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No. 4 (2024)

NEW MEDICINES

Cariprazine in Outpatient Therapy of Schizophrenia Comorbid with Chemical Addictions

https://doi.org/10.21265/PSYPH.2024.68.60.005

Published 2024-12-30

  • G.Yu. Selivanov
    • ,
  • N.A. Bokhan
    • ,
  • O.V. Shushpanova
    • ,
  • A.P. Otmakhov
    • ,
  • O.V. Semina
    • ,
  • K.A. Blonsky
    • ,
  • A.A. Salnikov

G.Yu. Selivanov
Mental Health Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences; St. Nicholas Psychiatric Hospital; Saint-Petersburg State Fire Service University of the Ministry of the Russian Federation for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters

N.A. Bokhan
Mental Health Research Institute, Tomsk National Research Medical Center; Siberian State Medical University

O.V. Shushpanova
Mental Health Research Center of the Russian Academy of Sciences

A.P. Otmakhov
St. Nicholas Psychiatric Hospital

O.V. Semina
Tomsk Clinical Psychiatric Hospital

K.A. Blonsky
Nizhnevartovsk Psychoneurological Hospital

A.A. Salnikov
Noyabrsk Psychoneurological Dispensary

Abstract

Objective — to study the most effective psychopharmacological treatment regimens using cariprazine in outpatient therapy of schizophrenia comorbid with chemical addictions.

Patients and methods. The study was conducted on the basis of psychiatric hospitals of the Tomsk region, St. Petersburg, Nizhnevartovsk and Noyabrsk in the period from 2018 to 2024 years. The study included 319 men aged from 18 to 45 years suffering from paranoid schizophrenia comorbid with psychoactive substances dependance (n = 64 — alcohol, n = 64 — cannabinoids, n = 64 — opioids and n = 64 — psychostimulants), 63 people were excluded from the study due to exacerbation of psychotic symptoms. The main group consisted of 128 people who received cariprazine (F20.0xx + F1х.2xx + Cariprazine) both as monotherapy and in combination with short-term use (no more than 2 weeks) of typical antipsychotics (haloperidol, zuclopenthixol, chlorpromazine, chlorprothixene). The control group consisted of 128 patients (F20.0xx + F1х.2xx) who received other atypical antipsychotics (risperidone, aripiprazole, olanzapine). The PANSS, SANS, CGI, and GAF scales were used for dynamic assessment of patients, symptoms and functioning. In the outpatient treatment of patients with schizophrenia comorbid with psychoactive substances dependance the main study group received cariprazine alone (n = 22) and in combination with haloperidol (n = 30), chlorpromazine (n = 24), chlorprothixene (n = 24), zuclopenthixol (n = 28) as treatment regimens. The first control point was at week 2 of the study, the second control point — at week 6 of the study.

Results. When comparing the control group with the main group, similar indicators were observed on the CGI and GAF scales, but lower indicators on the PANSS and SANS scales. Cariprazine therapy with average therapeutic dosage in short-term combination with typical neuroleptics for 7–14 days promoted rapid relief of subpsychotic symptoms associated with changes in the state of patients with and without use of psychoactive substances, such as anxiety, sleep disorders, psychopathic and addictive behavior, contributing to the onset of a psychotic state. Monotherapy with cariprazine for 6 weeks at outpatient stage had the most pronounced effect on smoothing negative schizophrenic symptoms, unlike other atypical neuroleptics, leading to an improvement in the symptoms of schizophrenia, and indirectly helped to reduce the frequency of the use of psychoactive substances, reduced the risk of rehospitalization (remission up to 3.4 ± 1.5 months), as well as achieving stable remission of schizophrenia and psychoactive substances dependance.

Conclusions. Cariprazine, compared with other atypical antipsychotics (risperidone, olanzapine, aripiprazole), showed a pronounced antipsychotic effect at the stage of outpatient therapy of patients with schizophrenia and psychoactive substances dependance, as well as a positive effect on negative deficit symptoms.

Keywords

comorbidity, schizophrenia, addiction, drugs, psychoactive substances, associated diseases, cariprazine, neuroleptics

PDF (Русский)

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