Guía de práctica clínica para el tratamiento farmacológico y psicológico de los pacientes adultos con un trastorno del espectro esquizofrénico y un diagnóstico comórbido de trastorno por uso de sustancias

  1. Belén Arranz
  2. Marina Garriga
  3. Miquel Bernardo
  4. Ana González-Pinto
  5. Manuel Arrojo
  6. Marta Torrens
  7. Judit Tirado-Muñoz
  8. Francina Fonseca
  9. Pilar A. Sáiz
  10. Gerardo Flórez
  11. José Manuel Goikolea
  12. Iñaki Zorrilla
  13. Ruth Cunill
  14. Xavi Castells
  15. Elisardo Becoña
  16. Ana López
  17. Luis San
Journal:
Adicciones: Revista de socidrogalcohol

ISSN: 0214-4840

Year of publication: 2022

Volume: 34

Issue: 2

Pages: 110-127

Type: Article

DIALNET GOOGLE SCHOLAR lock_openOpen access editor

More publications in: Adicciones: Revista de socidrogalcohol

Abstract

Although correct diagnosis and management of patients with schizophrenia and a comorbid substance use disorder (SUD) would determine a decrease in morbidity and mortality in these patients, development of efficient therapeutic strategies is still pending. We present recommendations on the pharmacological and psychological management of these patients following the ‘PICO’ structure (Patient-Intervention-Comparison-Outcomes). Evaluation of the quality of studies and summary of the evidence for each question was performed following the recommendations of the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) working group. Our results suggest: 1) In patients with schizophrenia and cannabis use disorder, it is not possible to recommend one antipsychotic drug over another (between olanzapine, risperidone or haloperidol) for improving psychotic symptoms, reducing cannabis use, or improving pragmatic variables (weak recommendation). Clozapine cannot be recommended to reduce cannabis use (weak recommendation). 2) In patients with schizophrenia and cocaine use disorder we recommend haloperidol over olanzapine to reduce craving (moderate recommendation), and olanzapine over haloperidol to improve motor side effects in these patients (moderate recommendation). 3) In patients with schizophrenia and alcohol use disorder while naltrexone is recommended to reduce alcohol use (in terms of reducing alcohol craving) (weak recommendation), there is insufficient evidence to make any recommendation on the use of adjuvant acamprosate (weak recommendation). 4) In patients with schizophrenia and nicotine use disorder, adjuvant bupropion and varenicline are recommended for reducing nicotine use and nicotine abstinence (strong/moderate recommendation). 5) In patients with schizophrenia and polydrug use disorder, second-generation over first-generation antipsychotic drugs and olanzapine over other second-generation antipsychotics are recommended to improve psychotic symptoms (moderate/weak recommendation).

Bibliographic References

  • Addy, P. H., Radhakrishnan, R., Cortes, J. A. y D’Souza, D. C. (2012). Comorbid alcohol, cannabis, and cocaine use disorders in schizophrenia: Epidemiology, consequences, mechanisms, and treatment. FOCUS: The Journal of Lifelong Learning in Psychiatry, 10, 140–153. doi:10.1176/appi.focus.10.2.140.
  • Akbarpour, F., Rezaei, O., Khodaie-Ardakani, M. R., Sheikhvatan, M., Goodarzi, H. y Dolatshahi, B. (2010). A double-blind placebo controlled trial of bupropion for smoking abstinence and cognition improvement in schizophrenia. Minerva Psichiatrica, 51, 263–269.
  • Akerele, E. y Levin, F. R. (2007). Comparison of olanzapine to risperidone in substance-abusing individuals with schizophrenia. The American Journal on Addictions, 16, 260–268. doi:10.1080/10550490701389658.
  • Arranz, B., Garriga, M., García-Rizo, C. y San, L. (2018). Clozapine use in patients with schizophrenia and a comorbid substance use disorder: A systematic review. European Neuropsychopharmacology, 28, 227-242. doi:10.1016/j.euroneuro.2017.12.006.
  • Baker, A. L., Thornton, L. K., Hiles, S., Hides, L. y Lubman, D. I. (2012). Psychological interventions for alcohol misuse among people with co-occurring depression or anxiety disorders: A systematic review. Journal of Affective Disorders, 139, 217–229. doi:10.1016/j.jad.2011.08.004.
  • Berk, M., Brook, S. y Trandafir, A. I. (1999). A comparison of olanzapine with haloperidol in cannabis-induced psychotic disorder: A double-blind randomized controlled trial. International Clinical Psychopharmacology, 14, 177–180.
  • Bloch, B., Reshef, A., Cohen, T., Tafla, A., Gathas, S., Israel, S.,… Ebstein, R. P. (2010). Preliminary effects of bupropion and the promoter region (HTTLPR) serotonin transporter (SLC6A4) polymorphism on smoking behavior in schizophrenia. Psychiatry Research, 175, 38–42. doi:10.1016/j.psychres.2008.12.015.
  • Brunette, M. F., Dawson, R., O’Keefe, C. D., Narasimhan, M., Noordsy, D. L., Wojcik, J. y Green, A. I. (2011). A randomized trial of clozapine vs. other antipsychotics for cannabis use disorder in patients with schizophrenia. Journal of Dual Diagnosis, 7, 50–63. doi:10.1080/15504263.2011.570118.
  • Crockford, D. y Addington, D. (2017). Canadian Schizophrenia Guidelines: Schizophrenia and other psychotic disorders with coexisting substance use disorders. Canadian Journal of Psychiatry, 62, 624–634. doi:10.1177/0706743717720196.
  • De Witte, N. J., Crunelle, C. L., Sabbe, B., Moggi, F. y Dom, G. (2014). Treatment for outpatients with comorbid schizophrenia and substance use disorders: A review. European Addiction Research, 20, 105–114. doi:10.1159/000355267.
  • Drake, R. E., Xie, H., McHugo, G. J. y Green, A. I. (2000). The effects of clozapine on alcohol and drug use disorders among patients with schizophrenia. Schizophrenia Bulletin, 26, 441–449.
  • Evins, A. E., Cather, C., Culhane, M. A., Birnbaum, A., Horowitz, J., Hsieh, E.,… Goff, D. C. (2007). A 12-week double-blind, placebo-controlled study of bupropion SR added to high-dose dual nicotine replacement therapy for smoking cessation or reduction in schizophrenia. Journal of Clinical Psychopharmacology, 27, 380–386. doi:10.1097/01.jcp.0b013e3180ca86fa.
  • Evins, A. E., Cather, C., Deckersbach, T., Freudenreich, O., Culhane, M. A., Olm-Shipman, C. M., Henderson, D. C.,… Rigotti, N. A. (2005). A double-blind placebo-controlled trial of bupropion sustained-release for smoking cessation in schizophrenia. Journal of Clinical Psychopharmacology, 25, 218–225. doi:10.1097/01.jcp.0000162802.54076.18.
  • Evins, A. E., Mays, V. K., Rigotti, N. A., Tisdale, T., Cather, C. y Goff, D. C. (2001). A pilot trial of bupropion added to cognitive behavioral therapy for smoking cessation in schizophrenia. Nicotine y Tobacco Research, 3, 397–403. doi:10.1080/14622200110073920.
  • Fonseca-Pedrero, E., Lucas-Molina, B., Pérez-Albéniz, A., Inchausti, F. y Ortuño-Sierra, J. (2020). Psychotic-like experiences and cannabis use in adolescents from the general population. Adicciones, 32, 41–51. doi:10.20882/adicciones.1149.
  • García, L., Gomar, J. J., García-Portilla, M. P. y Bobes, J. (2019). Cannabis use and cognitive impairment in schizophrenia and first-episode psychosis. Adicciones, 31, 89–94. doi:10.20882/adicciones.1328.
  • George, T., Vessicchio, J., Sacco, K., Weinberger, A., Dudas, M., Allen, T.,… Jatlow, P. I. (2008). A placebo-controlled trial of bupropion combined with nicotine patch for smoking cessation in schizophrenia. Biological Psychiatry, 63, 1092–1096. doi:10.1016/j.biopsych.2007.11.002.
  • George, T., Vessicchio, J., Termine, A., Bregartner, T., Feingold, A., Rounsaville, B. y Kosten, T. (2002). A placebo controlled trial of bupropion for smoking cessation in schizophrenia. Biological Psychiatry, 52, 53–61. doi:10.1016/S0006-3223(02)01339-2.
  • Gopalakrishna, G., Langendam, M. W., Scholten, R. J., Bossuyt, P. M. y Leeflang, M. M. (2013). Guidelines for guideline developers: A systematic review of grading systems for medical tests. Implementation Science, 8, 78. doi:10.1186/1748-5908-8-78.
  • Green, A., Noordsy, D. L., Brunette, M. F. y O’Keefe, C. (2008). Substance abuse and schizophrenia: Pharmacotherapeutic intervention. Journal of Substance Abuse Treatment, 34, 61–71. doi:10.1016/j.jsat.2007.01.008.
  • Green, A., Tohen, M. F., Hamer, R. M., Strakowski, S. M., Lieberman, J. A., Glick, I.,… Scott Clark, W. (2004). First episode schizophrenia-related psychosis and substance use disorders: Acute response to olanzapine and haloperidol. Schizophrenia Research, 66, 125–135. doi:10.1016/j.schres.2003.08.001.
  • Green, A., Zimmet, S. V, Strous, R. D. y Schildkraut, J. J. (1999). Clozapine for comorbid substance use disorder and schizophrenia: Do patients with schizophrenia have a reward-deficiency syndrome that can be ameliorated by clozapine? Harvard Review of Psychiatry, 6, 287–296.
  • Guyatt, G. H., Oxman, A. D., Kunz, R., Atkins, D., Brozek, J., Vist, G.,… Schünemann, H. J. (2011). GRADE guidelines: 2. Framing the question and deciding on important outcomes. Journal of Clinical Epidemiology, 64, 395–400. doi:10.1016/j.jclinepi.2010.09.012.
  • Hasan, A., Falkai, P., Wobrock, T., Lieberman, J., Glenthoj, B., Gattaz, W. F.,… Möller, H.-J. (2012). World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 1: Update 2012 on the acute treatment of schizophrenia and the management of treatment resistance. World Journal of Biological Psychiatry, 13, 318–378. doi:10.3109/15622975.2012.696143.
  • Hasan, A., Falkai, P., Wobrock, T., Lieberman, J., Glenthøj, B., Gattaz, W. F.,… Möller, H.-J. (2015). World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia Part 3: Update 2015 Management of special circumstances: Depression, suicidality, substance use disorders and pregnancy and lactation. The World Journal of Biological Psychiatry, 16, 142–170. doi:10.3109/15622975.2015.1009163.
  • Heiberg, I. H., Jacobsen, B. K., Nesvåg, R., Bramness, J. G., Reichborn-Kjennerud, T., Næss, Ø., … Høye, A. (2018). Total and cause-specific standardized mortality ratios in patients with schizophrenia and/or substance use disorder. PLoS One, 13, e0202028. doi:10.1371/journal.pone.0202028.
  • Hunt, G. E., Large, M. M., Cleary, M., Lai, H. M. X. y Saunders, J. B. (2018). Prevalence of comorbid substance use in schizophrenia spectrum disorders in community and clinical settings, 1990-2017: Systematic review and meta-analysis. Drug and Alcohol Dependence, 191, 234–258. doi:10.1016/j.drugalcdep.2018.07.011.
  • Hunt, G. E., Siegfried, N., Morley, K., Sitharthan, T. y Cleary, M. (2013). Psychosocial interventions for people with both severe mental illness and substance misuse. The Cochrane Database of Systematic Reviews, 10, CD001088. doi:10.1002/14651858.CD001088.pub3.
  • Kavanagh, D. J., Mcgrath, J., Saunders, J. B., Dore, G. y Clark, D. (2002). Substance misuse in patients with schizophrenia: Epidemiology and management. Drugs, 62, 743–755.
  • Kishi, T. y Iwata, N. (2015). Varenicline for smoking cessation in people with schizophrenia: Systematic review and meta-analysis. European Archives of Psychiatry and Clinical Neuroscience, 265, 259–268. doi:10.1007/s00406-014-0551-3.
  • Krause, M., Huhn, M., Schneider-Thoma, J., Bighelli, I., Gutsmiedl, K. y Leucht, S. (2019). Efficacy, acceptability and tolerability of antipsychotics in patients with schizophrenia and comorbid substance use. A systematic review and meta-analysis. European Neuropsychopharmacology, 29, 32–45. doi:10.1016/j.euroneuro.2018.11.1105.
  • Large, M., Mullin, K., Gupta, P., Harris, A. y Nielssen, O. (2014). Systematic meta-analysis of outcomes associated with psychosis and co-morbid substance use. The Australian and New Zealand Journal of Psychiatry, 48, 418–432. doi:10.1177/0004867414525838.
  • Makarski, J. y Brouwers, M. C. (2014). The AGREE Enterprise: A decade of advancing clinical practice guidelines. Implementation Science, 9, 103. doi:10.1186/s13012-014-0103-2.
  • Margolese, H. C., Malchy, L., Negrete, J. C., Tempier, R. y Gill, K. (2004). Drug and alcohol use among patients with schizophrenia and related psychoses: Levels and consequences. Schizophrenia Research, 67, 157–166. doi:10.1016/S0920-9964(02)00523-6.
  • Matali, J. L., Andión, O., Pardo, M., Iniesta, R., Serrano, E. y San, L. (2016). Adolescents and dual diagnosis in a psychiatric emergency service. Adicciones, 28, 71–79. doi:10.20882/adicciones.783.
  • Mueser, K. T. y Gingerich, S. (2013). Treatment of co-occurring psychotic and substance use disorders. Social Work in Public Health, 28, 424–439. doi:10.1080/19371918.2013.774676.
  • Murthy, P., Mahadevan, J. y Chand, P. K. (2019). Treatment of substance use disorders with co-occurring severe mental health disorders. Current Opinion in Psychiatry, 32, 293–299. doi:10.1097/YCO.0000000000000510.
  • Mustafa, R. A., Santesso, N., Brozek, J., Akl, E. A., Walter, S. D., Norman, G.,… Schünemann, H. J. (2013). The GRADE approach is reproducible in assessing the quality of evidence of quantitative evidence syntheses. Journal of Clinical Epidemiology, 66, 736–742. doi:10.1016/j.jclinepi.2013.02.004.
  • Nielsen, S. M., Toftdahl, N. G., Nordentoft, M. y Hjorthøj, C. (2017). Association between alcohol, cannabis, and other illicit substance abuse and risk of developing schizophrenia: A nationwide population based register study. Psychological Medicine, 47, 1668–1677. doi:10.1017/S0033291717000162.
  • Pearsall, R., Smith, D. J. y Geddes, J. R. (2019). Pharmacological and behavioural interventions to promote smoking cessation in adults with schizophrenia and bipolar disorders: A systematic review and meta-analysis of randomised trials. BMJ Open, 9, 1–12. doi:10.1136/bmjopen-2018-027389.
  • Perry, E. B., Gil, R., Miles, D., Brenner, L., Macdougall, L., Johnson, R.,… D’Souza, D. C. (2005). Mazindol augmentation of antipsychotic treatment for schizophrenic patients with comorbid cocaine abuse or dependence. Journal of Dual Diagnosis, 1, 37–47. doi:10.1300/J374v01n01_04.
  • Petrakis, I. L., O’Malley, S., Rounsaville, B., Poling, J., McHugh-Strong, C. y Krystal, J. H. (2004). Naltrexone augmentation of neuroleptic treatment in alcohol abusing patients with schizophrenia. Psychopharmacology, 172, 291–297. doi:10.1007/s00213-003-1658-9.
  • Ralevski, E., O’Brien, E., Jane, J. S., Dean, E., Dwan, R. y Petrakis, I. (2011). Effects of acamprosate on cognition in a treatment study of patients with schizophrenia spectrum disorders and comorbid alcohol dependence. The Journal of Nervous and Mental Disease, 199, 499–505. doi:10.1097/NMD.0b013e3182214297.
  • Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L. L. y Goodwin, F. K. (1990). Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA, 264, 2511–2518.
  • Sayers, S. L., Campbell, E. C., Kondrich, J., Mann, S. C., Cornish, J., O’ Brien, C. y Caroff, S. N. (2005). Cocaine abuse in schizophrenic patients treated with olanzapine versus haloperidol. The Journal of Nervous and Mental Disease, 193, 379–386. doi:10.1097/01.nmd.0000165089.14736.bf.
  • Schünemann, H. J., Oxman, A. D., Brozek, J., Glasziou, P., Jaeschke, R., Vist, G. E.,… Guyatt, G. H. (2008). Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ, 336, 1106–1110. doi:10.1136/bmj.39500.677199.AE.
  • Sevy, S., Robinson, D. G., Sunday, S., Napolitano, B., Miller, R., McCormack, J. y Kane, J. (2011). Olanzapine vs. risperidone in patients with first-episode schizophrenia and a lifetime history of cannabis use disorders: 16-week clinical and substance use outcomes. Psychiatry Research, 188, 310–314. doi:10.1016/j.psychres.2011.05.001.
  • Siris, S. G., Bermanzohn, P. C., Mason, S. E., Rifkin, A. y Alvir, J. M. (1992). Adjunctive imipramine for dysphoric schizophrenic patients with past histories of cannabis abuse. Progress in Neuro-Psychopharmacology y Biological Psychiatry, 16, 539–547.
  • Smelson, D. A., Ziedonis, D., Williams, J., Losonczy, M. F., Williams, J., Steinberg, M. L. y Kaune, M. (2006). The efficacy of olanzapine for decreasing cue-elicited craving in individuals with schizophrenia and cocaine dependence. Journal of Clinical Psychopharmacology, 26, 9–12. doi:10.1097/01.jcp.0000194624.07611.5e.
  • Swartz, M. S., Wagner, H. R., Swanson, J. W., Stroup, T. S., McEvoy, J. P., Reimherr, F.,… Lieberman, J. A. (2008). The effectiveness of antipsychotic medications in patients who use or avoid illicit substances: Results from the CATIE study. Schizophrenia Research, 100, 39–52. doi:10.1016/j.schres.2007.11.034.
  • Temmingh, H. S., Williams, T., Siegfried, N. y Stein, D. J. (2018). Risperidone versus other antipsychotics for people with severe mental illness and co-occurring substance misuse. The Cochrane Database of Systematic Reviews, 1, CD011057. doi:10.1002/14651858.CD011057.pub2.
  • Thornton, L. K., Baker, A. L., Lewin, T. J., Kay-Lambkin, F. J., Kavanagh, D., Richmond, R.,… Johnson, M. P. (2012). Reasons for substance use among people with mental disorders. Addictive Behaviors, 37, 427–434. doi:10.1016/j.addbeh.2011.11.039.
  • Van Nimwegen, L. J., de Haan, L., van Beveren, N. J., van der Helm, M., van den Brink, W. y Linszen, D. (2008). Effect of olanzapine and risperidone on subjective well-being and craving for cannabis in patients with schizophrenia or related disorders: A double-blind randomized controlled trial. Canadian Journal of Psychiatry, 53, 400–405.
  • Weiner, E., Ball, M. P., Buchholz, A. S., Gold, J. M., Evins, A. E., McMahon, R. P. y Buchanan, R. W. (2012). Bupropion sustained release added to group support for smoking cessation in schizophrenia. The Journal of Clinical Psychiatry, 73, 95–102. doi:10.4088/JCP.10m06143gre.
  • Weiner, E., Buchholz, A., Coffay, A., Liu, F., McMahon, R. P., Buchanan, R. W. y Kelly, D. L. (2011). Varenicline for smoking cessation in people with schizophrenia: A double blind randomized pilot study. Schizophrenia Research, 129, 94–95. doi:10.1016/j.schres.2011.02.003.
  • Williams, J. M., Anthenelli, R. M., Morris, C. D., Treadow, J., Thompson, J. R., Yunis, C. y George, T. P. (2012). A randomized, double-blind, placebo-controlled study evaluating the safety and efficacy of varenicline for smoking cessation in patients with schizophrenia or schizoaffective disorder. The Journal of Clinical Psychiatry, 73, 654–660. doi:10.4088/JCP.11m07522.
  • Wilson, R. P. y Bhattacharyya, S. (2016). Antipsychotic efficacy in psychosis with co-morbid cannabis misuse: A systematic review. Journal of Psychopharmacology, 30, 99–111. doi:10.1177/0269881115612237.
  • Wobrock, T. y Soyka, M. (2008). Pharmacotherapy of schizophrenia with comorbid substance use disorder--reviewing the evidence and clinical recommendations. Progress in Neuro-Psychopharmacology y Biological Psychiatry, 32, 1375–1385. doi:10.1016/j.pnpbp.2008.02.008.
Data source: Dialnet