Risperidone Decreases Craving and Relapses in Individuals with Schizophrenia and Cocaine Dependence

Abstract

P revious research suggests that 16% to 50% of individuals with schizophrenia abuse cocaine (1-3). The prevalence of cocaine abuse in persons with schizophrenia is problematic, considering the debilitating effect that the drug can have on acute symptoms and on illness course. Individuals with schizophrenia and cocaine dependence display more positive symptoms, fewer negative symptoms, and higher rates of extrapyramidal symptoms (EPS) (4,5), which may result from an interaction between dopamine and the psychostimulant properties of cocaine (6).It is widely accepted that aberrations in the dopamine system play a role in the etiology of schizophrenia (7,8) and the maintenance of cocaine addiction via craving (9-11). To examine the clinical impact of these dopamine abnormalities, we compared self-report craving among cocaine addicts and cocaine addicts with schizophrenia. Individuals with schizophrenia and cocaine dependence had significantly more craving, which remained stable over a 72-hour period (12). In a follow-up study, we included a cue-exposure paradigm and found that 97% of the cocaine-dependent persons with schizophrenia were cue-reactive, suggesting the need to target this state in treatment (11).Owing to the rapid increase in dopamine following cocaine use, which can persist for weeks and result in increased craving and depression, researchers have examined dopamine antagonists for treatment of protracted withdrawal. They found Objective: To examine the efficacy of atypical neuroleptics for decreasing craving and drug relapses during protracted withdrawal in individuals dually diagnosed with schizophrenia and cocaine dependence. Method:We conducted a 6-week, open-label pilot study comparing risperidone with typical neuroleptics in a sample of withdrawn cocaine-dependent schizophrenia patients. Results:Preliminary results suggest that individuals treated with risperidone had significantly less cue-elicited craving and substance abuse relapses at study completion. Further, they showed a trend toward a greater reduction in negative and global symptoms of schizophrenia. Clinical Implication · This research suggests that atypical neuroleptic medications, particularly olanzapine, may have anticraving effects and could improve treatment outcomes among the dually diagnosed patients. Conclusion Limitation· This research includes a small sample, an open-label design, and the use of a primarily male veteran population.

Long-Acting Injectable Risperidone Compared with Zuclopenthixol in the Treatment of Schizophrenia with Substance Abuse Comorbidity

“…Also, in a previous study (6), risperidone decreased positive urinary tests significantly more than zuclopenthixol in subjects with schizophrenia and SUDs. Smelson and others showed that individuals with schizophrenia and cocaine dependence treated with risperidone had significantly fewer cue-elicited cravings and relapses than did subjects treated with typical antipsychotics (7). Indirect evidence of the greater efficacy of risperidone can be found in other studies.…”

“…Despite high comorbidity and the impact of substance use on the outcome of schizophrenia, controlled studies assessing the effectiveness of pharmacologic treatment in this type of patient are rare (5). In 2 recent studies, risperidone decreased relapse for substances more than typical neuroleptics in subjects with schizophrenia and substance abuse (6)(7). However, owing to compliance problems, many psychiatrists tend to prefer using depot neuroleptics to ensure better compliance and to reduce exacerbations and hospitalization in these patients (8,9).…”

Substance Use Disorder Comorbidity in Schizophrenia

“…Kokain bağımlısı şizofreni tanılı hastalarda risperidon kullanımının relaps ve madde alma isteğinde azalmaya yol açtığını bildiren çalışmalar mevcuttur. [78] Yapı-lan bir çalışma ve iki olgu sunumu sonucuna göre, olanzapin kullanımı şizof-reni tanılı bireylerde kokain kullanma isteğini azaltıyor gibi görünüyorsa da, [79][80][81] başka bir çalışmada diğer atipik ajanlara göre üstünlüğü bulunmamıştır. [82] Parsiyel dopamin agonisti olan aripiprazol kullanan 10 hasta ile yapılan çalışma sonucunda kokain kullanım bozukluğu eş tanısı olan şizofreni tanılı hastalarda kokain kullanımını azalttığı bildirilmiştir.…”

Santé mentale, alcool/drogues et violence. Adaptation du modèle tripartite de Goldstein

“…Bien que la clozapine soit pour l'instant l'antipsychotique atypique le plus souvent associé à une stabilisation de l'état mental, à une diminution des états de besoin 1 de cocaïne et à une réduction de la consommation de substances intoxicantes chez les individus présentant à la fois un trouble sévère et persistant et un trouble lié à une substance, d'autres antipsychotiques atypiques tels que la quétiapine, l'olanzapine ou la rispéri-done se sont également révélés efficaces dans le traitement de cette double problématique et mériteraient, par conséquent, d'être étudiés davantage (Noordsy, O'Keefe, Mueser & Xie, 2001 ;Smelson, Losonczy, Davis, Kaune, Williams & Ziedonis, 2002 ;Brown, Netjek, Perantie & Bobadilla, 2002 ;Green, 2006 ;Stuyt, Sabjel & Allen, 2006).…”