Pharmacological treatment of alcohol use disorder in patients with psychotic disorders: A systematic review

Abstract

Background: Patients with psychotic disorders (PD) often have comorbid alcohol use dis- order (AUD), which is typically treated pharmacologically. Up till now, no systematic review has ex- amined the effectiveness and safety of AUD treatment in PD patients. Objectives: This study aimed to systematically review the literature on (1) the effects of pharmacolog- ical treatments for AUD on drinking outcomes, (2) the side effects of the drugs, and (3) the effects of polypharmacy in patients with comorbid AUD and PD. Methods: Bibliographic searches were conducted in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO. At least two reviewers extracted the data, assessed the risk of bi- as, and performed the qualitative synthesis of the collected evidence. Results: Twelve eligible studies were identified, half being randomized controlled trials (RCTs). Three studies examined disulfiram, nine naltrexone, two acamprosate, and one nalmefene by comparing the effects of treatment to placebo, baseline, or other pharmacological agents. Disulfiram and naltrexone were shown to reduce alcohol intake. Regarding acamprosate, the findings were mixed. Nalmefene decreased alcohol intake. All pharmacological agents appeared safe to use as AUD mono- therapy, but cardiac events were reported when combining naltrexone and disulfiram. Nine studies had a high risk of bias, and three had some other concerns. Conclusion: The studies provide tentative support for the use of naltrexone and disulfiram in this population, although combinations of pharmacological AUD treatments and other polypharmacy remain unexplored. The studies had high adherence rates that are hardly replicable in real-world settings. Thus, the findings need to be confirmed in larger RCTs with longer follow-ups for high-quality efficacy and effectiveness.