Efficacy and acceptability of interventions to reduce antipsychotic polypharmacy: A systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: Antipsychotic polypharmacy (APP) is frequent but evidence-based guidelines on reducing APP to antipsychotic monotherapy (APM) are sparse. We aimed to systematically review clinical interventions randomizing patients to reducing APP to APM versus continuing APP. METHODS: Systematic literature review searching Medline and Embase (latest search January 10, 2024) for randomized clinical trials (RCTs) studying interventions comparing individuals randomized to reduction of APP to APM with individuals continuing on APP. Two independent reviewers performed the literature screening, data extraction, and risk of bias assessment (RoB2). We performed random effects meta-analyses on the main outcome all-cause discontinuation/"acceptability" of the treatment strategy and secondary outcomes change in psychopathology, functional level, and side effects. RESULTS: The search identified 4672 hits, whereof 8 trials (N = 1204, 6 patient-level RCTs and 2 cluster-RCTs) were included, primarily in patients with schizophrenia. All trials were associated with high risk of bias. Compared to APP continuation, reduction to APM was associated with no significant change in all-cause discontinuation (studies = 6, n = 455, RR = 1.48, 95%CI = 0.74-2.95, I2 = 78 %) or inefficacy-related discontinuation (studies = 5, n = 351, RR = 1.60, 95%CI = 0.46-5.55, I2 = 70 %). Patients randomized to APM showed a trend towards greater reduction in psychopathology (studies = 5, n = 244, SMD = -0.24, 95%CI = -0.49, 0.02, I2 = 0 %) but no difference in functional level nor side effects. The cluster-RCTs found that interventions at the departmental level can result in lower rates of APP. CONCLUSION: Although switching patients from APP to APM can be a viable approach, too few RCTs exist on this important topic. Clinicians need to evaluate potential benefits and risks of APP and APM on an individual basis. PROSPERO REGISTRATION: CRD42022329955.

The Degree of Multidimensional Severity of Alcohol Use Disorder among Treatment-Seeking Patients: Is There an Additive Effect of Parental Alcohol Use Disorder?

BACKGROUND: The additive effect of parental alcohol use disorders (AUD) is conventionally defined as an increasing risk of the offspring developing AUD relative to family history negative, < family history positive with 1 parent (FHP1), < FHP2. The few studies on the additive effect of parental AUD have focused on the risk of development of offspring AUD and not on the degree of multidimensional AUD addiction severity. AIMS: The aims of the present study were to examine the frequency of treatment-seeking outpatients exposed to FHP1 and FHP2 and whether addiction severity was impacted by the additive effect of parental AUD among AUD female and male offspring. METHODS: This cross-sectional  study was based on 3,361 consecutive treatment-seeking outpatients from 2006 to 2016, assessed by means of the -European Addiction Severity Index (EUROP-ASI). The -EUROP-ASI assessed multidimensional addiction severity, comprising alcohol and other drug use, somatic and psychiatric health status, family and other social status, economy and employment-related problems and criminal status composite scores at treatment entry. RESULTS: Among females, 40.38% had FHP1 and 15.68% FHP2, whereas males had 40.90% FHP1 and 13.24% FHP2. No conventional additive effect was found on the composite scores among both genders. However, another type of synergistic additive effect, only manifesting with exposure to FHP2, was found for employment-related problems and psychiatric status composite scores among male offspring. CONCLUSIONS: Exposure to parental AUD is strikingly high among treatment-seeking outpatients. Nonetheless, the additive effect has a modest impact on multidimensional addiction severity and is mostly related to psycho-social impairment among treatment-seeking male offspring.

Cue exposure therapy for the treatment of alcohol use disorders: A meta-analytic review.

Cue Exposure Therapy (CET) is a behavioristic psychological approach to treating substance use disorders (SUD). Prior systematic reviews have found CET to be ineffective when targeting SUDs. The effect of this approach on alcohol use disorders (AUD) seems more promising at trial level but has yet to be systematically reviewed and quantitatively analyzed. Therefore, we aimed to examine the effectiveness of CET targeting AUD compared to active control conditions in a meta-analytic review. Following a systematic search of the literature, a total of seven controlled trials were identified. CET showed no to small additional effects on drinking intensity and drinking frequency, a small additional effect on total drinking score and a moderate additional effect on latency to relapse. Stratification and analysis of a-priori defined trial covariates revealed that CET may have an increased effect in the longer term, and that CET combined with urge-specific coping skills may be the better option for treating AUD than conventional CET. Also, CET may prove less effective when comparing it to cognitive behaviour therapy as opposed to other active control conditions. The overall quality of evidence was graded low due to high risk of bias, inconsistency, imprecision and suspected publication bias. Sounder methodological trials are needed to derive a firm conclusion about the effectiveness of CET for treating AUD.

Conscious knowledge influences decision-making differently in substance abusers with and without co-morbid antisocial personality disorder.

Decision-making impairment, as measured by the Iowa Gambling Task (IGT), is a consistent finding among individuals with substance use disorder (SUD). We studied how this impairment is influenced by co-morbid antisocial personality disorder (ASPD) and conscious knowledge of the task. Three groups were investigated: SUD individuals without co-morbid ASPD (n = 30), SUD individuals with co-morbid ASPD (n = 16), and healthy controls (n = 17). Both SUD and SUD+ASPD participants had poor overall IGT performance. A block-by-block analysis revealed that SUD participants exhibited slow but steady improvement across the IGT, whereas SUD+ASPD participants exhibited initial normal improvement, but dropped off during the last 40 trials. Conscious knowledge of the task was significantly correlated to performance for controls and SUD participants, but not for SUD+ASPD participants. Our findings suggest that decision-making proceeds differently in SUD and SUD+ASPD individuals due to differences in acquisition and application of conscious knowledge.