psychiatric conditions and addiction

Coexistence Mental Health Issues and Substance Use Disorders

Drug Addiction and Psychiatric Conditions


Behavioral Health Trends in the United States:Results from the 2014 National Survey on Drug Use and Health

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2Virgilio Vinas, MD, PhD, MPH 09/2013



3Virgilio Vinas, MD, PhD, MPH09 /2013



About 3.3 percent of all adults in 2014 had both any mental illness [AMI] andan substance use disorder [SUD] in the past year, and 1.0 percent had both serious mental illness [SMI] and an SUD.

An estimated 340,000 adolescents aged 12 to 17 in2014 (1.4 percent of adolescents) had an SUD and major depressive episode [MDE] in the past year.

The estimate in 2014 for the co-occurrenceof an MDE and an SUD in the past year among adolescentswas similar to those in most years between 2006 and 2013.

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CO-OCCURRING MENTAL ILLNESS AND SUBSTANCE USEDISORDERS


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Coexistence Mental Health Issues and Substance Use DisordersAtypical Antipsychotics in treating coexistence diseaseEstimates of the prevalence in Schizophrenia of substance use co-morbidity range from a low of 10%–70% depending on diagnostic assessment methods (Blanchard et al., 2000; Cantor-Graae et al., 2001; Dixon, 1999; Goswami et al., 2004; Kavanagh et al., 2002; Kessler et al., 1997; McCreadie, 2002; Mueser et al., 1998; Regier et al., 1990; Salyers and Mueser, 2001; Swartz et al., 2006a,b).

Two main explanations for the neurobiological basis of the comorbidity of schizophrenia and substance abuse:1-Self medication hypothesis, patients abuse drugs to reduce distressing symptoms, as neuroleptic-induced side effects, dysphoric mood states and residual withdrawal symptoms.2-Comorbid addiction vulnerability hypothesis says, neuropathology of schizophrenia includes a propensity for drug addiction.

Increased striatal dopamine levels are the most robust and most consistently reported dopamine abnormality in schizophrenia (Howes et al., 2012)

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Coexistence Mental Health Issues and Substance Use DisordersAtypical Antipsychotics in treating coexistence diseaseA common neural circuitry is implicated in both schizophrenia and substance abuse, involving cortical, temporal limbic and mesoaccumbens circuits

Substance abuse in people with bipolar disorder (1.3-1.7% prevalence in general population) may be more common than with any other major mental illness (Brown ES et al 2001; Strakowski SMI et al 2000).

61% lifetime prevalence of substance abuse in people with bipolar I disorder and a 48% prevalence in people with bipolar II disorder (Regier et al 1990)

Serotonergic and dopaminergic systems are implicated in substance abuse

The use of atypical antipsychotic in US and UK increased sharply during 90’s decade owing to safety and efficacy compared to typical and led off-label use in children and adolescents. (Hermann et al 2002, Ascroft et al 2002, Leslie and Rosenheck 2002)

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Coexistence Mental Health Issues and Substance Use Disorders2013Annual Report of the American Association of Poison Control Centers ’ National Poison Data System (NPDS): 31st Annual Report

The exposure in youth is magnified to treat a variety of other disorders not schizophrenia and bipolar, in teens overdose isn’t infrequent American Association Poison Control Centers National Data Collection System 1990-2003 Smita X. Antia, M.D., Ellen H. Sholevar, M.D., David A. Baron, MS. Ed, D.O.)

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2013Annual Report of the American Association of PoisonControl Centers ’ National Poison Data System (NPDS):31st Annual Report

Adolescent fatalities — ages 13 – 19 years

The first-ranked pharmaceuticals associated with these fatalities included:heroin (4), acetaminophen (3), methadone (3), oxycodone (3), drug, unknown (3), acetaminophen/hydrocodone (2), diphenhydramine (2), metformin (2), alprazolam (2), quetiapine (2), amphetamine (hallucinogenic), 2C-E (2), methamphetamine(2), methylenedioxymethamphetamine (MDMA

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Coexistence Mental Health Issues and Substance Use DisordersAtypical Antipsychotics in treating coexistence disease

Increased risk of cocaine abuse in schizophrenia is based on underlying dopamine-dependent mechanisms in both disorders, implicating mesolimbic and mesocortical dopamine in drug reward circuits (Bronstein and Cummings, 2001; Capote et al., 2001; Goldstein and Volkow, 2002)

Changes in dopamine receptor activity have been invoked to explain cocaine intoxication, withdrawal, tolerance, craving, and relapse (Bronstein and Cummings, 2001; Capote et al., 2001; Goldstein and Volkow, 2002).

Increased dopamine should worsen positive symptoms of schizophrenia, thereby discouraging abuse (Cleghorn et al., 1991)

Abuse of psychoactive substances: stimulants, depressants, hallucinogens, have high risk for developing psychiatric symptoms as anhedonia, depression, anxiety, psychotic and withdrawal (Leventhal AM et al 2008; Walsh SL et al 2009).

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A dopamine supersensitive state not only enhances the psychomotor activating effects of drugs, but their rewarding properties as well. Given that antipsychotic medications can induce a dopamine supersensitive state, could they potentiate the rewarding properties of drugs (Horger et al., 1990; Lorrain et al., 2000; Piazza et al., 1989)

The therapeutic effect on SUD (alcohol, cocaine and methamphetamine) occur via reuptake inhibition at D2 receptors and binds to H1 receptors, producing sedation, reduce anxiety and improve sleep, with average 153 mg/day (Sattar SP et al 2004)

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The CATIE study was initiated by the National Institute of Mental Health (NIMH) to determine the comparative effectiveness of antipsychotic drugs (Davis et al., 2003; Keefe et al., 2003; Stroup et al., 2003; Swartz et al., 2003)

Reports on the outcomes from CATIE to date, have found that patients in the initial randomization (Phase 1) olanzapine had longer time to treatment discontinuation than some of the other drugs, but had greater side effect burden related to weight gain and related metabolic sequelae (Lieberman et al., 2005).

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In alcoholics treated (25-200 mg), the goal was to help with normalization of a sleep disturbance, some use antidepressants (Monnelly EP et al 2004). On relapse prevention, keep up to 7 months (Croissant B et al 2006; Ray et al 2011), and improved craving (Kampman et al 2007). It’s unclear if the psychotropic effect (antidepressant, anxiolytic, mood stabilization.Somnolence and sedation are main side effects in treating alcoholics (Litten et al 2012). In ethanol withdrawal syndrome (EWS) risperidone and QTP seem potent and more active in rats. Ziprasidone and clozapine seen to be useful in treating EWS (Uzbay T et al 2012) IT’s difficult to ascertain whether improvement in alcohol consumption is directly correlated to improved psychiatric symptoms in case of any comorbid psychiatric diagnostic (Martinotti et al 2008).

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Coexistence Mental Health Issues and Substance Use DisordersAtypical Antipsychotics and counterfeit

Antipsychotics are considered by the EDQM (Council of Europe) one of the most used drugs in the world with tendency to counterfeit, reason the dual effect impacting serotonin/dopamine is applied to more common conditions and open to much more lucrative markets. UK- MHRA in 2007 found 100,000 fake tablets for 10mg Zyprexa According to the WHO, worldwide sales of counterfeit medications reached $75 billion in 2010 Attorney Barry Grissom reported that the FDA’s Office of Criminal Investigation uncovered an internet pharmacy that had sold approximately $1.4 million worth of misbranded and counterfeit drugs, including controlled substances

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Coexistence Mental Health Issues and Substance Use DisordersAtypical Antipsychotics in correctional institutions USA

Growing phenomenon of psychiatric care provision for incarcerated severely mentally ill (SMI) individuals and the subsequent increase in the abuse of quetiapine, until recently, a drug thought to be without “abusable” qualities. One of the greatest mental health care crises today (Puffenberger, 2007):

1-Deinstitutionalization denotes the depopulation of state mental hospitals, from approximately 560,000 patients in 1955 to about 70,000 in 2007 (Keltner, Schwecke, & Bostrom 2007).

2-Transinstitutionalization denotes the transfer of this care to jails and prisons where there are three times more mental patients than in mental hospitals and where one in six detainees is diagnosed with a mental illness (Fellner & Abramsky, 2003).

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Coexistence Mental Health Issues and Substance Use DisordersAtypical Antipsychotics in correctional institutions UK-Wales

There are now approximately 84,000 prisoners in England and Wales (Gov.UK management statistics 2013) and 120,000 new episodes of imprisonment each year (Gov.UK Receptions 2013):

1-Many prisoners are prescribed psycho-active drugs. Suicide in prisoners is linked to both a history of psychiatric disorder and use of psycho-active medication (Fazel S et al 2012) as is near lethal self-harm (Marzano L et al 2010).

2-Overdose is a common method of self-harm and a cause of suicide in prison, as elsewhere (National Confidential Inquiry, England and Wales 2013).

3-The Prison Inspectorate has expressed concern about patterns of prescribing of psycho-active medication in UK prisons

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Coexistence Mental Health Issues and Substance Use DisordersAtypical Antipsychotics in Atypical Antipsychotics in correctional institutions

Since illicit drugs are also available for incarcerated individuals, published accounts reveal quetiapine’s value for use during withdrawal from these substances (Waters & Joshi).

The New Jersey Department of Corrections (NJDOC) has a medication formulary controlled by the Pharmacy and Therapeutics (P&T) Committee, removal of quetiapine from the formulary was not taken lightly. Patients whose antipsychotic medications are discontinued may experience a relapse of psychotic symptoms (Dilsaver SC et al 1994), inmates threatened lawsuits and suicide (Pinta ER et al 2007).

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Coexistence Mental Health Issues and Substance Use DisordersAtypical Antipsychotics in Atypical Antipsychotics in correctional institutions

In the Florida Department of Corrections, use of quetiapine over the last 2 years has been stringently restricted, and currently providers must order the extended release (XR) formulation in place of immediate release quetiapine.

In particular, the XR has a delayed (by approximately 3 hours) and blunted (by approximately 67%) serum peak, which at least in theory could render the XR formulation less attractive to abusers.

Inmates shared that the sedation or mind-altering effects that they experienced with oral abuse of XR was less potent and less “liked” than that from immediate release

Quetiapine also revealed that when they crushed and snorted the XR formulation, it was not as rewarding or as pleasant as it had been with the immediate release quetiapine because the powder (perhaps due to the coating of the XR formulation) congealed in their nasal passages (Reccoppa L et al 2010)

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Coexistence Mental Health Issues and Substance Use DisordersAtypical Antipsychotics in treating coexistence diseaseOPPIDUM is an annual national study in Europe-USA, directed by the CEIP in France, objective determine which psychoactive prescription drugs are illegally obtained and through which ways of acquisition.

This work focuses on the different ways of acquisition specially the illegal ways of acquisition (bought on the street, forged prescription, stolen, given, internet).

Drug diversion is a major concern in France

Central nervous system (CNS) drugs represent themajority of illegally obtained prescription drugs: Antipsychotics 1.0%

The use of atypical antipsychotic in US and UK increased sharply during 90’s decade owing to safety and efficacy compared to typical (Hermann et al 2002, Ascroft et al 2002, Leslie and Rosenheck 2002) and led off-label use in children and adolescents.

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psychiatric conditions and addiction

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