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Effectiveness of antipsychotics in schizophrenia with comorbid substance use disorder

Published online by Cambridge University Press:  13 August 2021

M. Lähteenvuo ,
J. Luykx ,
H. Taipale ,
E. Mittendorfer-Rutz ,
A. Tanskanen ,
A. Batalla  and
J. Tiihonen
M. Lähteenvuo
Affiliation:
Dept Of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland
J. Luykx
Affiliation:
Department Of Psychiatry, Utrecht University, Utrecht, Netherlands
H. Taipale
Affiliation:
Department Of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
E. Mittendorfer-Rutz
Affiliation:
Department Of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
A. Tanskanen
Affiliation:
Department Of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
A. Batalla
Affiliation:
Psychiatry, University Medical Centre Utrecht, Utrecht, Netherlands
J. Tiihonen*
Affiliation:
Department Of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
*
*Corresponding author.

Abstract

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Introduction

Schizophrenia is highly comorbid with substance use disorders (SUD), which may negatively impact the course of illness. However, large studies exploring the best lines of treatment for this combination are lacking.

Objectives

We investigated what are the most effective antipsychotics for patients with schizophrenia in preventing the development of substance use disorders and preventing hospitalizations in patients already having substance use disorder.

Methods

We used two independent national cohort registries including all patient with schizophrenia aged under 46 years. Participants were followed during 22 (1996–2017, Finland) and 11 years (2006–2016, Sweden). We studied risk of rehospitalization, and risk of developing an SUD when using vs. not using antipsychotics, using Cox proportional hazards regression analysis models.

Results

45,476 patients with schizophrenia were identified (30,860 in Finland; 14,616 in Sweden). For patients without SUD, clozapine and antipsychotic polytherapy were associated with the lowest risks of developing SUD in both countries. For patients with co-existing SUD, the risk of hospitalization was the lowest during clozapine, polytherapy and long-acting injectable use.

Conclusions

In patients with schizophrenia and comorbid SUD, antipsychotic medications were effective in preventing relapses. In those without an SUD, antipsychotic use was associated with a markedly reduced risk of developing an initial SUD. Clozapine and long-acting injectables should be considered treatments of choice in patients with schizophrenia and SUD, or at risk of developing co-morbid SUD.

Disclosure

ML: Genomi Solutions Ltd, DNE Ltd, Sunovion, Orion Pharma, Janssen-Cilag, Finnish Medical Foundation, Emil Aaltonen Foundation. HT, EMR, AT: Eli Lilly, Janssen–Cilag. JT: Eli Lilly, Janssen-Cilag, Lundbeck, Otsuka.

Keywords

schizophréniaantipsychoticSubstance use
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S161
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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