Treating Dual-Diagnosis Alcoholism and Schizophrenia

In persons with schizophrenia, the rate of alcohol and substance abuse issues is much higher (possibly three times higher) than in the general population. Alcohol abuse inevitably complicates the treatment of schizophrenia and often leads to a less favorable outcome. Alcohol disrupts an already delicate neurochemical balance and impairs the action of psychotropic medications.

In some cases, drug interactions between medicines and recreational substances can have serious consequences. The clinical problem of “dual diagnosis” has no clear solution at this point. Traditionally, doctors have prescribed Clozaril (clozapine) to reduce the reward effects of alcohol. However, Clozaril leads to side effects that are sometimes equally counterproductive.

Researchers at the University of South Carolina School of Medicine and Dartmouth University are investigating whether a combination of Risperdal (risperidone) and Norpramin (desipramine) can reduce alcohol consumption in schizophrenic patients. Risperdal and Norpramin are both second-generation antipsychotic medications. In comparison with older antipsychotic drugs, they both have a relatively mild side effect profile and satisfactory rate of effectiveness.  The research team believes that this specific combination of drugs can have an effect similar to Clozaril, minus the unwanted side effects.

The first phase of research was conducted with rodents. The results were promising and indicated that the drug combination in question—Risperdal and Norpramin—could replicate the effects of Clozaril. The current phase of the trial involves human participants and is ongoing through early 2013. Researchers hope to gather data for at least 40 participants. Eligible participants will have a diagnosis of schizophrenia and alcohol use disorder, along with current outpatient treatment with an antipsychotic medication. If the participant is not taking Risperdal, they will be transitioned during a two-week period prior to the start of the trial.

The dual-diagnosis study consists of an experimental group and a placebo group. In the placebo group, participants will receive Risperdal plus sugar pill. The experimental group will include treatment with both Risperdal and Norpramin. Participants will keep a weekly journal of their drinking thoughts and behaviors. At the end of 14 weeks, a final interview will assess symptom response as well as any reduction in drinking days or heavy drinking episodes. Likewise, side effects will be recorded as a means to gauge the safety of this particular drug combination. The research team hopes that a positive result from the small trial may encourage the funding of a much larger, multi-center trial.

References:

  1. Risperidone – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000944/
  2. Risperidone and Desipramine in Alcohol Use and Schizophrenia – Full Text View – ClinicalTrials.gov. (n.d.). Home – ClinicalTrials.gov. Retrieved from http://clinicaltrials.gov/ct2/show/NCT01411085?recr=Open&intr=%22Risperidone%22&rank=4

© Copyright 2011 by James Pendleton. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

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