Atypical Antipsychotic Drugs in Dual Diagnosis Patients: A Review
Identificadores
URI: http://hdl.handle.net/20.500.12020/775ISSN: 2378-3001
DOI: 10.23937/2378-3001/2/1/1026
Autor/es
Marín-Mayor, Marta; López-Álvarez, Jorge; López-Muñoz, F.; Arias-Horcajadas, Francisco; Rubio, G.Fecha
2015Tipo de documento
articleÁrea/s de conocimiento
PsicologíaResumen
Introduction: Dual Diagnosis (DD), defined as the co-occurrence
of a Substance Use Disorder (SUD) and a Severe Mental Illness
(SMI), is associated with several negative outcomes. Typical
antipsychotics (TAP) are not of great value for patients with DD as
they are associated with poorer responses and can worsen SUD.
Atypical antipsychotics (AAP) offer several advantages compared
to TAP. In DD, they have been found to be effective in treating both,
psychiatric symptoms and substance use. The aim of this article is
to review the use of AAP for treating DD patients.
Methods: A search of MEDLINE, EMBASE and Pubmed was
performed in order to identify publications that examined the use of
AAP in the treatment of DD.
Results: The largest number of studies focuse on clozapine,
with consistently positive data. Data regarding aripiprazole are
also consistent but less substantial. Olanzapine, risperidone
and quetiapine have given inconclusive and inconsistent results.
Finally, there is little use of amisulpride, ziprasidone, paliperidone
and asenapine or it is has not been documented.
Discussion: Today, there is a consensus on using AAT instead
of TAP for treating patients with DD. Patients with DD show a
poorer response to treatment with TAP, and TAP may even worsen
the addictive behaviour. AAP are as effective as TAP in treating
psychiatric symptoms, but they are more effective in reducing
substance use in DD patients. Because with the exception of CLO
none of the AAP have shown to be superior to the others, when
choosing between the different AAP agents clinicians should take
into account other variables such as medical comorbidity, possible
pharmacological interactions of concomitant treatments and profile
of side effects. Even though a growing body of evidence suggests
the beneficial effects of AAP in DD patients, further randomized,
blinded, controlled trials, with larger sample sizes and longer followups
are needed.