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Reduced Cocaine And Amphetamine Craving After Discontinuation Of Typical Antipsychotic Therapy

Discontinuation of typical antipsychotic therapy reduced craving for cocaine and amphetamines in patients with psychiatric illness, but did not change drug use or psychiatric symptoms, report researchers from the United States.

High rates of substance abuse often accompany patients with psychiatric illness who receive chronic typical antipsychotic therapy for their illness, and animal studies suggest that the use of typical antipsychotics is associated with increased cocaine and amphetamine use.

To examine whether discontinuation of typical antipsychotic therapy would effect the use of cocaine and amphetamines in patients with psychiatric illness, E. Sherwood Brown, PhD, and colleagues from the University of Texas Southwestern Medical Center, Dallas, Texas, randomised 24 outpatients to continue (n=12) or discontinue (n=12) chronic typical antipsychotic therapy for illnesses that included bipolar disorder (n=13), schizoaffective disorder (n=6), schizophrenia (n=3), or major depressive disorder (n=2). Concurrent psychiatric disorders in these patients also included panic disorder, generalized anxiety disorder, social phobia, posttraumatic stress disorder, and obsessive-compulsive disorder. Antipsychotic therapy included halperidol (n=10), thioridazine (n=4), chlorpromazine (n=3), fluphenazine (n=2), loxapine (n=2), trifluoperazine (n=2), and thiothixene (n=1). For the 12 patients in whom therapy was discontinued, quetiapine was given as needed to treat psychosis (n=8).

Measurements used to evaluate outcomes included an Brief Psychiatric Rating Scale (BPRS), Hamilton Rating Scale for Depression (HRDS), and Cocaine Craving Questionnnaire (CCQ).

At 12 weeks, CCQ scores were significantly reduced in the 12 patients who discontinued therapy, but no significant differences were noted in BPRS or HRDS compared to the 12 patients who continued therapy. In the 8 patients in the discontinued therapy group who received quetiapine, significant improvement in BPRS, HRSD, and CCQ were seen compared to the 4 patients in the discontinued therapy group who received no further antipsychotic therapy.

Based on these results, the authors conclude that more double-blinded, randomised controlled trials are needed to further examine the effect of discontinuing typical antipsychotic therapy and quetiapine substitution on patients with psychiatric illness and substance abuse problems.

J Clin Psychopharmacol 2003 Aug;23:4:384-8. "Cocaine and amphetamine use in patients with psychiatric illness: a randomized trial of typical antipsychotic continuation or discontinuation"

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