PMID- 28959434
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200930
IS  - 2045-1253 (Print)
IS  - 2045-1261 (Electronic)
IS  - 2045-1253 (Linking)
VI  - 7
IP  - 8-9
DP  - 2017 Sep
TI  - Naltrexone efficacy in treating alcohol-use disorder in individuals with comorbid 
      psychosis: a systematic review.
PG  - 211-224
LID - 10.1177/2045125317709975 [doi]
AB  - BACKGROUND: Psychotic illnesses, such as schizophrenia, are typically enduring 
      and disabling conditions, impacting individual, family, and societal outcomes. 
      Individuals with these face greater vulnerabilities in developing alcohol-use 
      disorder (AUD). Furthermore, the nature of psychoses, often manifesting with 
      paranoia, cognitive impairment, a lack of insight, sub-optimal treatment 
      adherence, and stigma from others, means that they can pose unique treatment 
      challenges when these two conditions comorbidly occur. These challenges mean that 
      the standard literature on the effectiveness of the opioid antagonist naltrexone 
      in AUD does not necessarily translate to this vulnerable population. METHODS: 
      Following PRISMA guidelines, we herein systematically reviewed the evidence for 
      naltrexone in individuals with both psychosis and AUD. Overall, there is a 
      paucity of research in this important area, with only nine reports meeting search 
      criteria, only four of which were randomized control trials. Studies compared 
      naltrexone with: placebo, another pharmaceutical agent, or upon changes to 
      baseline drinking behaviour. One study evaluated the long-acting injectable 
      formulation of this drug. RESULTS: Most studies, including the methodologically 
      more robust ones, supported naltrexone's effectiveness over placebo in terms of 
      reduction in drinking days and numbers of drinks consumed on such days in this 
      cohort. Work comparing naltrexone to other pharmaceutical interventions showed 
      approximate equivalence with disulfiram, and modest superiority over acamprosate. 
      CONCLUSIONS: On this limited evidence base, this review endorses the use of 
      naltrexone as both safe and effective in those with both psychotic illnesses and 
      AUD. Several key issues remain to be elucidated. Critically, study designs meant 
      that they were limited to individuals with good engagement with services, and 
      levels of adherence were attained that are unlikely to be replicated in this 
      cohort in real-world settings. Finally, effects of specific psychosis 
      symptomatology, not least paranoia and insight, upon naltrexone use, and the 
      reverse directional potential of 'double dysphoria' from an opioid antagonist 
      remain largely unexplored.
FAU - Sawicka, Martyna
AU  - Sawicka M
AD  - Cognition, Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, 
      The Institute of Psychiatry, Psychology and Neuroscience, King's College London, 
      UK.
FAU - Tracy, Derek K
AU  - Tracy DK
AD  - Consultant Psychiatrist, The Memorial Hospital, Woolwich, London SE18 3RG, UK.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20170524
PL  - England
TA  - Ther Adv Psychopharmacol
JT  - Therapeutic advances in psychopharmacology
JID - 101555693
PMC - PMC5593217
OTO - NOTNLM
OT  - alcohol
OT  - alcohol-use disorder
OT  - comorbid psychosis
OT  - dependency
OT  - naltrexone
OT  - schizophrenia
COIS- Conflict of interest statement: The authors declare that there is no conflict of 
      interest.
EDAT- 2017/09/30 06:00
MHDA- 2017/09/30 06:01
PMCR- 2017/09/01
CRDT- 2017/09/30 06:00
PHST- 2016/08/31 00:00 [received]
PHST- 2017/02/23 00:00 [accepted]
PHST- 2017/09/30 06:00 [entrez]
PHST- 2017/09/30 06:00 [pubmed]
PHST- 2017/09/30 06:01 [medline]
PHST- 2017/09/01 00:00 [pmc-release]
AID - 10.1177_2045125317709975 [pii]
AID - 10.1177/2045125317709975 [doi]
PST - ppublish
SO  - Ther Adv Psychopharmacol. 2017 Sep;7(8-9):211-224. doi: 10.1177/2045125317709975. 
      Epub 2017 May 24.