Interpersonal group psychotherapy for comorbid alcohol dependence and non-psychotic psychiatric disorders.

Alcohol-dependent patients (N = 15) with comorbid non-psychotic psychiatric disorders were treated with Modified Interpersonal Group Therapy (MIGT) for eight weeks, 16 sessions, in a pilot intervention trial. Analysis of the group participants demonstrated that they achieved statistically significant improvements at post-treatment in four of five self-report outcome measures: number of drinking days, number of heavy drinking days, the Brief Symptom Inventory, and the Beck Depression Inventory. Furthermore, the improvements in heavy drinking days and the Brief Symptom Inventory were maintained at two and eight months post-treatment. This study yields preliminary evidence in support of MIGT as a useful treatment approach for an alcohol-dependent population with psychiatric comorbidity.

Drug and alcohol use among patients with schizophrenia and related psychoses: levels and consequences.

Patients with schizophrenia and related psychoses frequently use, abuse and become dependent on psychoactive substances. Local surveys indicate differences in both types and patterns of substances used. A cross-sectional survey was conducted to document abuse in 207 successive outpatients presenting to a psychiatric continuing care facility in a large Canadian city. Nicotine, alcohol and cannabis were the most frequently abused substances in the cohort. Excluding nicotine, 44.9% met criteria for lifetime and 14.0% for current abuse/dependence. Cocaine, heroin, hallucinogen, amphetamine, and inhalant use were rarely reported. Patients with current substance abuse/dependence and a psychotic disorder (dual diagnosis, DD) had significantly higher Positive and Negative Symptom Scale (PANSS) positive scores than lifetime-DD or those with a single diagnosis (SD). Significantly more current-DD (69.0%) patients were depressed (HAM-D score > or =12) compared to SD (45.6%). Furthermore, current-DD (27.6%) patients were more likely than SD (4.5%) to be medication non-compliant. Patients with current-DD were more likely to smoke cigarettes (88.9%) compared to those with SD (49.6%) and they had significantly longer histories of cigarette smoking (19.1 for DD vs. 11.5 years for SD). The smoking behavior of the DD population is discussed in terms of enhanced risk for alcohol abuse, as well as effects on antipsychotic blood levels and metabolism.

Conversation with Juan Carlos Negrete.

Juan Carlos Negrete is Emeritus Professor of Psychiatry, McGill University; Founding Director, Addictions Unit, Montreal General Hospital; former President, Canadian Society of Addiction Medicine; and former WHO/PAHO Consultant on Alcoholism, Drug Addiction and Mental Health.

Meta-analyses of placebo-controlled trials of acamprosate for the treatment of alcohol dependence: impact of the combined pharmacotherapies and behavior interventions study.

OBJECTIVES: : The Combined Pharmacotherapies and Behavior Interventions Study (COMBINE) reported no significant difference between acamprosate and placebo in the treatment of alcohol dependence. To evaluate the impact of COMBINE, we performed a meta-analysis of acamprosate placebo-controlled trials with the inclusion of data from COMBINE. As a secondary analysis, we added the COMBINE data to a recently published meta-analysis of naltrexone placebo-controlled trials. METHODS: : A structured literature search of major databases was performed from January 1990 to August 2007 for acamprosate placebo-controlled randomized trials. Mean differences in cumulative abstinent days (CAD) and abstinence rates (AR) from eligible studies were statistically combined to calculate point estimates and 95% CI for differences in CAD and AR. RESULTS: : Ten and 16 studies evaluating CAD and AR, respectively were suitable for statistical pooling. The findings revealed that acamprosate was superior to placebo in the mean number of CAD (P < 0.001) and AR (pooled AR = 1.58; P < 0.001). The pooled AR for naltrexone was also significant indicating a relative benefit over placebo (AR = 1.27; P < 0.001). The COMBINE trial results contributed a weight of less than 15% to the final pooled statistical outcomes for both agents. CONCLUSIONS: : The current study confirmed that acamprosate and naltrexone are both effective agents for the treatment of patients with alcohol dependence. Systematic reviews with meta-analyses of randomized controlled trials and randomized controlled trials with adequate sample sizes are in the same (highest) level of evidence. Therefore, clinicians should use both these sources of information as their foundation for selecting optimal therapy for patients with alcohol dependence.

Abuso de sustancias psicoactivas por parte de esquizofrénicos: Implicancias para la provisión de servicios / Psychoactive substance abuse by schizophrenics: Implications for the provision of services

Los individuos con esquizofrenia presentan tasas de abuso de sustancias más altas que la población en general. Las explicaciones propuestas para estos hallazgos incluyen: a) la ingesta de drogas como resultado de condiciones ambientales específicas, b) la automedicación de su psicosis (ej.: síntomas negativos y ansiedad) y los efectos secundarios del tratamiento neuroléptico. Se encontró que el abuso de drogas está asociado con una edad de comienzo más temprana y un desarrollo más repentino de la esquizofrenia. También se informó que empeora los síntomas positivos e interfiere con la respuesta terapéutica. Estos pacientes han resultado difíciles de manejar en los programas tradicionales no psiquiátricos para el tratamiento de adicciones. Las tendencias recientes apuntan hacia abordajes terapéuticos abarcativos, desarrollados y ofrecidos dentro de los servicios de salud mental. La presente revisión evalúa la extensión del problema y su importancia en el planteamiento y ejecución de la atención psiquiátrica.