Management of Schizophrenia with Substance Use Disorders

Lybrand, Janice; Caroff, Stanley N.

doi:10.1016/j.psc.2009.09.002

Cited by 32 publications

(16 citation statements)

References 69 publications

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“…Emergency department studies find that cannabis is the drug most often associated with exacerbations of schizophrenia and acute psychotic episodes and cannabis use contributes to poor treatment outcomes for psychotic patients (Latt et al, 2011; Moore et al, 2007). The atypical antipsychotic clozapine has been found to be the most effective medication in reducing alcohol and cannabis use (Green et al, 2003; Lybrand & Caroff, 2009; San et al, 2007), while findings on other medications are equivocal. Baker and colleagues' (2010) review suggests that using antipsychotics may be helpful in reducing cannabis use but studies that have found improvement have used active psychotherapies, thereby obscuring the degree of benefit from pharmacotherapy.…”

Section: Resultsmentioning

confidence: 99%

Treatment of substance abusing patients with comorbid psychiatric disorders

Kelly

Daley

Douaihy

2012

Addictive Behaviors

229

163

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Objective To update clinicians on the latest in evidence-based treatments for substance use disorders (SUD) and non-substance use disorders among adults and suggest how these treatments can be combined into an evidence based process that enhances treatment effectiveness in comorbid patients. Method Articles were extracted from Pubmed using the search terms “dual diagnosis,” “comorbidity” and “co-occurring” and were reviewed for evidence of effectiveness for pharmacologic and psychotherapeutic treatments of comorbidity. Results Twenty-four research reviews and 43 research trials were reviewed. The preponderance of the evidence suggests that antidepressants prescribed to improve substance-related symptoms among patients with mood and anxiety disorders are either not highly effective or involve risk due to high side-effect profiles or toxicity. Second-generation antipsychotics are more effective for treatment of schizophrenia and comorbid substance abuse and current evidence suggests clozapine, olanzapine and risperidone are among the best. Clozapine appears to be the most effective of the antipsychotics for reducing alcohol, cocaine and cannabis abuse among patients with schizophrenia. Motivational interviewing has robust support as a highly effective psychotherapy for establishing a therapeutic alliance. This finding is critical since retention in treatment is essential for maintaining effectiveness. Highly structured therapy programs that integrate intensive outpatient treatments, case management services and behavioral therapies such as Contingency Management (CM) are most effective for treatment of severe comorbid conditions. Conclusions Creative combinations of psychotherapies, behavioral and pharmacological interventions offer the most effective treatment for comorbidity. Intensity of treatment must be increased for severe comorbid conditions such as the schizophrenia/cannabis dependence comorbidity due to the limitations of pharmacological treatments.

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Section: Resultsmentioning

confidence: 99%

Treatment of substance abusing patients with comorbid psychiatric disorders

Kelly

Daley

Douaihy

2012

Addictive Behaviors

229

163

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“…One interpretation of this could be that providers of mental health care unintentionally exclude some psychiatric patients with SUD comorbidity. In patients with schizophrenia, where the prevalence of substance use has consistently been shown to be high (47 % reported in one study [6]), substance use can be expected as being part of the disorder [46] and, therefore, explain the better inclusion of these particular patients. The traditional organisation of treatment services has been a separation of psychiatric treatment and substance abuse treatment both in Denmark and internationally [47,48].…”

Section: Psychiatric Treatment Facility Utilisationmentioning

confidence: 99%

Prevalence of substance use disorders in psychiatric patients: a nationwide Danish population-based study

Toftdahl

Nordentoft

Hjorthøj

2015

Soc Psychiatry Psychiatr Epidemiol

175

116

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The study was the most comprehensive of its kind so far to estimate the prevalence of SUDs in an unselected population-based cohort, and it revealed remarkably high prevalence among the psychiatric patients. The results should encourage continuous focus on possible comorbidity of psychiatric patients, as well as specialised and integrated treatment along with increased support of patients with comorbid disorders.

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“…A number of these substances lead to worsening depression and thus further substance misuse, setting up and perpetuating a vicious cycle. The substance misuse itself thus becomes an important therapeutic target in dealing with the depression, and vice versa (Lybrand 2009).…”

Section: Discussionmentioning

confidence: 99%

Depression and schizophrenia

Bosanac¹

2012

Adv. psychiatr. treat

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SummaryDepressive symptoms commonly occur in schizophrenia and have a significant impact on the distress and burden of the illness. Yet they are often overlooked, inadequately characterised by current classification systems and not consistently integrated into treatment. We discuss nosology, practical and clinical implications of symptom differentiation, and the role of causal and confounding factors, including iatrogenic, as targets for therapeutic intervention. The evidence base of psychosocial and psychotropic management is reviewed, with recommendations for the treatment of established syndromal depression in people with schizophrenia.

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Management of Schizophrenia with Substance Use Disorders

Cited by 32 publications

References 69 publications

Treatment of substance abusing patients with comorbid psychiatric disorders

Treatment of substance abusing patients with comorbid psychiatric disorders

Prevalence of substance use disorders in psychiatric patients: a nationwide Danish population-based study

Depression and schizophrenia

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