M194. THE USE OF NOVEL PSYCHOACTIVE SUBSTANCES IN THE PRODROMAL PHASE OF SCHIZOPHRENIA- A CASE SERIES

Abstract

BackgroundThe so-called “novel psychoactive substances” (NPS) or “legal highs” have been highly used by adolescent and young population in the last decade, reaching a level at which they became a challenge for policy makers and public health [1]. Drugs like synthetic cannabinoids, synthetic cathinones, Salvia divinorum, phenylethylamines, synthetic cocaine substitutes and Mitragyna speciosa have been included in the NPS category and patients diagnosed with bipolar disorder, personality disorders or schizophrenia and related disorders were the most frequently associated disorders with NPD use (between 11.6 and 23.1%) [2]. Case reports of the NPS-induced relapses among patients with schizophrenia exist, and a toxicology screening rarely detect these substances [3]. The impact of NPS in the prodromal phase of schizophrenia is associated with several important questions, like “is there a common predisposition for both NPS abuse and schizophrenia spectrum disorders?”, or “how can the early treatment of the NPS abuse may interfere with the risk for the development of schizophrenia?”.MethodsA number of three patients who presented NPS use and attenuated psychotic syndrome (according to the DSM-5 criteria for conditions for further study) were monitored for 3 months during their detox treatment and after that period, during which they received a maintenance treatment with moodstabilizers (carbamazepine 600–900 mg daily or sodium valproate 500–1000 mg daily) and naltrexone (50 mg daily). Two patients accepted also low-dose antipsychotic treatment with olanzapine (5 mg/daily). Psychological counselling was offered and accepted by all three patients. These patients were evaluated every 4 weeks using Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Clinical Global Impressions – Severity (CGI-S), and Inventary for Drug Taking Situations (IDTS). No other axis I or III diagnoses were detected in any of these patients. However, two patients presented features of cluster A personality disorders, without reaching the threshold for a clear-cut axis II diagnosis.ResultsAll three patients reached the week 12 visit, and they presented improvements in the PANSS scores, including the patient who refused antipsychotic treatment (mean PANSS reduction was 23.7 points compared to baseline). GAF increased with 29.9 points, and CGI-S decreased with 1.9 points. IDTS had a more fluctuating course, with final values being modestly reduced to baseline (-10.7, p=0.127). One patient remained abstinent from NPS for 2 months, while the other two admitted a continuation of the drugs use during the 3 months of their monitoring period. No discontinuation of the treatment was reported during to the low tolerability.DiscussionThe initiation of pharmacological treatment and psychological counselling could improve the evolution of patients diagnosed with both NPS abuse and attenuated psychotic syndrome, as reflected at least by the PANSS scores, even if patients did not significantly improve their drug consumption.ReferencesSoussan C, Andersson M, Kjellgren A. The diverse reasons for using Novel Psychoactive Substances- a qualitative study of users’ own perspectives. Int J Drug Policy 2018;52:71–78.Acciavatti T, Lupi M, Santacroce R, et al. Novel psychoactive substance consumption is more represented in bipolar disorder than in psychotic disorders: a multicenter-observational study. Hum Psychopharmacol 2017;32(3). doi:10.1002/hup.2578.Vasiliu O. Therapeutic management of schizophrenia and substance use disorders dual diagnosis- clinical vignettes. Romanian Journal of Military Medicine 2018;CXXI(2):26–34.