In a sample of 412 patients with psychotic disorders, the authors examined whether comorbid substance use can be reliably diagnosed, is associated with increased rates of affective symptoms and syndromes and specific psychotic symptoms, and is associated with lowered reliability of the DSM-III-R principal diagnosis. Data from the DSM-IV Field Trial for Schizophrenia and Other Psychotic Disorders was analyzed. In this dataset, substance use was scored on a 4-point ordinal scale and reliability was determined using weighted kappa scores. The associations of significant substance use with affective syndromes and symptoms, and psychotic symptoms were analyzed. Kappa statistics were calculated for principal psychotic disorder diagnoses for patients with and without significant substance use. Weighted kappa scores for substance use ratings ranged from 0.27 to 0.96 (median = 0.85). Syndromal depression was significantly associated with current alcohol use in the entire sample and in the subgroup with schizophrenia alone. Grandiose delusions were also associated with substance use. Significant comorbid substance use was not associated with lowered reliability of diagnosing the principal psychotic disorder. These findings support the hypothesis that comorbid substance abuse can be reliably diagnosed and that alcohol abuse is associated with depressive syndromes in patients with psychotic disorders.
"However, when comparing psychiatric populations that exhibit such symptoms, schizophrenia patients are amongst those with the highest rates of cigarette smoking (Ziedonis et al., 2008). Finally, the most commonly abused substances in schizophrenia [tobacco, cannabis, alcohol and cocaine (DeQuardo et al., 1994; Drake et al., 1990; Martins and Gorelick, 2011; Schneier and Siris, 1987; Strakowski et al., 1994; Westermeyer and Schneekloth, 1999)] have different—sometimes opposite—effects on mood, cognition and behaviour, resulting in differential abilities to modulate schizophrenia symptoms or medication side effects. "
[Show abstract][Hide abstract] ABSTRACT: Individuals with schizophrenia are at very high risk for drug abuse and addiction. Patients with a coexisting drug problem fare worse than patients who do not use drugs, and are also more difficult to treat. Current hypotheses cannot adequately account for why patients with schizophrenia so often have a co-morbid drug problem. I present here a complementary hypothesis based on evidence showing that chronic exposure to antipsychotic medications can induce supersensitivity within the brain's dopamine systems, and that this in turn can enhance the rewarding and incentive motivational effects of drugs and reward cues. At the neurobiological level, these effects of antipsychotics are potentially linked to antipsychotic-induced increases in the striatal levels of dopamine D2 receptors and D2 receptors in a high-affinity state for dopamine, particularly at postsynaptic sites. Antipsychotic-induced dopamine supersensitivity and enhanced reward function are not inevitable consequences of prolonged antipsychotic treatment. At least two parameters appear to promote these effects; the use of antipsychotics of the typical class, and continuous rather than intermittent antipsychotic exposure, such that silencing of dopaminergic neurotransmission via D2/3 receptors is unremitting. Thus, by inducing forms of neural plasticity that facilitate the ability of drugs and reward cues to gain control over behaviour, some currently used treatment strategies with typical antipsychotics might contribute to compulsive drug seeking and drug taking behaviours in vulnerable schizophrenia patients.
Progress in Neuro-Psychopharmacology and Biological Psychiatry 06/2013; 52. DOI:10.1016/j.pnpbp.2013.06.008 · 3.69 Impact Factor
"Using data from the DSM-IV Field Trial, we found that a modified PDS could also be implemented successfully using items from the Field Trial Instrument (FTI; Amador et al., 1994; Strakowski et al., 1994), which were largely derived from the Comprehensive Assessment of Symptoms and History (Andreasen et al., 1992). In that dataset the deficit/nondeficit categorization was validated by replication of several findings first obtained in clinical samples diagnosed by administration of the SDS. "
[Show abstract][Hide abstract] ABSTRACT: Patients with schizophrenia in the Suffolk County Mental Health Project were categorized into groups with (n = 32) and without (n = 52) the deficit syndrome, using a case identification method based on the Brief Psychiatric Rating Scale. The deficit group had a lower level of function at both index admission and 24-month follow-up; these differences could not be attributed to group differences in demographic variables, chronicity of illness, or a greater severity of psychosis in the deficit syndrome group. The number of patients categorized as deficit was greater at 24 months (34%) than at 6 months (25%).
Schizophrenia Research 12/1996; 22(2):119-26. DOI:10.1016/S0920-9964(96)00057-6 · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Drug abuse is common in schizophrenia. Previous studies suggested patients with the deficit syndrome have a lower risk of drug abuse than do patients without deficit features. We distinguished deficit and nondeficit groups in the DSM-IV Field Trial dataset, and compared the two groups relative to current and lifetime (worst ever) severity of alcohol, cannabis, and other drugs of abuse. Deficit syndrome patients had a lower severity of current use of alcohol and other drugs, but the two groups did not differ significantly relative to cannabis use. Deficit patients also had less severe lifetime use of all three classes of drugs. These findings could not be attributed to differences between the deficit and nondeficit groups in demographics, severity of psychotic symptoms, chronicity of illness, or the quality of information available for the two groups. Deficit categorization and drug abuse were independently associated with poor level of function. Negative symptoms broadly defined were weaker predictors of drug abuse than was the deficit/nondeficit categorization. These findings further support the validity of the deficit syndrome of schizophrenia. Within schizophrenia, groups with relatively high or low risk for substance abuse can be identified.
Schizophrenia Research 06/1996; 20(1-2):69-77. DOI:10.1016/0920-9964(95)00102-6 · 3.92 Impact Factor
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