Clozapine, quetiapine and olanzapine among addicted schizophrenic patients: Towards testable hypotheses

Stéphane Potvin, Emmanuel Stip, Jean Yves Roy

Research output: Contribution to journalReview articlepeer-review

62 Citations (Scopus)

Abstract

Although life prevalence of substance use disorders among patients with schizophrenia is close to 50%, few studies have been carried out to date to identify an integrated pharmacological treatment for this comorbidity. So far, the most promising results, that we report here, have been obtained with clozapine. To a lesser extent, quetiapine and olanzapine, both clozapine analogues, have also shown promising results. Further to these observations, the present paper critically reviews the advantages associated with clozapine, quetiapine and olanzapine, and their relevance to the treatment of addiction among schizophrenic patients. Six characteristics seem to distinguish clozapine, quetiapine and olanzapine from the first-generation antipsychotics: (1) acting preferentially on the reward system, these second-generation antipsychotics (mainly clozapine and quetiapine) induce almost no extrapyramidal symptoms; (2) quickly dissociating from D2, theses drugs (mainly clozapine and quetiapine) seem not to induce dysphoria, unlike conventional antipsychotics like haloperidol; (3) these drugs (mainly clozapine) seem more effective in the treatment of negative symptoms than conventional antipsychotics; (4) because of a diversified activity on several serotoninergic and noradrenergic receptors, these drugs positively alter mood, which does not seem to be the case with conventional antipsychotics, except for flupenthixol; (5) these drugs have a positive impact on cognition, which is not the case with the first-generation antipsychotics; (6) unlike conventional antipsychotics, these drugs seem to have a moderate affinity for 5-HT3, the receptor on which ondansetron, an anti-craving medication, acts.

Original languageEnglish
Pages (from-to)121-132
Number of pages12
JournalInternational Clinical Psychopharmacology
Volume18
Issue number3
DOIs
Publication statusPublished - May 2003
Externally publishedYes

Keywords

  • Addiction
  • Brain reward system
  • Clozapine
  • Comorbidity
  • Fast release from D, 5-HT antagonism
  • Haloperidol
  • Mesolimbic selectivity
  • Negative symptoms
  • Neurocognition
  • Olanzapine
  • Quetiapine
  • Schizophrenia

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pharmacology (medical)

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