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Cavallotto C, Chiappini S, Mosca A, d’Andrea G, Di Carlo F, Piro T, Susini O, Stefanelli G, Di Cesare A, Ricci V, Pepe M, Dattoli L, Di Nicola M, Pettorruso M, Martinotti G. Examining Lurasidone Efficacy in Patients with Schizophrenia Spectrum Illness and Concurrent Alcohol and Substance Use Disorder: A Prospective, Multicentric, Real-World Investigation. J Clin Med 2024; 13:2206. [PMID: 38673478 PMCID: PMC11051375 DOI: 10.3390/jcm13082206] [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: 02/09/2024] [Revised: 03/18/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Dual disorders (DD) entail the coexistence of a substance use disorder (SUD) and another mental health condition, often within psychotic and affective disorders. This study aims to evaluate lurasidone, an innovative atypical antipsychotic, in individuals diagnosed with schizophrenia spectrum disorder and concurrent comorbidities of alcohol use disorder/substance use disorder (AUD/SUD). Methods: A cohort of 23 subjects diagnosed with schizophrenia spectrum disorder and comorbid AUD/SUD underwent psychometric assessments at baseline (T0) and one-month (T1) post-lurasidone initiation. Results: Lurasidone exhibited significant reductions in psychopathological burden, evidenced by decreased total PANSS scores (Z = 2.574, p = 0.011). Positive symptoms, substance craving (VAS Craving; Z = 3.202, p = 0.001), and aggressivity (MOAS scale; Z = 2.000, p = 0.050) were notably reduced. Clinical Global Impression (CGI) scores significantly improved (Z = 2.934, p = 0.003). Quality of life enhancements were observed in SF-36 subscales (energy, emotional well-being, and social functioning) (p < 0.05) and Q-LES-Q-SF scale (Z = -2.341, p = 0.021). A safety analysis indicated lurasidone's good tolerability, with only 8.7% reporting discontinuation due to side effects. Conclusions: This study offers initial evidence supporting lurasidone's efficacy and safety in dual diagnoses, highlighting positive effects on psychopathology, substance craving, and quality of life. These findings emphasize the need for tailored, comprehensive treatment strategies in managing the complexities of this patient population.
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Affiliation(s)
- Clara Cavallotto
- Department of Neurosciences, Imaging and Clinical Sciences, “G. D’Annunzio” University, 66100 Chieti, Italy; (C.C.); (G.d.); (F.D.C.); (T.P.); (G.S.); (L.D.); (M.P.)
| | - Stefania Chiappini
- School of Medicine, UniCamillus International Medical School University, 00131 Rome, Italy;
| | - Alessio Mosca
- Department of Neurosciences, Imaging and Clinical Sciences, “G. D’Annunzio” University, 66100 Chieti, Italy; (C.C.); (G.d.); (F.D.C.); (T.P.); (G.S.); (L.D.); (M.P.)
| | - Giacomo d’Andrea
- Department of Neurosciences, Imaging and Clinical Sciences, “G. D’Annunzio” University, 66100 Chieti, Italy; (C.C.); (G.d.); (F.D.C.); (T.P.); (G.S.); (L.D.); (M.P.)
| | - Francesco Di Carlo
- Department of Neurosciences, Imaging and Clinical Sciences, “G. D’Annunzio” University, 66100 Chieti, Italy; (C.C.); (G.d.); (F.D.C.); (T.P.); (G.S.); (L.D.); (M.P.)
| | - Tommaso Piro
- Department of Neurosciences, Imaging and Clinical Sciences, “G. D’Annunzio” University, 66100 Chieti, Italy; (C.C.); (G.d.); (F.D.C.); (T.P.); (G.S.); (L.D.); (M.P.)
| | - Ottavia Susini
- Department of Neurosciences, Imaging and Clinical Sciences, “G. D’Annunzio” University, 66100 Chieti, Italy; (C.C.); (G.d.); (F.D.C.); (T.P.); (G.S.); (L.D.); (M.P.)
| | - Giulia Stefanelli
- Department of Neurosciences, Imaging and Clinical Sciences, “G. D’Annunzio” University, 66100 Chieti, Italy; (C.C.); (G.d.); (F.D.C.); (T.P.); (G.S.); (L.D.); (M.P.)
| | - Andrea Di Cesare
- Department of Mental Health, ASL 02 Lanciano-Vasto-Chieti, 66100 Chieti, Italy;
| | - Valerio Ricci
- Department of Psychiatry, “San Luigi Gonzaga” Hospital, University of Turin, 10124 Turin, Italy
| | - Maria Pepe
- University Policlinic Foundation “A. Gemelli” IRCSS-Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00136 Rome, Italy (M.D.N.)
| | - Luigi Dattoli
- Department of Neurosciences, Imaging and Clinical Sciences, “G. D’Annunzio” University, 66100 Chieti, Italy; (C.C.); (G.d.); (F.D.C.); (T.P.); (G.S.); (L.D.); (M.P.)
| | - Marco Di Nicola
- University Policlinic Foundation “A. Gemelli” IRCSS-Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00136 Rome, Italy (M.D.N.)
| | - Mauro Pettorruso
- Department of Neurosciences, Imaging and Clinical Sciences, “G. D’Annunzio” University, 66100 Chieti, Italy; (C.C.); (G.d.); (F.D.C.); (T.P.); (G.S.); (L.D.); (M.P.)
| | - Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, “G. D’Annunzio” University, 66100 Chieti, Italy; (C.C.); (G.d.); (F.D.C.); (T.P.); (G.S.); (L.D.); (M.P.)
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Saulnier KG, Panaite V, Ganoczy D, Kim HM, Zivin K, Hofer T, Piette JD, Pfeiffer PN. Depression symptom outcomes and re-engagement among VA patients who discontinue care while symptomatic. Gen Hosp Psychiatry 2023; 85:87-94. [PMID: 37862961 DOI: 10.1016/j.genhosppsych.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Evaluate outcomes of Veterans who discontinued treatment with at least moderate ongoing depressive symptoms. METHOD Veterans with elevated depression symptoms from 29 Department of Veterans Affairs facilities completed baseline surveys and follow-up assessments for one year. Analyses examined rates and predictors of treatment discontinuation, treatment re-engagement, and subsequent symptoms among patients who remained out of care. RESULTS A total of 242 (17.8%; n = 1359) participants discontinued treatment while symptomatic, with Black participants, participants with less severe depression, and participants receiving only psychotherapy (versus combined psychotherapy and antidepressant medications) discontinuing at higher rates. Among all participants who discontinued treatment (n = 445), 45.8% re-engaged within the following six months with participants receiving combined treatment re-engaging at higher rates. Of participants who discontinued while symptomatic within the first 6 months of the study and did not return to care (n = 112), 68.8% remained symptomatic at 12 months. Lower baseline treatment expectancy and greater depression symptom severity were associated with remaining symptomatic while untreated. CONCLUSIONS Black race, lower symptom severity, and treatment modality may help identify patients at higher risk for discontinuing care while symptomatic, whereas patients with lower treatment expectations may be at greater risk for remaining out of care despite continuing symptoms.
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Affiliation(s)
- K G Saulnier
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA; VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan Medical School, Ann Arbor, MI, USA.
| | - V Panaite
- James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - D Ganoczy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - H M Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan Consulting for Statistics, Computing, and Analytics Research, Ann Arbor, MI, USA
| | - K Zivin
- University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - T Hofer
- University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - J D Piette
- University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - P N Pfeiffer
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Ishrat Husain M, Rodie DJ, Perivolaris A, Sanches M, Crawford A, Fitzgibbon KP, Levinson A, Geist R, Kurdyak P, Mitchell B, Oslin D, Sunderji N, Mulsant BH. A Collaborative-Care Telephone-Based Intervention for Depression, Anxiety, and at-Risk Drinking in Primary Care: The PARTNERs Randomized Clinical Trial. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:732-744. [PMID: 36855791 PMCID: PMC10517649 DOI: 10.1177/07067437231156243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Collaborative care (CC) could improve outcomes in primary care patients with common mental conditions. We assessed the effectiveness of a transdiagnostic model of telephone-based CC (tCC) delivered by lay providers to primary care patients with depression, anxiety, or at-risk drinking. METHODS PARTNERS was a pragmatic trial in 502 primary care adults presenting with depressive symptoms, anxiety symptoms, or at-risk drinking randomized to (1) usual care by primary care providers (PCPs) enhanced with the results of computer-assisted telephone-based assessments (at baseline and 4, 8, and 12 months later) (enhanced usual care [eUC]) or (2) tCC consisting of eUC plus frequent telephone coaching and psychoeducation provided by mental health technicians who also communicated to the PCP recommendations from a psychiatrist for evidence-based pharmacotherapy, psychotherapy, or, when indicated, referrals to mental health services. The primary analysis compared the change on the 9-item Patient Health Questionnaire (PHQ-9) in participants presenting with depression (n = 366) randomized to tCC versus eUC. Secondary analyses compared changes on the Generalized Anxiety Disorder-7 scale (GAD-7) in those presenting with anxiety (n = 298); or change in the number of weekly drinks in those presenting with at-risk drinking (n = 176). RESULTS There were no treatment or time×treatment effects between tCC and eUC on PHQ-9 scores for patients with depression during the 12-month follow-up. However, there was a treatment effect (tCC > eUC) on GAD-7 scores in those with anxiety and a time×treatment interaction effect on the number of weekly drinks (tCC > eUC) in those with at-risk drinking. CONCLUSION Implementing transdiagnostic tCC for common mental disorders using lay providers appears feasible in Canadian primary care. While tCC was not better than eUC for depression, there were some benefits for those with anxiety or at-risk drinking. Future studies will need to confirm whether tCC differentially benefits patients with depression, anxiety, or at-risk drinking.
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Affiliation(s)
- M. Ishrat Husain
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David J. Rodie
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Marcos Sanches
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Allison Crawford
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Andrea Levinson
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rose Geist
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - David Oslin
- Department of Psychiatry, University of Pennsylvania and the Department of Veteran Affairs, Philadelphia, PA, USA
| | - Nadiya Sunderji
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Killeen TK, Baker NL, Davis LL, Bowen S, Brady KT. Efficacy of mindfulness-based relapse prevention in a sample of veterans in a substance use disorder aftercare program: A randomized controlled trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209116. [PMID: 37364669 DOI: 10.1016/j.josat.2023.209116] [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: 11/01/2022] [Revised: 05/13/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Complementary integrative medicine, such as mindfulness-based interventions, (MBI) have demonstrated efficacy in the treatment of depression, anxiety, substance use disorders (SUDs), and pain. Mindfulness-based relapse prevention (MBRP) is an aftercare intervention targeting SUD relapse that integrates cognitive-behavioral relapse prevention and mindfulness meditation practices, raising awareness of substance use triggers and reactive behavioral patterns. This study evaluated the efficacy of MBRP in reducing relapse in veterans following completion of an SUD treatment program. METHODS This study was a two-site, randomized controlled trial comparing MBRP to 12-step facilitation (TSF) aftercare in military veterans following completion of intensive treatment for SUDs. The 8 weeks of 90-minute, group-based MBRP or TSF sessions were followed by 3-, 6- and 10-month follow-up periods with assessments of alcohol/substance use and secondary outcomes of depression, anxiety, and mindfulness. RESULTS Forty-seven percent of veterans attended ≥75 % of sessions. Veterans in both the MBRP and TSF aftercare groups maintained reductions in alcohol and illicit substance use during the aftercare treatment. Nineteen participants (11 %; 19/174) reported returning to alcohol use during the study treatment period and the study found no difference between study groups [MBRP: 9 % vs. TSF 13 %; p = 0.42]. Thirteen participants (7.5 %; 13/174) reported a return to illicit substance use during study treatment [MBRP: 5.4 % vs. TSF 10.3 % p = 0.34]. The number of days of drinking and illicit substance use was not different between groups (alcohol, p = 0.53; illicit substance use, p = 0.28). CONCLUSION Although retention in treatment limits interpretation of the findings, both MBRP and TSF were effective in maintenance of treatment gains following an intensive treatment program for veterans with SUDs. Future studies should focus on strategies to improve treatment participation.
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Affiliation(s)
- Therese K Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC, 29425, United States of America.
| | - Nathaniel L Baker
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC, 29425, United States of America.
| | - Lori L Davis
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama Health System, 3701 Loop Rd, Tuscaloosa, AL 35404, United States of America.
| | - Sarah Bowen
- Department of Psychology, Pacific University, Graduate Psychology Health Prof. Building 2 297 (Hillsboro), 503-352-3614, UC Box A191, Portland, OR, United States of America.
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC, 29425, United States of America.
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Quick CR, Conway KP, Swendsen J, Stapp EK, Cui L, Merikangas KR. Comorbidity and Coaggregation of Major Depressive Disorder and Bipolar Disorder and Cannabis Use Disorder in a Controlled Family Study. JAMA Psychiatry 2022; 79:727-735. [PMID: 35648395 PMCID: PMC9161121 DOI: 10.1001/jamapsychiatry.2022.1338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Cannabis use disorder (CUD) is increasing in the US. Clarification of the potential mechanisms underlying the comorbidity between mood disorders and CUD may help prevent CUD. OBJECTIVE To examine co-occurrence and familial aggregation of CUD and mood disorder subtypes. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional, community-based study in the Washington, DC, metropolitan area, semistructured diagnostic interviews and family history reports assessed lifetime DSM-IV disorders in probands and relatives. Familial aggregation and coaggregation of CUD with mood disorders were estimated via mixed-effects models, adjusting for age, sex, recruitment source, and comorbid mood, anxiety, and other substance use disorders. A total of 586 adult probands (186 with bipolar disorder; 55 with CUD) and 698 first-degree relatives (91 with bipolar disorder; 68 with CUD) were recruited from a community screening of the greater Washington, DC, metropolitan area from May 2004 to August 2020. Inclusion criteria were ability to speak English, and availability and consent to contact at least 2 living first-degree relatives. MAIN OUTCOMES AND MEASURES Lifetime CUD in first-degree relatives. RESULTS Of 586 probands, 395 (67.4%) were female; among 698 relatives, 437 (62.6%) were female. The mean (SD) age was 47.5 (15.2) years for probands and 49.6 (18.0) years for relatives. In the proband group, 82 participants (14.0%) self-identified as African American or Black, 467 (79.7%) as White, and 37 (6.3%) as American Indian or Alaska Native, Asian, more than one race, or another race or ethnicity or declined to respond. In the relative group, 53 participants (7.6%) self-identified as African American or Black, 594 (85.1%) as White, and 51 (7.3%) as American Indian or Alaska Native, Asian, more than one race, or another race or ethnicity or declined to respond. These groups were combined to protect privacy owing to small numbers. CUD in probands (55 [9.4%]) was associated with an increase in CUD in relatives (adjusted odds ratio [aOR], 2.64; 95% CI, 1.20-5.79; P = .02). Bipolar disorder II (BP-II) in probands (72 [12.3%]) was also associated with increased risk of CUD in relatives (aOR, 2.57; 95% CI, 1.06-6.23; P = .04). However, bipolar disorder I (114 [19.5%]) and major depressive disorder (192 [32.8%]) in probands were not significantly associated with CUD in relatives. Among relatives, CUD was associated with BP-II (aOR, 4.50; 95% CI, 1.72-11.77; P = .002), major depressive disorder (aOR, 3.64; 95% CI, 1.78-7.45; P < .001), and mean (SD) age (42.7 [12.8] years with CUD vs 50.3 [18.3] years without CUD; aOR, 0.98; 95% CI, 0.96-1.00; P = .02). Familial coaggregation of BP-II with CUD was attenuated by the inclusion of comorbid anxiety disorders. Further, rates of CUD were highest in relatives with both a familial and individual history of BP-II (no familial or individual history of BP-II: 41 [7.2%]; familial history but no individual history of BP-II: 13 [19.1%]; individual history but no familial history of BP-II: 10 [22.2%]; familial and individual history of BP-II: 4 [28.6%]; Fisher exact test, P < .001). The onset of mood disorder subtypes preceded CUD in probands and relatives in most cases. CONCLUSIONS AND RELEVANCE The findings confirmed a familial aggregation of CUD. The increase in risk of CUD among relatives of probands with BP-II suggests that CUD may share a common underlying diathesis with BP-II. Taken together with the temporal precedence of depression and mania with respect to CUD onset, these findings highlight a potential role for BP-II intervention as CUD prevention.
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Affiliation(s)
- Courtney R. Quick
- Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Kevin P. Conway
- Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Joel Swendsen
- Aquitaine Institute for Cognitive and Integrative Neuroscience, University of Bordeaux, Bordeaux, France
| | - Emma K. Stapp
- Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Lihong Cui
- Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Kathleen R. Merikangas
- Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
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Kalin NH. Scientific Advances Supporting New and Improved Treatment Strategies in Psychiatry. Am J Psychiatry 2021; 178:365-368. [PMID: 33979538 DOI: 10.1176/appi.ajp.2021.21030290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ned H Kalin
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
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