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Treatment of dual diagnosis disorders

Murthy, Pratima; Chand, Prabhat

Current Opinion in Psychiatry: May 2012 - Volume 25 - Issue 3 - p 194–200
doi: 10.1097/YCO.0b013e328351a3e0
ADDICTIVE DISORDERS: Edited by John B Saunders and Linda B Cottler

Purpose of review Treatment of dual diagnosis [co-occurrence of a substance use disorder (SUD) in patients with mental illness] poses several challenges for mental health professionals. This article seeks to review the recent advances in dual diagnosis treatment with respect to pharmacotherapy and psychosocial approaches.

Recent findings Atypical antipsychotics are commonly used for comorbid schizophrenia and SUD. Whereas there is no difference between risperidone and olanzapine, clozapine appears to have a distinct advantage in reducing psychotic symptoms as well as substance abuse (including smoking). There is emerging evidence that quetiapine is beneficial in dually diagnosed patients, particularly using alcohol, cocaine and amphetamine. A combination of naltrexone and sertraline was found to be effective in patients with depressive disorder and alcohol dependence. Effectiveness of atomoxetine is yet to be established in patients with comorbid adult attention-deficit/hyperactivity disorder with respect to decrease in substance abuse. Integrated intervention is the choice of treatment for patients with dual diagnosis.

Summary In spite of the high association between substance use and psychiatric disorders, there is a surprising paucity of studies related to treatment and outcome. A few well-designed studies have been recently published and more studies of this nature are required in order to address the challenges posed in the treatment of dual disorders.

Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India

Correspondence to Professor Pratima Murthy, Professor of Psychiatry and Chief, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India. Tel: +91 80 26995274; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.