The association of extrapyramidal symptoms (EPS) with the use of antipsychotics was first discovered in the 1950s. To our knowledge, little research has been conducted with any retrospective observational database to evaluate the comparative risk of EPS between first-generation antipsychotic (FGA) and second-generation antipsychotic (SGA) users in the U.S. population. The purpose of the study was to compare EPS risk between FGA and SGA users using propensity score-matching (PSM) and instrumental variable (IV) analyses. A retrospective cohort design with an intention-to-treat (ITT) analysis (where the patients included in the cohort were assumed to take the medications without switching or dropping out) was chosen to examine the relationship between antipsychotic treatment and EPS risk. First-time antipsychotic users (as identified in the MEPS database), during the time frame 2002 to 2009, were included in the cohort. All subjects included in the cohort were followed over time to assess EPS risk. Propensity score-based logistic regression (using the Greedy 5[right arrow]1 digit match technique) was used to compare EPS risk between the SGA and FGA users after adjusting for demographic variables and risk factors (associated with EPS). In order to identify the presence of unobserved confounding, an instrumental variable analysis was attempted. Based on previous research findings, "delay in obtaining prescribed medicines" was selected as the instrument to evaluate the relationship between EPS risk and antipsychotic type. The feasibility of instrumental variable analyses was examined by evaluating the strength of the chosen instrument. The propensity score-based logistic regression analysis showed no difference in EPS risk [OR = 1.77, 95% CI = (0.49, 6.40)] between FGA and SGA users. The strength (partial r² = 0.0002) of the instrument was low. A weak instrument used in a regression model may produce biased estimates while evaluating treatment/outcome relationship; therefore, instrumental variable analysis was not conducted. EPS risk was found not to differ between the FGA and SGA users. However, clinicans may choose to evaluate other side-effects (in addition to EPS) of antipsychotics while making treatment decisions. Evaluation of economic, clinical and humanistic outcomes associated with treatment of antipsychotic-related side-effects (besides EPS) can provide clinicans the rationale for selecting one class of antipsychotics over the other. Interpretation of the study findings should be considered in light of the limitations of the MEPS database. Future research is necessary to identify a strong instrument to assess the presencec of unobserved confounding between antipsychotic exposure and EPS risk. Furthermore, additional research is warranted to assess differences in time to development of EPS between the FGA and SGA users. / text

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Neuroleptic medications are commonly administered in the emergency department but are known to induce extrapyramidal symptoms (EPS) in some patients; typically dystonia and akathisia. This systematic review will examine if adjunctive medications are efficacious when given in conjunction with neuroleptic medications to prevent these extrapyramidal symptoms. The Central, DARE, LILACS, PubMed, CINAHL, and OVID databases were searched for relevant articles between January 2014 and February 2016. Inclusion criteria required the article to be a randomized controlled trial; administer an anticholinergic medication given concurrently or just prior to treatment with medications with known extrapyramidal side effects; and be published in English. The initial search strategy yielded 1222 prospective articles of which 1208 were excluded by title and/or abstract. Fourteen articles were retrieved in full text and independently reviewed by each author. Seven 7 RCTs representing 645 patients were determined to be appropriate for analysis. Meta‐analysis of 5 studies found a significant effect (OR 0.4 with 95% CI 0.23‐0.71) for utilizing anticholinergic adjunct medications in the prevention of EPS for 60 minutes after administration. No reduction was found (OR 1.14 with 95% CI 0.01‐164) in EPS after 60 minutes in meta‐analysis of 2 studies with opposing results. Adjunctive anticholinergic medication was effective in reducing symptoms of dystonia (OR 0.13 with 95% CI 0.04‐0.43) but not in reducing symptoms of akathisia (OR 0.74 with 95% CI 0.27‐1.98). This systematic review found that anticholinergic adjuvant anticholinergic treatment reduced EPS induced by antipsychotic medications during 60 minutes after administration, with the greatest reduction in dystonic symptoms.

The present study attempted to predict the serious side effects of akathisia and parkinsonism on the basis of individualized measurement of changes in visuomotor functioning. The following were the hypotheses for this investigation. 1. A deterioration of visuomotor ability as measured by a modification of Haase and Janssen' s (1965) Handwriting Test will predict which patients undergoing neuroleptic therapy will experience the extrapyramidal symptoms of akathisia and parkinsonism (symptom group) and which will not (no-symptom group). 2. A deterioration of visuomotor ability as measured by the Bender-Gestalt will predict which patients undergoing neuroleptic therapy will experience the extrapyramidal symptoms of akathisia and parkinsonism (symptom group) and which will not (no-symptom group). It was not possible to predict the symptom group as a whole on the basis of the Handwriting Test scores since a t test of the difference was not significant between group means. However, inspection of these scores showed clear deterioration of performance among the patients who experienced parkinsonian reactions as opposed to those who experienced akathisia or who did not experience extrapyramidal symptoms at all. The symptom group was separated into akathisic and parkinsonian groups and compared to the subjects who did not experience extrapyramidal side effects (no-symptom group). A one-way ANOVA showed a nonsignificant difference between the three groups. Similar analysis of the Bender-Gestalt scores failed to support the second hypothesis since no significant difference was found between groups.

Submitted by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2016-01-27T12:50:08Z No. of bitstreams: 1 arquivototal.pdf: 1442835 bytes, checksum: 6b70176bf31acd5711693f3965397116 (MD5) / Made available in DSpace on 2016-01-27T12:50:08Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1442835 bytes, checksum: 6b70176bf31acd5711693f3965397116 (MD5) Previous issue date: 2015-04-24 / Recommended as Complementary Medicine by World Health Organization (WHO), Aromatherapy is widespread around the world and uses 100% pure essential oils to prevent and/or treat health problems. Thus, these oils extracted from plants can be considered innovative tools for the treatment of certain pathologies, including mental disorders, because there is evidence for theirs effectiveness in treating disorders related to the Central Nervous System (CNS), and also has low toxicity and easy access. The most common mental conditions treated include mood disorders, anxiety, age-related cognitive decline, psychotic disorders, stress symptoms and chronic pain. This study aimed to investigate possible antipsychotic effects of essential oils but also verify whether it is able to relieve extrapyramidal symptoms. Males Swiss mice, albinos, weighing 32-49 grams, with approximately 2 months of age were used as experimental subjects. The essential oil Lavandula angustifólia was used through inhalation route (5 minutes). Data were analyzed using Graph Pad Prism, using the one-way ANOVA and the Kruskal-Wallis tests. In all comparisons, p<0.005 was considered statistically significant. In the hypolocomotion test with lavender oil treatment at concentrations of 2.5%; 5% and 10% we observed that ambulatory movement, rearing, number of jumps, rest (sc), distance (cm), velocity (mm/s), clockwise and counter-clockwise rotation the results showed that, in all parameters, there was a potentiation of the hipolocomotor effect of haloperidol. In the catatonia test induced by haloperidol (1 mg/kg intraperitoneal injection) treatment with the essential oil showed significant result (p<0.05) compared with animals pretreated with Haloperidol+Saline (GC-), being able to reduce time of catatonia. In the catatonia test induced by haloperidol via oral administration,also presented effect of statistical significance, it is possible to observe a decrease in catatonia time (s) of the oil group compared to Haloperidol+Saline (GC-) group. In the hyperlocomotion test induced by amphetamine (3 mg/kg intraperitoneal injection), the same parameters of hypolocomotion were observed, however, no statistically significant results were found when we compared the group treated with lavender and the Amphetamine+Saline (GC-) group in most tests. In the stereotypy test induced by apomorphine (20 mg/kg intraperitoneal injection), the treatment with the oil inhibited the stereotyped behavior with p <0.05. In Climbing test induced by apomorphine (same dose and route of administration) the animals treated with lavender decreased the climb behavior level when compared to animals treated with Haloperidol+Saline (GC-). After analyzing the results we can conclude that the essential oil of lavender, administered by inhalation route, can have a similar profile to antipsychotics because both alter neurotransmission involved in schizophrenia. / Preconizada como Medicina Complementar pela Organização Mundial de Saúde, a Aromaterapia está bastante difundida pelo mundo e utiliza Óleos Essenciais 100% puros para prevenir e/ou tratar problemas relacionados à saúde. Assim, estes óleos obtidos de plantas podem ser considerados ferramentas inovadoras para o tratamento de certas patologias, incluindo transtornos mentais, pois têm mostrado eficácia sobre distúrbios relacionados ao Sistema Nervoso Central (SNC), além de possuir baixa toxidade e facilidade de acesso. As condições mentais mais frequentes tratadas incluem transtornos do humor, ansiedade, declínio cognitivo relacionado com a idade, perturbações psicóticas, sintomas do estresse e dores crônicas. O presente estudo teve como objetivo investigar possíveis efeitos antipsicóticos dos óleos essenciais como também verificar se o mesmo era capaz de aliviar os sintomas extrapiramidais. Foram utilizados camundongos Swiss machos, albinos, pesando de 32-49 g, com aproximadamente 2 meses de idade. O óleo essencial utilizado foi Lavandula angustifólia via inalatória (5 minutos). Os dados foram analisados pelo Graph Pad Prism, sendo utilizado o teste one-way ANOVA e o Kruskall-Wallis, os resultados foram considerados significativos quando apresentaram um nível de significância de 5% (p < 0,05). No teste de Hipolocomoção com tratamento do óleo de lavanda (GE) nas concentrações de 2,5%; 5% e 10% observou-se, movimento ambulatório, rearing, quantidade de pulos, de descanso (s), distância (cm), velocidade (mm/s), rotação horária e anti-horária os resultados mostraram que na maioria dos parâmetros houve uma potenciação do efeito hipolocomotor do haloperidol. No teste de Catatonia induzida por Haloperidol (1 mg/kg via i.p) o tratamento com o óleo essencial mostrou resultado significativo (p < 0,05) quando comparado com os animais pré-tratados com Haloperidol+salina (GC-), mostrando-se capaz de reduzir o tempo (s) da catatonia. No teste de Catatonia induzida por Halperidol via oral, também apresentou efeito significativo estatisticamente, é possível observar uma diminuição do tempo (s) de catatonia do GE em relação ao GC-. No teste de Hiperlocomoção induzida por Anfetamina (3 mg/kg i.p) foram observados os mesmos parâmetros da Hiperlocomoção, contudo, não encontramos resultados estatisticamente significativos em relação aos animais tratados com a lavanda e o grupo Anfetamina+Salina (GC-) na maioria dos testes. No teste de Estereotipia induzida por Apomorfina (20 mg/kg i.p) o tratamento com o óleo inibiu o comportamento estereotipado com p < 0,05. No teste do Climbing induzido por Apomorfina, na mesma dose e via de administração, o nível do comportamento de subida dos animais tratados com a lavanda GE diminuiu em relação aos animais tratados com GC-. Diante da análise dos resultados podemos concluir que o óleo essencial de lavanda, administrado por via inalatória, pode ter um perfil semelhante aos antipsicóticos por alterar a neurotransmissão envolvida na esquizofrenia.

No description available.

No description available.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Haloperidol is a typical neuroleptic widely used in the treatment of several psychotic disorders and it remains the most prescribed antipsychotic worldwide, due to its high potency and low cost. Despite its good therapeutic efficacy, the use of this drug is related to development of serious side effects of endocrine and cognitive nature, besides movement disturbances. Of particular importance, the motor disorders may be manifested in an irreversible and disabling form, whose pathophysiology has been linked to free radical generation, oxidative stress and dopaminergic neuronal death in extrapyramidal regions. Currently, polymeric nanoparticles are important terapeutic tools in the pharmaceutical area, because they permit a vectorization and a control drug release, it increasing the therapeutic efficacy and reducing adverse side effects. In this context, the present study aimed to perform a comparative evaluation among formulations of haloperidol-loaded nanocapsules and the free drug considering to its therapeutic action and side effects in rats. Firstly, it was prepared suspensions containing nanocapsules of haloperidol whose physicochemical characterization showed that haloperidol can be satisfactory encapsulated. After a first study using a pseudo-psychosis animal model, the haloperidol nanoencapsulated formulation demonstrated qualitative and quantitative therapeutic superiority, which were observed by the higher eficacy and action duration. In relation to extrapyramidal side effects, encapsulated formulation was able to prevent and/or minimize the characteristic acute and chronic movement disturbances, frequently observed with the free drug. In order to improve the results already obtained, a new formulation containing haloperidol nanocapsules was developed from the replacement of the oily core composed of caprylic and capric triglycerides in fish oil rich in polyunsaturated fatty acids, that has been described by its neuroprotective and antiapoptotic properties. This formulation showed physicalchemical suitability and reduced side effects in relation to the free drug, showing also ability to act in the prevention of oxidative stress which was observed by lower levels of lipid peroxidation, as well as an increase of antioxidant defenses in extrapyramidal regions. A third experimental phase was developed from the preparation of a new formulation of haloperidol containing grape seed oil in place of medium chain fatty acids mentioned above, which did not reach the necessary properties for a nanoformulation, but it was included for the comparative study of different nanocapsules formulations. The nanoformulation of haloperidol containing fish oil showed higher ability to prevent the motor side effects commonly seen with the free drug, which were observed by the maintenance of cell viability and control of free radical generation. Taken together, the results of this study point favorably to the development of nanocapsules formulations containing haloperidol, characterizing a positive perpective for minimizing of motor side effects consequent to the free drug. In this sense, these formulations can reduce the disabling physical limitations that cause embarrassment, contributing to a better quality of life of psychiatric patients. / O haloperidol é um neuroléptico típico comumente utilizado no tratamento de desordens psicóticas e continua sendo o antipsicótico mais prescrito no mundo, por sua elevada potência e baixo custo. Apesar da boa eficácia terapêutica, o uso do fármaco é relacionado ao desenvolvimento de sérios efeitos adversos de natureza endócrina, cognitiva e motora. De particular importância, os distúrbios motores podem se manifestar de forma irreversível e incapacitante e sua fisiopatologia tem sido associada à geração de radicais livres, estresse oxidativo e morte neuronal dopaminérgica em regiões extrapiramidais. Atualmente, as nanopartículas poliméricas constituem uma importante ferramenta na farmacologia, pois possibilitam uma vetorização e liberação controlada de fármacos, o que pode aumentar a eficácia terapêutica e reduzir os efeitos adversos. Neste contexto, o presente estudo teve como objetivo geral fazer uma avaliação comparativa entre formulações de haloperidol nanoencapsulado e o fármaco livre, considerando sua atividade terapêutica e efeitos colaterais em ratos. Inicialmente, foram desenvolvidas suspensões contendo nanocápsulas de haloperidol, cuja caracterização físico-química mostrou que o fármaco foi satisfatoriamente nanoencapsulado. Após um primeiro estudo utilizando um modelo animal de pseudo-psicose, a formulação de haloperidol nanoencapsulado mostrou superioridade terapêutica qualitativa e quantitativa, observadas através da maior eficácia e maior tempo de ação antipsicótica. Em relação aos efeitos colaterais extrapiramidais, a formulação nanoencapsulada foi capaz de prevenir e/ou minimizar os distúrbios motores agudos e subcrônicos característicos, os quais são frequentemente observados com o fármaco livre. Com o objetivo de otimizar os resultados até então observados, foi desenvolvida uma nova formulação contendo nanocápsulas de haloperidol a partir da substituição do núcleo oleoso composto por triglicerídeos cápricos e caprílicos por óleo de peixe, o qual é rico em ácidos graxos poliinsaturados e tem sido descrito por suas propriedades neuroprotetoras e antiapoptóticas. Esta formulação mostrou adequabilidade físico-química e redução de efeitos adversos motores em relação ao fármaco livre; demonstrando também capacidade de atuar na redução do estresse oxidativo, observado através dos menores níveis de peroxidação lipídica, bem como aumento das defesas antioxidantes em regiões extrapiramidais. Uma terceira etapa experimental foi desenvolvida a partir de uma nova formulação de haloperidol contendo óleo de semente de uva em substituição aos ácidos graxos de cadeia média acima referidos, a qual não atingiu completamente as propriedades necessárias para uma nanoformulação, mas mesmo assim foi incluída no estudo comparativo entre as diferentes formulações de nanocápsulas. Neste estudo, a nanoformulação de haloperidol com óleo de peixe mostrou maior capacidade de prevenir os efeitos colaterais motores comuns com o fármaco livre, atuando na manutenção da viabilidade celular e no controle da geração de radicais livres. Tomados em conjunto, os resultados do presente estudo apontam de forma favorável quanto ao desenvolvimento de formulações de nanocápsulas contendo haloperidol, o que caracteriza uma perspectiva positiva para a minimização de efeitos adversos motores decorrentes do uso do fármaco livre. Neste sentido, estas formulações poderiam colaborar na redução das limitações físicas incapacitantes e causadoras de constrangimento frequentemente descritas, contribuindo para uma melhor qualidade de vida dos pacientes psiquiátricos.

No description available.

Contexte Autant dans une population schizophrène que non schizophrène, l‘abus de substance a pour conséquence la manifestation de symptômes psychiatriques et neurologiques. Dans les présentes études cas-témoins, nous avons examiné les différences initiales ainsi que les changements suite au traitement de 12 semaines à la quetiapine au niveau de la sévérité de la toxicomanie et des symptômes psychiatriques et neurologiques chez 3 groupes distincts. Ces 3 groupes sont: des patients schizophrènes avec une toxicomanie (double diagnostic: DD), des patients schizophrènes sans toxicomanie concomittante (SCZ) et finalement, des toxicomanes non schizophrènes (SUD). Parallèlement, afin de nous aider à interpréter nos résultats, nous avons mené deux revues systématiques: la première regardait l‘effet d‘antipsychotiques dans le traitement de troubles d‘abus/dépendance chez des personnes atteintes ou non de psychoses, la deuxième comparait l‘efficacité de la quetiapine et sa relation dose-réponse parmi différents désordres psychiatriques. Méthodes Pour nos études cas-témoins, l‘ensemble des symptômes psychiatriques et neurologiques ont été évalués via l‘Échelle du syndrome positif et négatif (PANSS), l‘Échelle de dépression de Calgary, l‘Échelle des symptômes extrapyramidaux (ESRS) ainsi qu‘avec l‘Échelle d‘akathisie de Barnes. Résultats À la suite du traitement de 12 semaines avec la quetiapine, les groupes SCZ et DD recevaient des doses de quetiapine significativement plus élevées (moyenne = 554 et 478 mg par jour, respectivement) par rapport au groupe SUD (moyenne = 150 mg par jour). Aussi, nous avons observé chez ces mêmes patients SUD une plus importante baisse du montant d‘argent dépensé par semaine en alcool et autres drogues, ainsi qu‘une nette amélioration de la sévérité de la toxicomanie comparativement aux patients DD. Par conséquent, à la fin de l‘essai de 12 semaines, il n‘y avait pas de différence significative dans l‘argent dépensé en alcool et drogues entre les deux groupes de toxicomanes iv or, les patients DD présentait, comme au point de départ, un score de toxicomanie plus sévère que les SUD. Étonnamment, aux points initial et final de l‘étude, le groupe DD souffrait de plus de symptômes parkinsoniens et de dépression que le groupe SCZ. Par ailleurs, nous avons trouvé qu‘initiallement, les patients SUD présentaient significativement plus d‘akathisie, mais qu‘en cours de traitement, cette akathisie reliée à l‘abus/dépendance de cannabis s‘est nettement améliorée en comparaison aux patients SCZ. Enfin, les patients SUD ont bénéficié d‘une plus grande diminution de leurs symptômes positifs que les 2 groupes atteints de schizophrénie. Conclusions Bref, l‘ensemble de nos résultats fait montre d‘une vulnérabilité accentuée par les effets négatifs de l‘alcool et autres drogues dans une population de patients schizophrènes. Également, ces résultats suggèrent que l‘abus de substance en combinaison avec les états de manque miment certains symptômes retrouvés en schizophrénie. De futures études seront nécessaires afin de déterminer le rôle spécifique qu‘a joué la quetiapine dans ces améliorations. / Background Psychiatric and neurological symptoms are consequences of substance abuse in schizophrenia and non-schizophrenia patients. The present case-control studies examined differences in substance abuse/dependence, and psychiatric symptoms and neurological symptoms in substance abusers with [dual diagnosis (DD) group] and without schizophrenia [substance use disorder (SUD) group] and in non-abusing schizophrenia patients (SCZ group) –undergoing 12-week treatment with quetiapine. Furthermore, two systematic reviews were conducted in order help explain our results. The first examined the usefulness of antipsychotics for the treatment of substance abuse/dependence in psychosis and non-psychosis patients. The second examined the dose-response and comparative efficacy of quetiapine across psychiatric disorders. Methods Psychiatric symptoms and neurological symptoms were evaluated with the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, the Extrapyramidal Symptoms Rating Scale, and the Barnes Akathisia Rating Scale. Results DD and SCZ patients were receiving significantly higher doses of quetiapine (mean = 554 and 478 mg per day, respectively), relative to SUD patients (mean = 150 mg per day). We found that SUD patients showed greater improvement in weekly dollars spent on alcohol and drugs and SUD severity, compared to DD patients. At endpoint, there was no significant difference in dollars spent, but DD patients still had a higher mean SUD severity. Interestingly, DD patients had significantly higher parkinsonism and depression than SCZ patients at baseline and endpoint. On the other hand, we found that SUD patients had significantly more akathisia at baseline, improved more than SCZ patients, and this was related to cannabis abuse/dependence. Finally, SUD patients improved more in Positive and Negative Syndrome Scale positive scores than DD and SCZ patients. Conclusions Taken together, our results provide evidence for increased vulnerability to the adverse effects of alcohol and drugs in schizophrenia patients. They also suggest that substance abuse/withdrawal may mimic some symptoms of schizophrenia. Future studies will need to determine the role quetiapine played in these improvements.

Contexte Autant dans une population schizophrène que non schizophrène, l‘abus de substance a pour conséquence la manifestation de symptômes psychiatriques et neurologiques. Dans les présentes études cas-témoins, nous avons examiné les différences initiales ainsi que les changements suite au traitement de 12 semaines à la quetiapine au niveau de la sévérité de la toxicomanie et des symptômes psychiatriques et neurologiques chez 3 groupes distincts. Ces 3 groupes sont: des patients schizophrènes avec une toxicomanie (double diagnostic: DD), des patients schizophrènes sans toxicomanie concomittante (SCZ) et finalement, des toxicomanes non schizophrènes (SUD). Parallèlement, afin de nous aider à interpréter nos résultats, nous avons mené deux revues systématiques: la première regardait l‘effet d‘antipsychotiques dans le traitement de troubles d‘abus/dépendance chez des personnes atteintes ou non de psychoses, la deuxième comparait l‘efficacité de la quetiapine et sa relation dose-réponse parmi différents désordres psychiatriques. Méthodes Pour nos études cas-témoins, l‘ensemble des symptômes psychiatriques et neurologiques ont été évalués via l‘Échelle du syndrome positif et négatif (PANSS), l‘Échelle de dépression de Calgary, l‘Échelle des symptômes extrapyramidaux (ESRS) ainsi qu‘avec l‘Échelle d‘akathisie de Barnes. Résultats À la suite du traitement de 12 semaines avec la quetiapine, les groupes SCZ et DD recevaient des doses de quetiapine significativement plus élevées (moyenne = 554 et 478 mg par jour, respectivement) par rapport au groupe SUD (moyenne = 150 mg par jour). Aussi, nous avons observé chez ces mêmes patients SUD une plus importante baisse du montant d‘argent dépensé par semaine en alcool et autres drogues, ainsi qu‘une nette amélioration de la sévérité de la toxicomanie comparativement aux patients DD. Par conséquent, à la fin de l‘essai de 12 semaines, il n‘y avait pas de différence significative dans l‘argent dépensé en alcool et drogues entre les deux groupes de toxicomanes iv or, les patients DD présentait, comme au point de départ, un score de toxicomanie plus sévère que les SUD. Étonnamment, aux points initial et final de l‘étude, le groupe DD souffrait de plus de symptômes parkinsoniens et de dépression que le groupe SCZ. Par ailleurs, nous avons trouvé qu‘initiallement, les patients SUD présentaient significativement plus d‘akathisie, mais qu‘en cours de traitement, cette akathisie reliée à l‘abus/dépendance de cannabis s‘est nettement améliorée en comparaison aux patients SCZ. Enfin, les patients SUD ont bénéficié d‘une plus grande diminution de leurs symptômes positifs que les 2 groupes atteints de schizophrénie. Conclusions Bref, l‘ensemble de nos résultats fait montre d‘une vulnérabilité accentuée par les effets négatifs de l‘alcool et autres drogues dans une population de patients schizophrènes. Également, ces résultats suggèrent que l‘abus de substance en combinaison avec les états de manque miment certains symptômes retrouvés en schizophrénie. De futures études seront nécessaires afin de déterminer le rôle spécifique qu‘a joué la quetiapine dans ces améliorations. / Background Psychiatric and neurological symptoms are consequences of substance abuse in schizophrenia and non-schizophrenia patients. The present case-control studies examined differences in substance abuse/dependence, and psychiatric symptoms and neurological symptoms in substance abusers with [dual diagnosis (DD) group] and without schizophrenia [substance use disorder (SUD) group] and in non-abusing schizophrenia patients (SCZ group) –undergoing 12-week treatment with quetiapine. Furthermore, two systematic reviews were conducted in order help explain our results. The first examined the usefulness of antipsychotics for the treatment of substance abuse/dependence in psychosis and non-psychosis patients. The second examined the dose-response and comparative efficacy of quetiapine across psychiatric disorders. Methods Psychiatric symptoms and neurological symptoms were evaluated with the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, the Extrapyramidal Symptoms Rating Scale, and the Barnes Akathisia Rating Scale. Results DD and SCZ patients were receiving significantly higher doses of quetiapine (mean = 554 and 478 mg per day, respectively), relative to SUD patients (mean = 150 mg per day). We found that SUD patients showed greater improvement in weekly dollars spent on alcohol and drugs and SUD severity, compared to DD patients. At endpoint, there was no significant difference in dollars spent, but DD patients still had a higher mean SUD severity. Interestingly, DD patients had significantly higher parkinsonism and depression than SCZ patients at baseline and endpoint. On the other hand, we found that SUD patients had significantly more akathisia at baseline, improved more than SCZ patients, and this was related to cannabis abuse/dependence. Finally, SUD patients improved more in Positive and Negative Syndrome Scale positive scores than DD and SCZ patients. Conclusions Taken together, our results provide evidence for increased vulnerability to the adverse effects of alcohol and drugs in schizophrenia patients. They also suggest that substance abuse/withdrawal may mimic some symptoms of schizophrenia. Future studies will need to determine the role quetiapine played in these improvements.