, Volume 172, Issue 3, pp 291-297
Date: 21 Nov 2003

Naltrexone augmentation of neuroleptic treatment in alcohol abusing patients with schizophrenia

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Abstract

Objective

Alcohol abuse in patients with schizophrenia is associated with psychiatric and social complications. While two medications have been approved by the Federal Drug Administration (FDA) for the treatment of alcoholism: disulfiram and naltrexone, no medications have been approved for individuals with alcohol dependence and comorbid schizophrenia. The purpose of this study was to evaluate the efficacy of naltrexone in alcohol-abusing schizophrenic patients.

Method

Thirty-one patients with schizophrenia and comorbid alcohol abuse or dependence were treated for 12 weeks in an outpatient study using naltrexone or placebo in a randomized, double-blind fashion in addition to their neuroleptic medication. Patients also participated in a weekly therapy using cognitive-behavioral drug relapse prevention strategies combined with skills training. Outcomes included drinking measured by the time line follow-back method, craving using the Tiffany Craving Questionnaire, psychotic symptoms using the Positive and Negative Symptoms Scale (PANSS), side effects and a measures of abnormal involuntary movements.

Results

There were no significant differences in treatment exposure or medication compliance between groups. Naltrexone treated patients had significantly fewer drinking days, heavy drinking days (>5 drinks) and reported less craving compared to the placebo treated patients. Naltrexone did not affect symptoms of schizophrenia, such as psychosis. The medication was well tolerated and there were no group differences in side effects.

Conclusions

These data suggest that naltrexone may be an effective medication for individuals with comorbid alcohol dependence and schizophrenia. Given the widespread problems associated with alcohol misuse in this population, and the lack of effective pharmacotherapies, these findings represent an exciting clinical development.

An erratum to this article can be found at http://dx.doi.org/10.1007/s00213-004-1881-z
Preliminary results from this study were presented at the Society of Biological Psychiatry 57th Annual Scientific Convention, Philadelphia, Pa., USA in May 2002. The VA Naltrexone Study Collaboration Group: West Haven: Diana Congdon, Ned Cooney, Roberto Gil, Kathy Keegan, Debra Miles, Alison Oville, Barbara Peluse, Louis Trevisan; Northampton: Lynn Gordon, John Reino, Wayne Costello, Christopher Cryan; Bedford: Nitigna Desai, Marylee Losardo, Doreen Farrell, Barbara E. Rofman. W. Costello is deceased.