Comparative analysis of clinical and psychometric indicators in various strategies of antipsychotic therapy in patients with comorbid schizophrenia and alcohol dependence

Background. The comorbidity of schizophrenia and alcohol dependence is associated with a more severe clinical course, decreased adherence to treatment, and poorer treatment outcomes. The choice of antipsychotic therapy in patients with a dual diagnosis remains controversial, while comparative data on different antipsychotic treatment strategies, including long-acting injectable formulations and third-generation antipsychotics, are limited. Objective. To compare clinical and psychometric indicators in patients with comorbid schizophrenia and alcohol dependence depending on the type of antipsychotic therapy. Materials and Methods. A cross-sectional observational study included 49 patients with paranoid schizophrenia (ICD-10: F20.0) and alcohol dependence syndrome. The patients were divided into four groups according to their main antipsychotic treatment strategy: long-acting injectable antipsychotics, first-generation antipsychotics (FGA) (haloperidol), second-generation atypical antipsychotics (SGA), and third-generation antipsychotics (TGA) (aripiprazole/cariprazine). Psychopathological symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), severity of alcohol dependence using the Alcohol Use Disorders Identification Test (AUDIT), current alcohol craving using the Visual Analog Scale (VAS), and cognitive functioning using the Brief Assessment of Cognition in Schizophrenia (BACS). Nonparametric statistical methods were applied. Results. Statistically significant between-group differences were found in the AUDIT, VAS, and PANSS Positive Symptoms subscale. The haloperidol-treated group had higher rates of alcohol dependence and craving. More favorable AUDIT and VAS scores were observed in patients receiving third-generation antipsychotics. Long-acting injectable formulations and second-generation antipsychotics demonstrated comparable intermediate results, outperforming first-generation antipsychotics on several measures. Conclusions. In this cross-sectional observational study, differences in clinical and psychometric indicators were identified across antipsychotic treatment strategies in patients with comorbid schizophrenia and alcohol dependence. The findings should be interpreted as associations and require confirmation in prospective controlled studies.