Meta-analysis of the effects of adjuvant drugs in co-occurring bipolar and substance use disorder

被引：3

作者：

Radua, Joaquim ^{[1
,2
,3
]}

Fortea, Lydia ^{[1
]}

Goikolea, Jose Manuel ^{[1
]}

Zorrilla, Inaki ^{[4
]}

Bernardo, Miquel ^{[1
]}

Arrojo, Manuel ^{[5
]}

Cunill, Ruth ^{[6
]}

Castells, Xavi ^{[7
]}

Becona, Elisardo ^{[8
]}

Lopez-Duran, Ana ^{[8
]}

Torrens, Marta ^{[9
]}

Tirado-Munoz, Judit ^{[10
]}

Fonseca, Francina ^{[9
]}

Arranz, Belen ^{[6
]}

Garriga, Marina ^{[1
]}

Saiz, Pilar A. ^{[11
]}

Florez, Gerardo ^{[12
]}

San, Luis ^{[6
]}

Gonzalez-Pinto, Ana ^{[4
]}

机构：

[1] Univ Barcelona, Hosp Clin, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Inst Invest Biomed August Pi I Sunyer IDIBAPS, Barcelona, Spain

[2] Kings Coll London, Inst Psychiat Psychol & Neurosci, Inst Psychiat Psychol & Neurosci, London, England

[3] Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden

[4] OSI Araba Hosp Univ, Inst Invest Sanitaria BioAraba, Serv Cardiol, CIBERSAM,UPV EHU, Vitoria, Alava, Spain

[5] Complejo Hosp Univ Santiago, Inst Invest Sanitaria IDIS, Serv Gallego Salud SERGAS Santiago De Compostela, Santiago, Spain

[6] Univ Barcelona, Parc Sanitari Sant Joan Deu, Parc Sanit St Joan de Deu, Barcelona, Spain

[7] Univ Girona, Dept Ciencias Med, Grp Invest TransLab, Girona, Spain

[8] Univ Santiago de Compostela, Dept Polit Sci & Sociol, Unidad Tabaquismo & Trastornos Adict, Santiago De Compostela 15782, Spain

[9] Univ Autonoma Barcelona, Univ Vic, Inst Neuropsiquiatria Addicc, Red Invest Atenc Primaria Adicc RIAPAD,Cent Catalu, E-08193 Barcelona, Spain

[10] Univ Europea Madrid, Grp Invest Microbiota Alimentac & Salud MAS, Fac Ciencias Biomed & Salud, Madrid, Spain

[11] Inst Invest Sanitaria Principado Asturias ISPA, Inst Invest Sanitaria Principado Asturias ISPA,Ins, Oviedo, Asturias, Spain

[12] Complejo Hosp Ourense, Unidad Conductas Adict, Complejo Hospitalario Ourense, Orense, Spain

来源：

SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH | 2024年 / 17卷 / 04期

关键词：

Abstinence; Adjuvant drugs; Adverse events; Alcohol; Bipolar disorder; PLACEBO-CONTROLLED TRIAL; DOUBLE-BLIND; RATING-SCALE; SMOKING-CESSATION; MENTAL-DISORDERS; CLINICAL-TRIAL; ALCOHOL; ABUSE; QUETIAPINE; COMORBIDITY;

D O I：

10.1016/j.rpsm.2023.01.005

中图分类号：

R749 [精神病学];

学科分类号：

100205 ;

摘要：

Background: Individuals with bipolar disorder (BD) often have co-occurring substance use disorders (SUDs), which substantially impoverish the course of illness. Despite the importance of this dual diagnosis, the evidence of the efficacy and safety of adjuvant treatments is mostly unknown. Objective: To perform a meta-analysis to evaluate the efficacy and safety of adjuvant drugs in patients with co-occurring BD and SUD. Methods: We searched PubMed, Scopus, and Web of Knowledge until 30th April 2022 for randomized clinical trials (RCT) evaluating the efficacy and safety of adjuvant drugs compared to placebo in patients with a dual diagnosis of BD and SUD. We meta-analyzed the effect of adjuvant drugs on general outcomes (illness severity, mania, depression, anxiety, abstinence, substance craving, substance use, gamma-GT, adherence, and adverse events) and used the results to objectively assess the quality of the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. For completeness, we also report the specific effects of specific adjuvant drugs in patients with specific substance disorders. Results: We included 15 RCT studies (9 alcohol, 3 cocaine, 2 nicotine, and 1 cannabis) comprising 628 patients allocated to treatment and 622 to placebo. There was low-quality evidence that adjuvant drugs may reduce illness severity (g = -0.25, 95% CI: -0.44, -0.06), and very-low quality evidence that they may decrease substance use (g = -0.23, 95% CI: -0.44, -0.02) and increase substance abstinence (g = 0.21,95% CI: 0.04, 0.38). Discussion: There is low-quality evidence that adjuvant drugs may help reduce illness severity, probably via facilitating abstinence and lower substance use. However, the evidence is weak; thus, these results should be considered cautiously until better evidence exists. (c) 2023 SEP y SEPB. Published by Elsevier Espa & ntilde;a, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

引用

页码：239 / 250

页数：12

共 65 条

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