Substance Abuse and Schizophrenia: Editors' Introduction

Yale University School of Medicine, West Haven, CT, USA.
Schizophrenia Bulletin (Impact Factor: 8.45). 02/1997; 23(2):181-6. DOI: 10.1093/schbul/23.2.181
Source: PubMed


Most individuals with schizophrenia have problems with abuse of substances ranging from licit substances, such as nicotine, to illicit ones, such as cocaine. This comorbidity may reflect self-medication, as well as a biological susceptibility to both disorders. Twin studies have suggested that this biological susceptibility may involve genetic factors. Other biological risk factors may involve the medications used to treat schizophrenia, which may produce symptoms that provoke abuse of drugs to relieve negative symptoms or may even enhance the euphoric response to abused drugs. The articles in this issue address several research areas related to substance abuse and schizophrenia, including the differential diagnosis of schizophrenia and organic disorders induced by substance abuse and the impact of substance abuse on the course of early schizophrenia. The management of substance-abusing schizophrenia patients requires a careful balance of pharmacotherapy and psychotherapies, and atypical antipsychotic agents may be particularly helpful. Psychotherapy needs to focus both on the management of affect and on the adequate monitoring of drug abstinence.

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Available from: Douglas Ziedonis, May 28, 2015
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    • "The high prevalence of substance use in schizophrenic patients could be explained by the self-medication hypothesis (Kosten and Ziedonis, 1997). Some studies have shown that smoking could improve neurocognitive function in schizophrenic patients via neurological effects at the central nicotinic acetylcholine receptors (Mackowick et al., 2014; Morisano et al., 2013; Rezvani and Levin, 2001; Wing et al., 2012) and might reduce antipsychotic extrapyramidal side effects (Decina et al., 1990; Sagud et al., 2009; Thoma and Daum, 2013). "
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    ABSTRACT: Co-occurring substance use in psychotic patients causes many subsequences including increased illness severity, decreased medication compliance, higher relapse rates, more hospitalizations, and legal problems. We aim to investigate the prevalence, patterns, associated factors and severity of substance use risk among psychotic patients in southern Thailand. Psychotic out-patients were screened with the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST) for their history of substance use in the past three months and categorized as None-to-Low Risk (NLR) or Moderate-to-High Risk (MHR) levels. Multivariate logistic regression was used to examine the associated factors of substance use risk-level. The associations between substance use risk-level and emotional and behavioural symptoms, functional status and family functional status were examined using multivariate linear regression analysis. Of 663 participants screened, 322 (48.6%) used at least one substance in the past three months. Tobacco was the most common substance used (47.2%). The factors associated with a higher risk of any substance use were male gender, young age group, low level of education, being employed and being diagnosed with schizophrenia. A higher number of emotional and behavioural symptoms was significantly associated with higher substance use risk-level. In conclusion, the prevalence of substance use in psychotic patients was high and associated with their emotional and behavioural symptoms. Recommendations for implementation of screening and early intervention programs of substance-related problems in psychotic patients are important for preventing unwanted outcomes.
    Asian Journal of Psychiatry 11/2014; 13. DOI:10.1016/j.ajp.2014.11.006
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    • "A number of studies suggest a high level of comorbidity between substance abuse and schizophrenia [1-3], and approximately half of the patients suffering from schizophrenia have also been substance abusers at some point during their illness [4]. The comorbidity of schizophrenia and substance abuse is associated with more frequent relapses, more positive symptoms and depression, cognitive impairment, and a poorer outcome and treatment response [5-9]. "
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    ABSTRACT: Several studies suggest a high comorbidity of substance abuse and schizophrenia, associated with higher frequency of relapse, more positive symptoms and depression, cognitive impairment, poorer outcome and treatment response. A high incidence of substance abuse is also observed in first-episode patients. Among patients with substance abuse, the onset precedes the onset of psychosis of several years in most cases. All the patients with a first episode of schizophrenia, at first admission to the Psychiatric Service of Diagnosis and Treatment of Ospedale Maggiore of Milan during the years 1990 to 2004, have been included in our study. The clinical evaluation has been obtained considering the following items of Brief Psychiatric Rating Scale (BPRS): conceptual disorganization, depressed mood, hostility, hallucinations, unusual content of thought. The results showed that 34.7% of first-episode schizophrenic patients had a lifetime history of substance abuse. The age of onset of schizophrenia is significantly lower for drug abusers than for patients without any type of abuse and for alcohol abusers (p < 0.005). In multi drug abusers, cannabis resulted the most frequently used (49%), followed by alcohol (13%), and cocaine (4%). Substance abusers have obtained a significant higher score in "thought disturbance" item (p < 0.005) and in "hostility" item (p < 0.005) compared to non substance abusers. Non drug abusers showed lower mean scores of "hostility" item compared to cocaine abusers and multi drug abusers (p < 0.005). Our findings seem to indicate that substance abuse in the early course of illness determines an earlier onset of schizophrenia and increases severity of some psychotic symptoms like "hallucination" and "unusual content of thought". Therefore persons incurring a risk of schizophrenia may be warned of the possible relation between substances and psychosis and have to be counselled against the use of them.
    Clinical Practice and Epidemiology in Mental Health 03/2006; 2(1):4. DOI:10.1186/1745-0179-2-4
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    • "They have a positive family history of sociopathy or alcoholism leading to a disruptive and chaotic environment (Kay et al.,1989), with increased risk for serious acts of violence (Scott et al., 1998) Poor adjustment (Bartels et al.,1993) leads to increased risk for homelessness (Drake & Wallach,1989) Also, such patients are hostile and uninterested in mental health services (Ziedoms 8. Trudeau.1997), indulge in illegal activities (Johnson,1997), show lack of responsibility with less concern of societal and moral values (Kay et al.,1989) which leads to poorer compliance (Bartels et al.,1993; Kosten & Ziedonis,1997; Newman et al ,1998) and symptomatic worsening (Dixon.1999). Treatment and outcome issues related to dual diagnosis also influence the need for comprehens've management Such patients get hospitalized at an early age (Kay et al.,1989), with longer duration of illness (Hall & Farrell, 1997) and frequent relapse and hospitalizations (Johnson, 1997. "
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    ABSTRACT: The term 'dual diagnosis' denotes the coexistence of substance use disorder(s) and other, non-substance-use, psychiatric disorder(s). The last two decades, and especially the 1990s, have witnessed tremendous research and clinical interest in this previously neglected area. India, however, lags behind, inspite of indications that the problem exists here too. The current approach to managing such patients is the 'integrated treatment model' in which the same clinician (or team of clinicians) provides treatment for both the disorders at the same time, treating both with equal understanding and importance. Both pharmacotherapy as well as psychosocial therapies are specifically designed keeping in mind the 'integrated' philosophy of treatment. The specific principles and components are described Areas of difficulty, uncertainty, and future considerations are highlighted, with a note on the Indian setting.
    Indian Journal of Psychiatry 01/2000; 42(1):34-47.
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