Title:Pharmacological Treatment of Alcohol use Disorder in Patients with
Psychotic Disorders: A Systematic Review
Volume: 22
Issue: 6
Author(s): Niels Jørgen Rosenstand, Anette Søgaard Nielsen, Lotte Skøt, Simon Anhøj, Dorthe Grüner Nielsen, Mikkel Højlund and Angelina Isabella Mellentin*
Affiliation:
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Public Health, Clinical Pharmacology, Pharmacy, and Environmental Medicine, University of Southern
Denmark, Odense, Denmark
- Department of Psychiatry, Odense University Hospital, Region of Southern Denmark,
Odense, Denmark
- Research Unit for Telepsychiatry and
E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense, Denmark
Keywords:
Pharmacological agents, alcohol use disorder, psychotic disorders, dual diagnosis, side effects, polypharmacy.
Abstract:
Background: Patients with psychotic disorders (PD) often have comorbid alcohol use disorder
(AUD), which is typically treated pharmacologically. Up till now, no systematic review has examined
the effectiveness and safety of AUD treatment in PD patients.
Objectives: This study aimed to systematically review the literature on (1) the effects of pharmacological
treatments for AUD on drinking outcomes, (2) the side effects of the drugs, and (3) the effects of
polypharmacy in patients with comorbid AUD and PD.
Methods: Bibliographic searches were conducted in MEDLINE, Embase, Cochrane Central Register
of Controlled Trials, and PsycINFO. At least two reviewers extracted the data, assessed the risk of bias,
and performed the qualitative synthesis of the collected evidence.
Results: Twelve eligible studies were identified, half being randomized controlled trials (RCTs).
Three studies examined disulfiram, nine naltrexone, two acamprosate, and one nalmefene by comparing
the effects of treatment to placebo, baseline, or pharmacological agents. Disulfiram and naltrexone
were shown to reduce alcohol intake. Regarding acamprosate, the findings were mixed. Nalmefene
decreased alcohol intake. All pharmacological agents appeared safe to use as AUD monotherapy, but
cardiac events were reported when combining naltrexone and disulfiram. Nine studies had a high risk
of bias, and three had some other concerns.
Conclusion: The studies provide tentative support for the use of naltrexone and disulfiram in this population,
although combinations of pharmacological AUD treatments and other polypharmacy remain
unexplored. The studies had high adherence rates that are hardly replicable in real-world settings.
Thus, the findings should be confirmed in larger high quality efficacy and effectiveness RCTs with
longer follow-ups.