Historique
Article de Périodique
Treatment of substance abusing patients with comorbid psychiatric disorders (2012)
Auteur(s) :
KELLY, T. M. ;
DALEY, D. C. ;
DOUAIHY, A. B.
Année
2012
Page(s) :
11-24
Sous-type de document :
Revue de la littérature / Literature review
Langue(s) :
Anglais
Domaine :
Plusieurs produits / Several products
Thésaurus mots-clés
TROUBLE BIPOLAIRE
;
TRAITEMENT
;
COMORBIDITE
;
PSYCHIATRIE
;
PHARMACOTHERAPIE
;
PSYCHOSE
;
CANNABIS
;
ALCOOL
;
DEPRESSION
;
COCAINE
;
PSYCHOSE MANIACO-DEPRESSIVE
;
ANXIETE
;
OPIACES
;
METHODE
Note de contenu :
1. Introduction
2. Method
3. Results
3.1. Pharmacotherapy of psychosis and alcohol and cannabis use disorder
3.2. Pharmacotherapy of psychosis and cocaine use disorder
3.3. Behavioral and psychotherapeutic interventions for psychotic and substance use disorders
3.4. Combined treatment for alcohol abuse and depression
3.5. Pharmacotherapy of cannabis use disorder and depression
3.6. Combined treatments for cocaine use disorder and depression
3.7. Combined treatments for opioid abuse and depression
3.8. Pharmacotherapy of bipolar disorder and alcohol use disorder
3.9. Pharmacotherapy of cocaine, cannabis use disorders and bipolar disorder
3.10. Psychotherapy for bipolar disorder and substance use disorders
3.11. Pharmacotherapy of anxiety disorders and comorbid SUD
3.12. Behavioral and psychotherapy of anxiety disorders
3.13. Pharmacotherapy of PTSD, alcohol abuse and opioid abuse
3.14. Psychotherapy and behavior therapy of PTSD
3.15. Pharmacotherapy and psychotherapy of SUD and generalized anxiety disorder (GAD)
3.16. Pharmacotherapy of social anxiety disorder (SoAD) and AUD
3.17. Psychotherapy of social anxiety disorder and AUD
3.18. Pharmacotherapy and Psychotherapy for panic disorder and SUD
3.19. Pharmacotherapy and psychotherapy for obsessive compulsive disorder (OCD) and SUD
3.20. Pharmacotherapy of AUD
3.21. Pharmacotherapy for opioid and cocaine use disorder
3.22. Other important findings
4. Discussion
2. Method
3. Results
3.1. Pharmacotherapy of psychosis and alcohol and cannabis use disorder
3.2. Pharmacotherapy of psychosis and cocaine use disorder
3.3. Behavioral and psychotherapeutic interventions for psychotic and substance use disorders
3.4. Combined treatment for alcohol abuse and depression
3.5. Pharmacotherapy of cannabis use disorder and depression
3.6. Combined treatments for cocaine use disorder and depression
3.7. Combined treatments for opioid abuse and depression
3.8. Pharmacotherapy of bipolar disorder and alcohol use disorder
3.9. Pharmacotherapy of cocaine, cannabis use disorders and bipolar disorder
3.10. Psychotherapy for bipolar disorder and substance use disorders
3.11. Pharmacotherapy of anxiety disorders and comorbid SUD
3.12. Behavioral and psychotherapy of anxiety disorders
3.13. Pharmacotherapy of PTSD, alcohol abuse and opioid abuse
3.14. Psychotherapy and behavior therapy of PTSD
3.15. Pharmacotherapy and psychotherapy of SUD and generalized anxiety disorder (GAD)
3.16. Pharmacotherapy of social anxiety disorder (SoAD) and AUD
3.17. Psychotherapy of social anxiety disorder and AUD
3.18. Pharmacotherapy and Psychotherapy for panic disorder and SUD
3.19. Pharmacotherapy and psychotherapy for obsessive compulsive disorder (OCD) and SUD
3.20. Pharmacotherapy of AUD
3.21. Pharmacotherapy for opioid and cocaine use disorder
3.22. Other important findings
4. Discussion
Résumé :
OBJECTIVE: To update clinicians on the latest in evidence-based treatments for substance use disorders (SUD) and non-substance use disorders among adults and suggest how these treatments can be combined into an evidence-based process that enhances treatment effectiveness in comorbid patients.
METHOD: Articles were extracted from Pubmed using the search terms "dual diagnosis," "comorbidity" and "co-occurring" and were reviewed for evidence of effectiveness for pharmacologic and psychotherapeutic treatments of comorbidity.
RESULTS: Twenty-four research reviews and 43 research trials were reviewed. The preponderance of the evidence suggests that antidepressants prescribed to improve substance-related symptoms among patients with mood and anxiety disorders are either not highly effective or involve risk due to high side-effect profiles or toxicity. Second generation antipsychotics are more effective for treatment of schizophrenia and comorbid substance abuse and current evidence suggests clozapine, olanzapine and risperidone are among the best. Clozapine appears to be the most effective of the antipsychotics for reducing alcohol, cocaine and cannabis abuse among patients with schizophrenia. Motivational interviewing has robust support as a highly effective psychotherapy for establishing a therapeutic alliance. This finding is critical since retention in treatment is essential for maintaining effectiveness. Highly structured therapy programs that integrate intensive outpatient treatments, case management services and behavioral therapies such as Contingency Management (CM) are most effective for treatment of severe comorbid conditions.
CONCLUSIONS: Creative combinations of psychotherapies, behavioral and pharmacological interventions offer the most effective treatment for comorbidity. Intensity of treatment must be increased for severe comorbid conditions such as the schizophrenia/cannabis dependence comorbidity due to the limitations of pharmacological treatments.
HIGHLIGHTS:
• Limited evidence exists that antidepressants reduce substance use.
• Pharmacotherapy of comorbidity should focus on non-substance related symptoms.
• Available medications specific for reducing substance use should be used as needed.
• Psychotherapy for comorbidity should initially target substance abuse.
• Treatment of comorbidity should use an integration of evidence-based therapies.
METHOD: Articles were extracted from Pubmed using the search terms "dual diagnosis," "comorbidity" and "co-occurring" and were reviewed for evidence of effectiveness for pharmacologic and psychotherapeutic treatments of comorbidity.
RESULTS: Twenty-four research reviews and 43 research trials were reviewed. The preponderance of the evidence suggests that antidepressants prescribed to improve substance-related symptoms among patients with mood and anxiety disorders are either not highly effective or involve risk due to high side-effect profiles or toxicity. Second generation antipsychotics are more effective for treatment of schizophrenia and comorbid substance abuse and current evidence suggests clozapine, olanzapine and risperidone are among the best. Clozapine appears to be the most effective of the antipsychotics for reducing alcohol, cocaine and cannabis abuse among patients with schizophrenia. Motivational interviewing has robust support as a highly effective psychotherapy for establishing a therapeutic alliance. This finding is critical since retention in treatment is essential for maintaining effectiveness. Highly structured therapy programs that integrate intensive outpatient treatments, case management services and behavioral therapies such as Contingency Management (CM) are most effective for treatment of severe comorbid conditions.
CONCLUSIONS: Creative combinations of psychotherapies, behavioral and pharmacological interventions offer the most effective treatment for comorbidity. Intensity of treatment must be increased for severe comorbid conditions such as the schizophrenia/cannabis dependence comorbidity due to the limitations of pharmacological treatments.
HIGHLIGHTS:
• Limited evidence exists that antidepressants reduce substance use.
• Pharmacotherapy of comorbidity should focus on non-substance related symptoms.
• Available medications specific for reducing substance use should be used as needed.
• Psychotherapy for comorbidity should initially target substance abuse.
• Treatment of comorbidity should use an integration of evidence-based therapies.
Affiliation :
The Center for Psychiatric and Chemical Dependency Services, University of Pittsburgh Medical Center, Pittsburgh, PA 15213-2593, USA