The phenomenon of substance use disorders (SUDs) presents extremely complex etiopathogenesis with intermingled psychological, social, economic, and biological factors. Therefore, the prophylactic and therapeutic approach is multidimensional and should involve targeting all the aforementioned variables. However, it is frequently difficult to separate these factors and construct specific strategies to mitigate their direct negative effects, so caution is needed when formulating recommendations for this population, starting from guidelines for case management and finishing with optimization of healthcare policies. Based on the lack of good practices approved at the national level in Romania for the prevention and treatment of SUDs, this article suggests a draft for such an instrument that could help both clinicians and decisional factors with attribution in healthcare and drug abuse prevention. The methods used in this article are (1) a literature review of studies, guidelines, and other reviews focused on specific aspects of drug abuse/dependence and (2) expert opinions derived from clinical and administrative experience. The results are formulated as recommendations, scored according to the GRADE system, and grouped into three categories: (1) preventative measures for SUDs, (2) secondary prophylaxis, (3) therapeutic and other SUD-targeted interventions. In conclusion, the need for guidelines and policies focused on the prevention and treatment of SUDs, especially in vulnerable populations, is an unmet need in our country. The suggested algorithm in this paper tried to bridge the gap between the available literature dedicated to SUDs, practical experience, and future policies in the healthcare of patients with SUDs.
Background: A large number of augmentation agents have been tried in patients with schizophrenia spectrum disorders, because negative and cognitive symptoms are difficult-to-treat with current pharmacological agents, and because the high percentage of treatment-resistant cases requires new therapeutic solutions. Inflammation is one of the supposed pathophysiological mechanisms in schizophrenia; therefore, antibiotics have been explored as add-on agents. No systematic review or meta-analysis about the efficacy of antibiotics in psychotic disorders has yet been conducted. Objectives: To assess if the use of antibiotics as add-on to current antipsychotic treatment may improve core symptoms of schizophrenia spectrum disorders, global clinical status, overall functionality, and if this augmentation strategy is well tolerated. Methods: A systematic literature review was conducted, including papers published between 1980 and 2018, which have been found in the main electronic databases (PubMed/MEDLINE, CINAHL, NCBI, Embase, Thomson Reuters/Web of Science). The keyword search strategy was formulated using the following paradigm: „schizophrenia spectrum disorders”/ „schizophrenia”/ „schizo-affective disorder”/ „schizophreniform disorder”, AND „antibiotics”/ all the names of currently marketed antibiotics classes. This review was registered to PROSPERO database with the protocol number CRD42019119152. Results: Based on reviewing the selected trials regarding the efficacy of antibiotics over core symptoms of schizophrenia, only two agents were detected – minocycline and D-cycloserine. Minocycline as add-on to antipsychotic treatment was associated with mixed results, while regarding the efficacy of d-cycloserine either no significant difference, or superiority to placebo over negative and cognitive symptoms was reported. Minocycline had an overall effect over the clinical impression that was not distinguishable from placebo, although there was one trial supporting the efficacy of this antibiotic. The impact of minocycline over the global functioning when added to antipsychotic in patients with schizophrenia was mixed, with one positive and one negative trial (moderate to high quality designed trials). D-cycloserine had no significant impact over global clinical status or patients’ overall functionality. Conclusion: From all the data reviewed and hierarchized resulted that larger trials are needed in order to confirm the efficacy of antibiotics as add-on to antipsychotics over negative and cognitive symptoms of schizophrenia spectrum disorders.
