Course Of Psychosis In Schizophrenia With Alcohol Use Disorder: A Post Hoc Analysis Of The Clinical Antipsychotic Trials Of Intervention Effectiveness In Schizophrenia Phase 1 Study

Objective: Patients with schizophrenia and comorbid alcohol use disorder remain understudied. This post hoc analysis evaluated data from Phase 1 of the Clinical Antipsychotic Trials of Intervention Effectiveness in Schizophrenia study (January 2001-December 2004).Methods: Patients without substance abuse (except marijuana use) in the month before study entry were categorized into those with a history of alcohol use disorder (SZ+ AUD) within 5 years before study entry and those without alcohol use disorder (SZ-only) per DSM-IV criteria. Time to first and recurrent exacerbations and hospitalizations were compared between disease states and between olanzapine and perphenazine, quetiapine, risperidone, and ziprasidone.Results: A total of 1,338 patients (SZ + AUD = 22.6%; SZ-only= 77.4%) were included.Time to first exacerbation of SZ was significantly shorter in the SZ +AUD versus SZ-only population (median = 5.4 vs 6.4 months; hazard ratio [FIR] = 1.20 [95% CI, 1.01-1.42]; P=.039). Similar findings were observed for first hospitalization (HR = 1.63 [95% CI, 1.20-2.22]; P=.002) and recurrent hospitalizations (HR =1.60 [95% CI, 1.18-2.15]; P =.002). The most common reasons leading to exacerbation in both groups were an increase in symptom severity and lack of efficacy. In patients with SZ +AUD related or unrelated to marijuana, perphenazine, quetiapine, risperidone, and ziprasidone were associated with significantly shorter time to first exacerbation versus olanzapine.Conclusions: This post hoc analysis confirmed that patients with SZ +AUD had a worse illness course than patients with SZ-only and suggests that olanzapine may be associated with a longer time to first and recurrent exacerbations versus other antipsychotics in this difficult-to-treat population. Further research is needed to identify effective treatments for this important yet understudied patient population.