The long-term outcome of patients with heroin use disorder/dual disorder (chronic psychosis) after admission to enhanced methadone maintenance

Maremmani, Angelo Giovanni Icro; Pallucchini, Alessandro; Rovai, Luca; Bacciardi, Silvia; Spera, Vincenza; Maiello, Marco; Perugi, Giulio; Maremmani, Icro

doi:10.1186/s12991-018-0185-3

Cited by 16 publications

(15 citation statements)

References 43 publications

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“…There is little other literature on outcomes of MMT in patients with psychotic disorders with just 2 small studies specifically examining outcomes in this population. 16 , 17 A retrospective study of 206 participants with a variety of psychiatric diagnoses, including 13 individuals with a diagnosis of schizophrenia-examined retention in treatment. 16 At 12 months, only 1/13 (7.7%) people with schizophrenia remained in treatment, a retention rate markedly lower than the rate of retention among all other psychiatric comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“… 14 In fact, individuals with psychosis are often excluded from controlled trials of opioid substitution therapy. 15 , 16 The existing literature on outcomes in opioid substitution therapy in individuals with comorbid psychotic disorders includes a limited number of small observational studies, 16 , 17 one that identified a markedly lower rate of retention in treatment for individuals with schizophrenia 16 and the other that found no significant difference in treatment retention. 17 Integrated treatment is considered to be the gold standard for individuals with schizophrenia and substance use disorders, though treatment is rarely offered in this way.…”

Section: Introductionmentioning

confidence: 99%

“… 15 , 16 The existing literature on outcomes in opioid substitution therapy in individuals with comorbid psychotic disorders includes a limited number of small observational studies, 16 , 17 one that identified a markedly lower rate of retention in treatment for individuals with schizophrenia 16 and the other that found no significant difference in treatment retention. 17 Integrated treatment is considered to be the gold standard for individuals with schizophrenia and substance use disorders, though treatment is rarely offered in this way. 18 In Ontario, Canada, where this study was conducted, opioid substitution therapy is largely provided in clinics that operate in a location separate from primary care and mental health services.…”

Section: Introductionmentioning

confidence: 99%

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Psychosis and Comorbid Opioid Use Disorder: Characteristics and Outcomes in Opioid Substitution Therapy

Lamont

Rosic

Sanger

et al. 2020

Schizophrenia Bulletin Open

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Background and Objectives Substance use disorders are highly prevalent among individuals with psychotic disorders and are associated with negative outcomes. This study aims to explore differences in characteristics and treatment outcomes for individuals with psychotic disorders as compared to individuals with other non-psychotic psychiatric disorders enrolled in treatment for opioid use disorder (OUD). Methods Data were collected from a prospective cohort study of 415 individuals enrolled in outpatient methadone maintenance treatment (MMT). Psychiatric comorbidity was assessed using the Mini-International Neuropsychiatric Interview. Participants were followed for 12 months. Participant characteristics associated with having a psychotic disorder versus another non-psychotic psychiatric disorder were explored by logistic regression analysis. Results Altogether, 37 individuals (9%) with a psychotic disorder were identified. Having a psychotic disorder was associated with less opioid-positive urine drug screens (OR=0.97, 95% CI 0.95,0.99, p=0.046). Twelve-month retention in treatment was not associated with psychotic disorder group status (OR=0.73, 95% CI 0.3,1.77, p=0.485). Participants with psychotic disorders were more likely to be prescribed antidepressants (OR=2.12, 95% CI 1.06,4.22, p=0.033), antipsychotics (OR=3.57, 95% CI 1.74,7.32, p=0.001), mood-stabilizers (OR=6.61, 95% CI 1.51,28.97, p=0.012), and benzodiazepines (OR=2.22, 95% CI 1.11,4.43, p=0.024). Discussion and Conclusions This study contributes to the sparse literature on outcomes of individuals with psychotic disorders and OUD receiving MMT. Rates of retention in treatment and opioid use are encouraging and contrast to the widely held belief that these individuals do more poorly in treatment. Higher rates of co-prescription of sedating and QTc prolonging medications in this group may pose unique safety concerns.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Psychosis and Comorbid Opioid Use Disorder: Characteristics and Outcomes in Opioid Substitution Therapy

Lamont

Rosic

Sanger

et al. 2020

Schizophrenia Bulletin Open

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“…Achieving control of mood instability or psychotic episodes is the next step. It should, eventually, be followed by a preventive strategy to counter residual cravings and breakthrough episodes of mood disorders or psychotic episodes by using long-term pharmacological maintenance with a double target [53,54]. Relapse prevention must never be understood as complete extinction, but as a trend towards a lower grade of severity, a reduction in frequency, while successfully delaying the possible occurrence of a relapse [55,56].…”

Section: Towards a Hierarchical Approach To Dual Disorder Treatmentmentioning

confidence: 99%

The Conceptual Framework of Dual Disorders and Its Flaws

Pacini¹,

Maremmani

2020

JCM

Self Cite

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When psychiatric illness and substance use disorder coexist, the clinical approach to the patient is, unsurprisingly, awkward. This fact is due to a cultural context and, more directly, to the patient’s psychiatric condition and addiction behaviors—a situation that does not favor a scientific approach. In dual disorder facilities, several types of professionals work together: counselors, social workers, psychologists, and psychiatrists. Treatment approaches vary from one service to another and even within the same service. It is crucial to provide dual disorder patients with multiple treatments, comprising hospitalization, rehabilitative and residential programs, case management, and counselling. Still, when treating dual disorder (DD) heroin use disorder (HUD) patients, it is advisable to follow a hierarchical algorithm. First, we must deal with addiction: by detoxification, whenever possible. This means starting most patients on anti-craving pharmacological maintenance, though aversion therapy may be appropriate for a few of them. Opiate antagonists may be used with heroin-addicted patients as long as those patients are only mildly ill. In contrast, agonist opioid medications, i.e., buprenorphine and methadone suit moderately and severely ill patients, respectively. Achieving control of mood instability or psychotic episodes is the next step, to be followed by a prevention strategy to counteract residual cravings and dominate mood disorders or psychotic episodes through long-term pharmacological maintenance that is focused on a double target.

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“…Several studied are been performed for the management of psychosis and opioid use. Drugs such as buprenorphines and olanazepines are generally used in the management of opioid-induced psychosis (Maremmani et al, 2018). For acute opioid withdrawal, benzodiazepenes are generally used, but it is recommended only for short term use only (Gaur et al, 2019).…”

Section: Management Of Opioid-induced Psychiatric Disordersmentioning

confidence: 99%

Drug induced psychiatric disorder-A mini review

Divya

Arul

et al. 2019

ijrps

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This article reviews the agents that are responsible for producing psychiatric symptoms in an individual as a result of drug abuse, which may lead to delusions and hallucinations. There are several categories of drug that are responsible for producing psychiatric syndromes such as benzodiazepines, cannabis, amphetamines, alcohol, inhalants and hallucinogens. Long term use of these drugs may lead to drug dependence, intoxication and may even worsen the condition. The general management of drug-induced psychiatric disorder is to minimize the use of the drug, gradual withdrawal of the drug and patient counseling.

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The long-term outcome of patients with heroin use disorder/dual disorder (chronic psychosis) after admission to enhanced methadone maintenance

Cited by 16 publications

References 43 publications

Psychosis and Comorbid Opioid Use Disorder: Characteristics and Outcomes in Opioid Substitution Therapy

Psychosis and Comorbid Opioid Use Disorder: Characteristics and Outcomes in Opioid Substitution Therapy

The Conceptual Framework of Dual Disorders and Its Flaws

Drug induced psychiatric disorder-A mini review

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