Psychotic patients addicted to cannabis and other substances treated with risperidone long acting injectable: Follow-up and reintegration

Abstract

Method: A 43 patients group, 30 male and 13 female, mean age 42.1, admitted during an acute phase of chronic schizophrenia (DSM-IV-TR), were distributed on flexible dose of olanzapine (N¼12) 10-20 mg/day, aripiprazole (N¼11) 15-30 mg/day, risperidone (N¼10) 4-8 mg/day or haloperidol (N¼10) 10-20 mg/day. Weight, fasting glucose and HDL-cholesterol were weekly monitored during the first month and monthly after that. Inclusion criteria: baseline glucose and HDL-cholesterol levels within normal range. Exclusion criteria: familial history of diabetus mellitus or obesity. Results: Regarding the weight gain, the safest antipsychotic is aripiprazole (+0.4+/-0.2 kg at endpoint), followed by haloperidol (+1.9+/-0.2 kg), while olanzapine (+5.6+/-1.1 kg) and risperidone (+3.4+/-0.5 kg) are less tolerated. The glucose level >125 mg/dl was observed at endpoint in 3 patients with risperidone, 6 with olanzapine, 2 with haloperidol. The HDL-cholesterol over 40 mg/dl (men) and over 50 mg/dl (female) appeared in 4 cases of olanzapine and 3 cases of risperidone treated patients. Conclusions: There are quantitative differences in the level of weight gain, HDL-cholesterol and glucose level induced by antipsychotics. The safest antipsychotic agent is aripiprazole because it doesn't induce significant weight gain or other metabolic complications.

A retrospective study of the role of long-acting injectable antipsychotics in preventing rehospitalization in early psychosis with cannabis use

“…Among antipsychotics, second generation compounds as a group, and clozapine in particular, provide a modest advantage over first generation antipsychotics, in decreasing cannabis use in patients with schizophrenia and concurrent cannabis use disorder (Bosanac et al, 2018). Long-acting injectable antipsychotics are superior to oral equivalents in preventing relapse in dually diagnosed patients with psychosis and comorbid substance use disorder (Starr et al, 2018, Viala et al, 2007).…”

“…It follows, therefore, that interventions directed at enhancing medication adherence may prevent relapse. Long-acting injectable antipsychotics are superior to oral equivalents in preventing relapse in patients with early psychosis (Kishi, Oya, & Iwata, 2016), and in dually diagnosed patients with psychosis and comorbid substance use disorder (Starr et al, 2018, Viala et al, 2007). We are unaware of any study that examined the role of long-acting antipsychotics in preventing relapse in patients with early psychosis and concurrent cannabis use disorder.…”