Schizophrenia Clinical Trial
Official title:
Efficacy of Quetiapine in Treating Patients With Active Substance Use Disorder and Schizophrenia
The purpose of this study is to examine the efficacy of quetiapine (Seroquel) in reducing substance use in persons diagnosed with schizophrenia. The primary hypothesis is that quetiapine treatment will be associated with a decrease in substance use.
Comorbid alcohol/substance use disorder (SUD) in schizophrenia is a major concern, both in
view of the high frequency of SUD among patients with schizophrenia and the difficulty in
managing such patients. Though antipsychotic medications are effective in reducing symptoms
and impairment in persons with schizophrenia, the typical antipsychotic agents are of limited
value in controlling alcohol/substance use in these patients. Extrapyramidal, dysphoric side
effects of conventional neuroleptics may actually promote the use of substances in an attempt
to counteract these effects.
Novel antipsychotics have radically altered treatment expectations and outcomes for patients
with severe forms of schizophrenia. With the greater availability of novel agents in clinical
practice, it has been noted that these benefits have also extended to specific subgroups of
patients including patients with comorbid SUD. Several retrospective studies have
demonstrated a decrease in comorbid substance use in patients with schizophrenia treated with
clozapine. There is little data available, however, on the efficacy of quetiapine in patients
with schizophrenia and comorbid SUD. Its receptor profile, including a weak Dopamine2 (D2)
receptor blocking ability and substantial effects at noradrenergic receptors, makes it a
logical antipsychotic to use in the comorbid population.
The study is an open-label investigation of the efficacy of quetiapine in a group of 30
patients with schizophrenia and comorbid substance use disorder. Patients diagnosed with
schizophrenia or schizoaffective disorder and a comorbid substance use disorder are switched
to quetiapine for 12 weeks. We hypothesize that quetiapine treatment will be associated with
a decrease in substance use. Moreover, we further hypothesize that measures of symptoms,
cognition and quality of life will also improve over baseline assessments in patients treated
with quetiapine. Data suggesting a beneficial effect of quetiapine will have to be confirmed
in a prospective double-blind study. This pilot investigation will provide preliminary data
and effect sizes that will be used in the design of this subsequent investigation.
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