Course of Psychosis in Schizophrenia With Alcohol Use Disorder: A Post Hoc Analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness in Schizophrenia Phase 1 Study.

Abstract

OBJECTIVE:

Patients with schizophrenia and comorbid alcohol use disorder remain understudied. This post hoc analysis evaluated data from Phase 1 of the Clinical Antipsychotic Trials of Intervention Effectiveness in Schizophrenia study (January 2001-December 2004).

METHODS:

Patients without substance abuse (except marijuana use) in the month before study entry were categorized into those with a history of alcohol use disorder (SZ + AUD) within 5 years before study entry and those without alcohol use disorder (SZ-only) per DSM-IV criteria. Time to first and recurrent exacerbations and hospitalizations were compared between disease states and between olanzapine and perphenazine, quetiapine, risperidone, and ziprasidone.

RESULTS:

A total of 1,338 patients (SZ + AUD = 22.6%; SZ-only = 77.4%) were included. Time to first exacerbation of SZ was significantly shorter in the SZ + AUD versus SZ-only population (median = 5.4 vs 6.4 months; hazard ratio [HR] = 1.20 [95% CI, 1.01-1.42]; P = .039). Similar findings were observed for first hospitalization (HR = 1.63 [95% CI, 1.20-2.22]; P = .002) and recurrent hospitalizations (HR = 1.60 [95% CI, 1.18-2.15]; P = .002). The most common reasons leading to exacerbation in both groups were an increase in symptom severity and lack of efficacy. In patients with SZ + AUD related or unrelated to marijuana, perphenazine, quetiapine, risperidone, and ziprasidone were associated with significantly shorter time to first exacerbation versus olanzapine.

CONCLUSIONS:

This post hoc analysis confirmed that patients with SZ + AUD had a worse illness course than patients with SZ-only and suggests that olanzapine may be associated with a longer time to first and recurrent exacerbations versus other antipsychotics in this difficult-to-treat population. Further research is needed to identify effective treatments for this important yet understudied patient population.

TRIAL REGISTRATION:

ClinicalTrials.gov identifier: NCT00014001.

• Authors: Sanjeev Pathak, Ying Jiang, Lauren DiPetrillo, Mark S Todtenkopf, Yan Liu, Christoph U Correll
• Journal: The Journal of clinical psychiatry (J Clin Psychiatry) Vol. 81 Issue 2 (03 17 2020) ISSN: 1555-2101 [Electronic] United States
• PMID: 32220153 (Publication Type: Clinical Trial, Phase I, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © Copyright 2020 Physicians Postgraduate Press, Inc.

Chemical References

• Antipsychotic Agents
• Piperazines
• Thiazoles
• Quetiapine Fumarate
• ziprasidone
• Perphenazine
• Risperidone
• Olanzapine

Topics

• Adult
• Alcoholism (epidemiology)
• Antipsychotic Agents (pharmacology)
• Comorbidity
• Female
• Hospitalization (statistics & numerical data)
• Humans
• Male
• Olanzapine (pharmacology)
• Outcome Assessment, Health Care
• Perphenazine (pharmacology)
• Piperazines (pharmacology)
• Psychotic Disorders (drug therapy, epidemiology)
• Quetiapine Fumarate (pharmacology)
• Risperidone (pharmacology)
• Schizophrenia (drug therapy, epidemiology)
• Severity of Illness Index
• Symptom Flare Up
• Thiazoles (pharmacology)
• Time Factors