Pharmacological treatment for dual diagnosis: a literature update and a proposal of intervention

Interdisciplinary Study Group CRARL - SITAC - SIPaD - SITD - SIPDip, Giovanni Laviola, Simone Macri, Rosanna Mancinelli

Research output: Contribution to journalReview article

Abstract

Background: It has long been appreciated that alcohol use disorder (AUD) is associated with increased risk of psychiatric disorder. As well, people with history of mental disorder are more likely to develop lifetime AUD. Nevertheless, the treatment of dual diagnosis (DD) in alcohol addiction still remains a challenge. The efficacy of pharmacological treatment for these patients has been widely investigated with controversial results. Patients with untreated psychiatric disorder are at higher risk to return to drinking and tend to do so more quickly. The aim of this review was to collect clinical data for developing guidelines for the pharmacological treatment of psychiatric diseases in a population with AUD.

Materials and methods: A literature review was conducted using the following databases: PubMed-NCBI, Cochrane database, Embase Web of Science, and Scopus, including studies published between 1980 and 2015. Search terms were: “guideline”, “treatment”, “comorbidity”, “substance abuse”, “alcohol”, “dual-diagnosis”, “antidepressant”, “antipsychotic”, “mood-stabilizer”. Out of 1521 titles, 84 studies were included for their relevance on pharmacological treatment of psychiatric disorders in people with AUD.

Results: Different drugs were collected in major pharmacological classes (antidepressant, mood-stabilizer, antipsychotic), in order to identify their proved efficacy for treating specific psychiatric disorder in the AUD population. Data were selected and verified for publications from randomized clinical trials, open-label trials and case reports.

Conclusions: DD in alcohol dependence is a complex clinical entity, and its high prevalence is supported by epidemiological data. Pharmacological management of psychiatric disorders in patients with AUD remains partially anecdotal. Based on reviewed articles, we propose a classification of psychiatric medications for treatment of mental disorders comorbid with AUD, listed with evidence-based recommendations. More research is needed to obtain and collect clinical data, in order to organize and share evidence-based guidelines.

Original languageEnglish
Pages (from-to)160-169
Number of pages10
JournalRivista di Psichiatria
Volume53
Issue number3
DOIs
Publication statusPublished - Jun 19 2018

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Dual (Psychiatry) Diagnosis
Psychiatry
Alcohols
Pharmacology
Guidelines
Therapeutics
Mental Disorders
Antidepressive Agents
Antipsychotic Agents
Alcoholism
Databases
PubMed
Population
Drinking
Substance-Related Disorders
Publications
Comorbidity
Randomized Controlled Trials

Keywords

  • Alcohol Deterrents/classification
  • Alcoholism/drug therapy
  • Anticonvulsants/therapeutic use
  • Antidepressive Agents/therapeutic use
  • Antipsychotic Agents/therapeutic use
  • Clinical Trials as Topic
  • Comorbidity
  • Diagnosis, Dual (Psychiatry)
  • Evidence-Based Medicine
  • Humans
  • Mental Disorders/drug therapy
  • Practice Guidelines as Topic
  • Psychotropic Drugs/therapeutic use

Cite this

Pharmacological treatment for dual diagnosis : a literature update and a proposal of intervention. / Interdisciplinary Study Group CRARL - SITAC - SIPaD - SITD - SIPDip ; Laviola, Giovanni; Macri, Simone; Mancinelli, Rosanna.

In: Rivista di Psichiatria, Vol. 53, No. 3, 19.06.2018, p. 160-169.

Research output: Contribution to journalReview article

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abstract = "Background: It has long been appreciated that alcohol use disorder (AUD) is associated with increased risk of psychiatric disorder. As well, people with history of mental disorder are more likely to develop lifetime AUD. Nevertheless, the treatment of dual diagnosis (DD) in alcohol addiction still remains a challenge. The efficacy of pharmacological treatment for these patients has been widely investigated with controversial results. Patients with untreated psychiatric disorder are at higher risk to return to drinking and tend to do so more quickly. The aim of this review was to collect clinical data for developing guidelines for the pharmacological treatment of psychiatric diseases in a population with AUD.Materials and methods: A literature review was conducted using the following databases: PubMed-NCBI, Cochrane database, Embase Web of Science, and Scopus, including studies published between 1980 and 2015. Search terms were: “guideline”, “treatment”, “comorbidity”, “substance abuse”, “alcohol”, “dual-diagnosis”, “antidepressant”, “antipsychotic”, “mood-stabilizer”. Out of 1521 titles, 84 studies were included for their relevance on pharmacological treatment of psychiatric disorders in people with AUD.Results: Different drugs were collected in major pharmacological classes (antidepressant, mood-stabilizer, antipsychotic), in order to identify their proved efficacy for treating specific psychiatric disorder in the AUD population. Data were selected and verified for publications from randomized clinical trials, open-label trials and case reports.Conclusions: DD in alcohol dependence is a complex clinical entity, and its high prevalence is supported by epidemiological data. Pharmacological management of psychiatric disorders in patients with AUD remains partially anecdotal. Based on reviewed articles, we propose a classification of psychiatric medications for treatment of mental disorders comorbid with AUD, listed with evidence-based recommendations. More research is needed to obtain and collect clinical data, in order to organize and share evidence-based guidelines.",
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author = "{Interdisciplinary Study Group CRARL - SITAC - SIPaD - SITD - SIPDip} and Mario Vitali and Martino Mistretta and Giovanni Alessandrini and Giovanna Coriale and Marina Romeo and Fabio Attilia and Claudia Rotondo and Francesca Sorbo and Fabiola Pisciotta and Attilia, {Maria Luisa} and Mauro Ceccanti and Giovanni Laviola and Simone Macri and Rosanna Mancinelli",
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T2 - a literature update and a proposal of intervention

AU - Interdisciplinary Study Group CRARL - SITAC - SIPaD - SITD - SIPDip

AU - Vitali, Mario

AU - Mistretta, Martino

AU - Alessandrini, Giovanni

AU - Coriale, Giovanna

AU - Romeo, Marina

AU - Attilia, Fabio

AU - Rotondo, Claudia

AU - Sorbo, Francesca

AU - Pisciotta, Fabiola

AU - Attilia, Maria Luisa

AU - Ceccanti, Mauro

AU - Laviola, Giovanni

AU - Macri, Simone

AU - Mancinelli, Rosanna

PY - 2018/6/19

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N2 - Background: It has long been appreciated that alcohol use disorder (AUD) is associated with increased risk of psychiatric disorder. As well, people with history of mental disorder are more likely to develop lifetime AUD. Nevertheless, the treatment of dual diagnosis (DD) in alcohol addiction still remains a challenge. The efficacy of pharmacological treatment for these patients has been widely investigated with controversial results. Patients with untreated psychiatric disorder are at higher risk to return to drinking and tend to do so more quickly. The aim of this review was to collect clinical data for developing guidelines for the pharmacological treatment of psychiatric diseases in a population with AUD.Materials and methods: A literature review was conducted using the following databases: PubMed-NCBI, Cochrane database, Embase Web of Science, and Scopus, including studies published between 1980 and 2015. Search terms were: “guideline”, “treatment”, “comorbidity”, “substance abuse”, “alcohol”, “dual-diagnosis”, “antidepressant”, “antipsychotic”, “mood-stabilizer”. Out of 1521 titles, 84 studies were included for their relevance on pharmacological treatment of psychiatric disorders in people with AUD.Results: Different drugs were collected in major pharmacological classes (antidepressant, mood-stabilizer, antipsychotic), in order to identify their proved efficacy for treating specific psychiatric disorder in the AUD population. Data were selected and verified for publications from randomized clinical trials, open-label trials and case reports.Conclusions: DD in alcohol dependence is a complex clinical entity, and its high prevalence is supported by epidemiological data. Pharmacological management of psychiatric disorders in patients with AUD remains partially anecdotal. Based on reviewed articles, we propose a classification of psychiatric medications for treatment of mental disorders comorbid with AUD, listed with evidence-based recommendations. More research is needed to obtain and collect clinical data, in order to organize and share evidence-based guidelines.

AB - Background: It has long been appreciated that alcohol use disorder (AUD) is associated with increased risk of psychiatric disorder. As well, people with history of mental disorder are more likely to develop lifetime AUD. Nevertheless, the treatment of dual diagnosis (DD) in alcohol addiction still remains a challenge. The efficacy of pharmacological treatment for these patients has been widely investigated with controversial results. Patients with untreated psychiatric disorder are at higher risk to return to drinking and tend to do so more quickly. The aim of this review was to collect clinical data for developing guidelines for the pharmacological treatment of psychiatric diseases in a population with AUD.Materials and methods: A literature review was conducted using the following databases: PubMed-NCBI, Cochrane database, Embase Web of Science, and Scopus, including studies published between 1980 and 2015. Search terms were: “guideline”, “treatment”, “comorbidity”, “substance abuse”, “alcohol”, “dual-diagnosis”, “antidepressant”, “antipsychotic”, “mood-stabilizer”. Out of 1521 titles, 84 studies were included for their relevance on pharmacological treatment of psychiatric disorders in people with AUD.Results: Different drugs were collected in major pharmacological classes (antidepressant, mood-stabilizer, antipsychotic), in order to identify their proved efficacy for treating specific psychiatric disorder in the AUD population. Data were selected and verified for publications from randomized clinical trials, open-label trials and case reports.Conclusions: DD in alcohol dependence is a complex clinical entity, and its high prevalence is supported by epidemiological data. Pharmacological management of psychiatric disorders in patients with AUD remains partially anecdotal. Based on reviewed articles, we propose a classification of psychiatric medications for treatment of mental disorders comorbid with AUD, listed with evidence-based recommendations. More research is needed to obtain and collect clinical data, in order to organize and share evidence-based guidelines.

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KW - Alcoholism/drug therapy

KW - Anticonvulsants/therapeutic use

KW - Antidepressive Agents/therapeutic use

KW - Antipsychotic Agents/therapeutic use

KW - Clinical Trials as Topic

KW - Comorbidity

KW - Diagnosis, Dual (Psychiatry)

KW - Evidence-Based Medicine

KW - Humans

KW - Mental Disorders/drug therapy

KW - Practice Guidelines as Topic

KW - Psychotropic Drugs/therapeutic use

U2 - 10.1708/2925.29419

DO - 10.1708/2925.29419

M3 - Review article

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VL - 53

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EP - 169

JO - Rivista di Psichiatria

JF - Rivista di Psichiatria

SN - 0035-6484

IS - 3

ER -