
- Vol 37, Issue 12
- Volume 37
- Issue 12
Schizophrenia and AUD
Navigating the treatment options for comorbid schizophrenia and alcohol use
RESEARCH UPDATE
Schizophrenia is associated with an increased prevalence of alcohol use disorder (AUD),1 which is also associated with relapse and
Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), funded by the
Case vignette 1
“Ms Norman” is in her 40s and has a longstanding history of
Data for the study were obtained from the publicly available, limited-access CATIE study dataset from the NIMH. Briefly, CATIE was an 18-month, double-blind, randomized trial of perphenazine, olanzapine, quetiapine, risperidone, and ziprasidone in 1493 patients with schizophrenia. The primary end point was time to all-cause discontinuation.
Patients were categorized into schizophrenia and AUD and schizophrenia-only groups (based on DSM-IV criteria). The authors excluded 155 patients with nonalcohol substance-use disorders, except for marijuana use, which was permitted. Exacerbation was defined as hospitalization for psychopathology; more than a 25% or 15-point increase in baseline
Both the time to first exacerbation (median, 5.4 versus 6.4 months; HR, 1.20) and time to first hospitalization (HR, 1.63) were significantly shorter in the schizophrenia and AUD group than the schizophrenia-only group (
Overall, perphenazine, quetiapine, risperidone, and ziprasidone were all associated with a significantly shorter time to first exacerbation compared with olanzapine (HRs, 1.81-2.80). A similar pattern of findings was observed for time to first hospitalization.
The authors concluded that patients with schizophrenia plus AUD had a poorer course of illness, with higher risk of disease progression, compared with patients with only schizophrenia. The investigators also found that olanzapine may be associated with longer time to first and recurrent exacerbations compared with other treatments in patients with schizophrenia and AUD comorbidity.
Case vignette 2
“Mr Greggs” is in his 30s with a history of chronic schizophrenia and severe AUD, as well as cannabis use disorder. He is currently serving a 1-year probation for a driving-while-impaired citation. He is adherent with monthly administration of a long-acting injectable antipsychotic but continues to drink alcohol and smoke marijuana regularly. He lives at home with his parents and is chronically unemployed. He has not had a psychiatric hospitalization in many years but remains precontemplative regarding the need for treatment for substance use disorder.
Strengths of the present study included the large number of subjects and the real-world design of the CATIE trial. Potential limitations included the post hoc nature of the analysis as well as the lack of generalizability of findings to patients with schizophrenia and other (nonalcohol) substance use disorders. Future trials are needed to identify effective treatment for this patient population.
The bottom line
Patients with schizophrenia with alcohol use disorder comorbidity versus those without have a worse course of illness, and olanzapine may be associated with a longer time to exacerbations versus other nonclozapine antipsychotics.
Dr Miller is professor, Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA. He is the schizophrenia section chief for Psychiatric TimesTM. The author reports that he receives research support from Augusta University, the National Institute of Mental Health, the Brain & Behavior Research Foundation, and the Stanley Medical Research Institute.
References
1. Hartz SM, Pato CN, Medeiros H, et al; Genomic Psychiatry Cohort Consortium. Comorbidity of severe psychotic disorders with measures of substance use. JAMA Psychiatry. 2014;71(3):248-254.
2. Bradizza CM, Stasiewicz PR, Dermen KH.
3. Jones RM, Lichtenstein P, Grann M, Långström N, Fazel S. Alcohol use disorders in schizophrenia: a national cohort study of 12,653 patients. J Clin Psychiatry. 2011;72(6):775-779.
4. Lieberman JA, Stroup TS, McEvoy JP, et al; Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353(12):1209-1223.
5. Pathak S, Jiang Y, DiPetrillo L, Todtenkopf MS, Liu Y, Correll CU.
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Diverse Patients, Common Groundalmost 5 years ago
Schizophrenia in the Newsalmost 5 years ago
The Intertwining Effect of Mood Disorders and Infertilityalmost 5 years ago
Lessons Learned From Treating COVID-Related Anxietyalmost 5 years ago
An Optimistic Prognosis for 2021almost 5 years ago
Of Personas and Perfection—and Physician Suicidealmost 5 years ago
A Dickens of a Yearalmost 5 years ago
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