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P.3.d.029 Analyzing the efficacy of second-generation antipsychotic drugs in treatment-resistant schizophrenia: a meta-analysis
| Content Provider | Semantic Scholar |
|---|---|
| Author | Dold, Markus Leucht, Stefan |
| Copyright Year | 2014 |
| Description | Background: Patients with schizophrenia have a lifetime prevalence of comorbid use disorder of 50% with alcohol having a negative effect on brain structure and function evident in this dual diagnosed population [1]. An administered as-needed drug could be provocative in a sensitive population in terms of insight like that of schizophrenia diagnosed patients. Nalmefene is associated with favorable response in alcohol use disorders and decrease the substance consumption [2] and the same drug was used as augmentation treatment in antipsychotic-stabilized schizophrenic patients with some positive results [3]. Objective: To assess the efficacy of pharmacological management with nalmefene in alcohol dependence and chronic schizophrenia dual diagnosed patients. Methods: A group of 22 patients, 12 female and 10 male, mean age 44.2, diagnosed with schizophrenia and alcohol dependence, according DSM IV TR criteria, were admitted to our department for an exacerbation of schizophrenia. After a mean duration of 2.7 weeks of psychotic symptoms stabilization under treatment with an atypical antipsychotic (olanzapine n = 13, risperidone n = 6, amisulpride n = 3), they received also treatment with nalmefene orally 18mg taken as needed. Patients' alcohol consumption was evaluated at baseline and every 4 weeks for 6 months using Inventory of Drug Taking Situations − alcohol focused version (IDTS) and gamma-glutamyl transpeptidase level (GGT). With the same frequency we applied Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF) and Clinical Global Impressions − Severity/Improvement (CGI-S/I). Inclusion criteria: high drinking risk level (alcohol >60 g/day for men and >40 g/day for women), IDTS score over 100, age between 18 and 65. Exclusion criteria: previous treatment with nalmefene, positive pregnancy test, alcohol withdrawal symptoms, other comorbid axis I disorder (including other drug related/induced disorders) or axis III chronic pathology. Intent-to-treat-analysis and last-observationcarried-forward were used in the statistical processing of data. Results: At week 24, patients had an overall improved PANSS score of 15.4% reported to baseline, with an IDTS score amelioration of 25.4 points at endpoint (p< 0.05) and a greater improvement was observed in the area of 'physical discomfort' (p = 0.032). The GGT level decrease with 70% at week 8, had a fluctuant evolution after that, but at week 24 the value was significantly lower compared to baseline (p = 0.002). CGI-S decreased from a mean value of 4.2 to 1.8 at week 24 and the GAF scores increased with 11.5% at endpoint. A number of 4 patients discontinued treatment due to either adverse events (vomiting, nausea, abdominal pains, n = 3) or non-adherence (n = 1). Mild and moderate adverse events were reported in 12 patients, especially gastro-intestinal discomfort and sedation. Conclusions: Nalmefene could be used in schizophrenia diagnosed patients with alcohol dependence, due to its efficacy and relatively low rate of adverse events. Nalmefene decreased significantly alcohol consumption in situations of 'physical discomfort'. The psychotic symptoms features had an overall good evolution during the combined antipsychotic and nalmefene treatment. |
| Starting Page | s538 |
| Ending Page | s539 |
| Page Count | 2 |
| File Format | PDF HTM / HTML |
| DOI | 10.1016/S0924-977X(14)70862-4 |
| Volume Number | 24 |
| Alternate Webpage(s) | https://api.elsevier.com/content/article/pii/S0924977X14708624 |
| Alternate Webpage(s) | https://www.sciencedirect.com/science/article/pii/S0924977X14708624?dgcid=api_sd_search-api-endpoint |
| Alternate Webpage(s) | https://doi.org/10.1016/S0924-977X%2814%2970862-4 |
| Journal | European Neuropsychopharmacology |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Synopsis |
