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Psychosis with Coexisting Substance Misuse: Assessment and Management in Adults and Young People

Psychosis with Coexisting Substance Misuse: Assessment and Management in Adults and Young People

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK)

Version: 2011

PHARMACOLOGICAL AND PHYSICAL INTERVENTIONS

There are many pharmacological treatments for both psychotic disorders and substance misuse, but there is very little overlap between the treatments for each group of disorders. The pharmacological treatments for each of the substance-use disorders are generally specific ones for each substance of dependence, for example, disulfiram and acamprosate for alcohol dependence, and methadone for opioid addiction. In the treatment of psychoses, however, there is much greater overlap, with lithium salts and other mood stabilisers, antipsychotics of all types, and anticonvulsants being used; these medications show little commonality with the treatments for substance misuse. It might be expected that with a large number of drugs being used to treat each group of disorders, there could be important interactions between them, both pharmacodynamic and pharmacokinetic. In practice, there is insufficient data about such interactions. It might also be expected that polypharmacy would be a problem for these coexisting disorders but the data here are conflicting with no clear evidence of greater use of drug treatment in people with psychosis and coexisting substance misuse (Centorrino et al., 2008; Goldberg et al., 2009; Kreyenbuhl et al., 2007).

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