was conducted using the databases PubMed, PsychInfo and Google Scholar for English-language studies, investigating the use of LAIs in co-occurring schizophrenia and substance use disorders (SCZ-SUDs). Results: Eight reports [one case study (n = 1), one case series (n = 8), three open-label retrospective studies (n = 75), and three randomized controlled trials (n = 273)] investigated the use of LAI antipsychotics in 357 participants with SCZ-SUDs [alcohol use disorder: 5 studies, n = 282; cocaine use disorder: 5 studies, n = 85; amphetamine use disorder: 1 study, n = 1; cannabis use disorder: 3 studies, n = 160; opioid use disorder: 3 studies, n = 19; methylenedioxymethamphetamine (MDMA) use disorder: 2 studies, n = 9; ketamine use disorder: 1 study, n = 4] and were included in this systematic review. Findings indicate significant improvements in substance use related outcomes across 7 of 8 studies, while in 6 of 8 studies, significant improvements in psychopathology-related outcomes were reported. Conclusions: LAI antipsychotics may be an efficacious intervention option for the treatment of SCZ-SUDs. However, varying methodological rigor, generally small sample sizes and heterogeneity of samples, settings, substances of abuse, tested LAIs and comparators, as well as psychosocial cotreatments and level of reported detail across studies requires that these findings be considered preliminary and interpreted with caution. Further research is required to better understand the effects of LAIs among individuals with SCZ-SUDs.
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Affiliation(s)
- Alexandria S Coles
- Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Dunja Knezevic
- Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Tony P George
- Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Christoph U Correll
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, United States
| | - John M Kane
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, United States
| | - David Castle
- Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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