Atypical Antipsychotic Drugs in Dual Disorders: Current Evidence for Clinical Practice

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.

Acute Alcoholic Hallucinosis: A Review

“…In terms of side effects and possible interactions, a recent review regarding the role of atypical antipsychotic drugs in dual disorders suggested some advantages for second-generation antipsychotics, specifically for D2 partial agonists [43]. However, these results should be confirmed in alcoholic hallucinosis.…”

“…Finally, dual disorders are common in patients with alcohol use disorder, and a specific diagnostic assessment is mandatory. The list of the most common mental comorbidities in dual disorders includes anxiety disorders, post-traumatic stress disorder, attention deficit with/without hyperactivity disorder, and personality disorders (mainly antisocial and borderline) [43].…”

Aripiprazole once monthly as a maintenance treatment for patients with schizophrenia and alcohol/substance use disorder: an observational, real-world study

“…Aripiprazole may also guarantee further benefits in terms of minimal weight gain or sedation and cardiac parameters, e.g. QTc alteration, frequently altered in subjects with AUD and SUD (Martinotti et al , 2022; McRae-Clark et al , 2009; Nosè et al , 2016). Generally, the advantage of long-acting treatments is not just in providing better compliance in cases of poor adherence to oral formulation but also in their more consistent bioavailability, more predictable correlations of dosage/plasma levels and reduced peak-trough plasma levels, which might provide a long-term clinical stabilization.…”

Investigating the Effectiveness of Brexpiprazole in Subjects with Schizophrenia Spectrum Illness and Co-Occurring Substance Use Disorder: A Prospective, Multicentric, Real-World Study

“…Since then, various definitions have emerged, yet a universally accepted, unambiguous definition remains elusive. Currently, the World Health Organization (WHO) defines them as “the co-occurrence in the same individual of a psychoactive substance use disorder and another psychiatric disorder,” reflecting the complexity and the overlapping nature of these conditions [ 3 , 4 ]. DDs present a formidable challenge for healthcare professionals, primarily due to the complex and variable interaction between psychoactive substances and psychiatric disorders.…”

“…As previously mentioned, the utilization of atypical antipsychotics can be particularly beneficial in DDs, given their dual efficacy in addressing both psychotic and affective symptoms. This characteristic makes them a versatile option for treating conditions where both sets of symptoms are present or intertwined [ 4 , 35 ]. Brexpiprazole, classified as a third-generation antipsychotic, is characterized by its partial agonist activity at D2 receptors, a defining feature of its pharmacological profile within this class of medications.…”