Naltrexone augmentation of neuroleptic treatment in alcohol abusing patients with schizophrenia

Petrakis, Ismene L.; O’Malley, Stephanie S.; Rounsaville, Bruce J.; Poling, James; McHugh-Strong, Colette; Krystal, John H.

doi:10.1007/s00213-003-1658-9

Cited by 103 publications

(68 citation statements)

References 42 publications

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“…However, data suggesting that naltrexone may have value in this population [42] may indicate that blocking the rewarding effect of alcohol (without decreasing overall hedonic tone, as could occur during treatment with a potent D2 blocking agent, such as haloperidol [106], also could facilitate effective treatment in some patients. However, by contrast, the potential value of disulfiram, which provides a negative reinforcement to alcohol use, seems to decrease alcohol use in a manner akin to that for psychosocial interventions described below.…”

Section: Pharmacologic Treatmentsmentioning

confidence: 94%

“…Naltrexone, an agent that has been shown to reduce alcohol consumption in people with primary alcohol use disorders, also may be associated with decreased use and craving for alcohol in patients with comorbid SUDs and schizophrenia or bipolar disorder [42]. The one randomized placebocontrolled study of naltrexone plus cognitive behavioral therapy (CBT) for patients with schizophrenia and alcohol use disorders reported that, compared with patients receiving placebo and CBT, patients receiving naltrexone and CBT had more days of abstinence and less alcohol craving [42].…”

Section: Other Medications To Treat Substance Use Disordersmentioning

confidence: 99%

“…The one randomized placebocontrolled study of naltrexone plus cognitive behavioral therapy (CBT) for patients with schizophrenia and alcohol use disorders reported that, compared with patients receiving placebo and CBT, patients receiving naltrexone and CBT had more days of abstinence and less alcohol craving [42]. Acamprosate also has been shown to reduce alcohol consumption [43], but has not been studied in psychiatric patients.…”

Section: Other Medications To Treat Substance Use Disordersmentioning

confidence: 99%

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Treatment of substance use disorders in schizophrenia: A unifying neurobiological mechanism?

Roth¹,

Brunette²,

Green

2005

Curr Psychiatry Rep

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Substance use disorders (SUDs) are highly prevalent and are associated with poor outcomes among individuals with schizophrenia. Integrating treatments for both disorders improves outcomes. Numerous individual pharmacologic and psychosocial treatments have shown effectiveness at reducing substance use in individuals with a primary diagnosis of schizophrenia and co-occurring substance use disorders. Of these treatments, medications such as certain atypical antipsychotics and naltrexone, and psychosocial treatments such as contingency management, seem to be particularly promising. The development and evaluation of psychopharmacologic and psychosocial treatments for SUDs in schizophrenia would benefit from a better understanding of the neurobiological mechanisms underlying the effectiveness of such treatments. Several theories have been put forth to explain the heightened risk for SUDs in schizophrenia. Of these, brain reward circuitry dysfunction, hypothesized to be etiologically important in SUDs, may be an especially salient target for treatments aimed at the reduction of substance use in patients with schizophrenia. We review current pharmacologic and psychosocial treatments for SUDs in schizophrenia, and theoretical mechanisms underlying the increased risk for SUDs in this population. We propose that effective treatments may in part work through the modulation of brain reward circuitry dysfunction.

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Section: Pharmacologic Treatmentsmentioning

confidence: 94%

Section: Other Medications To Treat Substance Use Disordersmentioning

confidence: 99%

Section: Other Medications To Treat Substance Use Disordersmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of substance use disorders in schizophrenia: A unifying neurobiological mechanism?

Roth¹,

Brunette²,

Green

2005

Curr Psychiatry Rep

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“…Naltrexone decreased alcohol use and improved depressive symptoms in an open study with patients manifesting alcohol dependence (Salloum et al, 1998). A small, placebo-controlled, randomized clinical trial with naltrexone in 31 patients manifesting schizophrenia and alcohol dependence (Petrakis et al, 2004) showed naltrexone-treated patients had fewer drinking days and "heavy drinking" days and less "craving" in comparison to patients treated with placebo. Overall, naltrexone was well tolerated and did not cause a worsening of psychosis.…”

Section: Pharmacotherapy Of Alcohol Use Disorders 2009mentioning

confidence: 98%

Pharmacotherapy of Alcohol Use Disorders

Buonopane

Petrakis

2005

Substance Use & Misuse

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Therapeutic interventions to treat alcoholism have increased in number, including several pharmacotherapies. Aspects of epidemiology, gender, and psychiatric comorbidity as well as a brief overview of neurobiology are presented as an introduction. The medications used clinically for the treatment of alcoholism, disulfiram and naltrexone, approved by the Food and Drug Administration in the United States for the treatment of alcoholism and acamprosate, a medication used extensively in Europe that is currently being evaluated in the United States, are reviewed in detail. An overview of the serotonergic agents is also provided. Finally, future directions, including new medications and some clinical strategies that show promise but are not yet used extensively clinically, are mentioned.

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“…Many studies indicate that treatment of SUD among psychiatric patients is associated with better drug-related, psychiatric and psychosocial outcomes (e.g. [9,10,11,12,13,14,15,16]). Considering this, identification of SUD among psychiatric patients is of importance.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test among Patients at a Norwegian Psychiatric Emergency Ward

Gundersen¹,

Mordal²,

Berman

et al. 2013

Eur Addict Res

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High rates of substance use disorders (SUD) among psychiatric patients are well documented. This study explores the usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT) in identifying SUD in emergency psychiatric patients. Of 287 patients admitted consecutively, 256 participants (89%) were included, and 61-64% completed the questionnaires and the Mini-International Neuropsychiatric Interview (MINI), used as the reference standard. Both AUDIT and DUDIT were valid (area under the curve above 0.92) and reliable (Cronbach's alpha above 0.89) in psychotic and nonpsychotic men and women. The suitable cutoff scores for AUDIT were higher among the psychotic than nonpsychotic patients, with 12 versus 10 in men and 8 versus 5 in women. The suitable cutoff scores for DUDIT were 1 in both psychotic and nonpsychotic women, and 5 versus 1 in psychotic and nonpsychotic men, respectively. This study shows that AUDIT and DUDIT may provide precise information about emergency psychiatric patients' problematic alcohol and drug use.

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Naltrexone augmentation of neuroleptic treatment in alcohol abusing patients with schizophrenia

Cited by 103 publications

References 42 publications

Treatment of substance use disorders in schizophrenia: A unifying neurobiological mechanism?

Treatment of substance use disorders in schizophrenia: A unifying neurobiological mechanism?

Pharmacotherapy of Alcohol Use Disorders

Evaluation of the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test among Patients at a Norwegian Psychiatric Emergency Ward

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