539. EARLY ASSERTIVE PHARMACOTHERAPY INTERVENTION STUDY FOR STIMULANT ASSOCIATED PSYCHOSIS—A 24-MONTH PROSPECTIVE RANDOMIZED CONTROLLED TRIAL
Bibliographic record
Abstract
Abstract Background Both cocaine and methamphetamine are the top two commonest misused stimulants worldwide. It is well established that stimulant use can induce psychotic disorder, and a substantial proportion of stimulant associated psychosis will convert to schizophrenia. Thus, early assertive pharmacotherapy is in utmost need. Scanty evidence is available on the suitable choices of antipsychotics that can benefit both stimulant use and its associated psychosis. Aims & Objectives This study aimed to compare the clinical outcomes from using aripiprazole or paliperidone to treatment-as-usual (TaU) in stimulant users with stimulant associated psychosis on their efficacies in treating the psychosis, stimulant dependence, and changes in mood, cognitive and functional outcomes. It also looked into the conversion rate from stimulant-induced psychotic disorder to schizophrenia after the use of early assertive pharmacotherapy among stimulant users. Method This study was a 24-month, two phases, three-arm, prospective longitudinal interventional study. Consented stimulant users with psychotic symptoms were randomized to receive either aripiprazole, paliperidone or TaU for 12 months in the single-blinded “Active Intervention” phase, followed by another 12 months open-labelled “Observation Maintenance” phase when the allocated interventions could be continued, stopped or changed to other medications. Primary outcomes including: 24-item Brief Psychiatric Rating Scale (BPRS-24), Clinical Global Impression (CGI), Glasgow Antipsychotic Side-effect Scale (GASS), Severity of Dependence Scale (SDS), severity of DSM-5 defined stimulant use disorder (SUD), Stages of Change Readiness and Treatment Eagerness Scale-Drug (SOCRATES-D), and secondary outcomes including: Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Frontal Assessment Battery (FAB), Montreal Cognitive Assessment (MoCA), and Addiction Severity Index-Lite (ASI-Lite) were assessed. Results 165 stimulant users with psychotic symptoms were randomized. At the end of the “Active Intervention” phase and the “Observation Maintenance” phase, there were no significant intervention group differences in BPRS-24, GASS, CGI-S, SDS and SUD for cocaine, SOCRATES-D, BAI, BDI-II, FAB and ASI-Lite. There could be a potential transient worsening of psychological dependence to methamphetamine when aripiprazole and paliperidone were prescribed in the first six months when compared to TaU group (p < .05). Stimulant users taking aripiprazole had better CGI-I scores (p < .001), and had mitigated DSM-5 defined methamphetamine use disorder severity when compared to the TaU group (p < .05). Stimulant users taking paliperidone showed the worst MoCA scorings (p < .05) among the three intervention groups. The prevalence of schizophrenia converted from stimulant-induced psychotic disorder was 10%. Discussion & Conclusions Clinicians should aware that early antipsychotic pharmacotherapy can help lowering the conversion rate of stimulant induced psychosis to schizophrenia. Both aripiprazole and paliperidone were well tolerated in stimulant users with associated psychosis. Aripiprazole demonstrated significantly better clinical improvement in stimulant associated psychotic symptoms and was able to improve the severity of methamphetamine use disorder than the other two intervention groups. When paliperidone is prescribed to stimulant users with associated psychosis, their cognitive function should be monitored.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".