Article

Opis przypadku pary bliźniąt jednojajowych z rozpoznaniem schizofrenii paranoidalnej oraz dodatkowo uzależnienia od substancji psychoaktywnych u jednego z nich.

Psychiatr.Psychol.Klin 05/2002; 2(3):225-229.

ABSTRACT Streszczenie
Przedstawiono przypadek pary bliźniąt jednojajowych cierpiących na schizofrenię paranoidalną. U jednego z nich dodatkowo rozpoznano uzależnienia od substancji psychoaktywnych. Obaj byli hospitalizowani z powodu zaostrzenia schizofrenii, a u pacjenta uzależnionego stwierdzono po¬nadto objawy abstynencyjne spowodowane odstawieniem substancji psychoaktywnych. Po zasto¬sowaniu właściwego leczenia i uzyskaniu poprawy stanu psychicznego u obu z nich, pod koniec hospitalizacji dokonano porównania pod względem przebiegu leczenia, a także innych parametrów opisujących ich funkcjonowanie społeczne, jakość życia. U obu dokonano też oceny procesów po¬znawczych przy pomocy odpowiedniej baterii testów psychologicznych. Powyższa analiza wykaza¬ła, że u pacjenta z tzw. „podwójną diagnozą", czyli współistnieniem choroby psychicznej i uza¬leżnienia od substancji, konieczne było zastosowanie wyższych dawek neuroleptyków w celu osiąg¬nięcia poprawy stanu psychicznego. Ponadto stwierdzono, że poziom funkcjonowania społecznego i jakość życia utrzymywały się u niego na znacznie niższym poziomie niż u bliźniaka nie używa¬jącego substancji psychoaktywnych. Ocena procesów poznawczych u obu bliźniaków, dokonana po ustabilizowaniu stanu psychicznego, wykazała, że u bliźniaka z „podwójną diagnozą" stwierd¬zono gorsze wyniki w większości testów (ocena selektywności i czujności uwagi, przestrzennej i werbalnej pamięci operacyjnej) w porównaniu z bliźniakiem nie używającym substancji. Powyższe wnioski oparte są na ocenie jednej tylko pary bliźniąt, ponieważ szanse znalezienia i poddania badaniu podobnej pary są minimalne.
Słowa kluczowe: schizofrenia, uzależnienie, podwójna diagnoza, bliźnięta jednojajowe

Summary
A case of monozygotic twins suffering from paranoid schizophrenia was described. In one of them also an addiction to psychoactive substances was diagnosed. Both were hospitalized for exacerba¬tion of schizophrenia, and in the addicted patient also abstinence signs caused by discontinuation of psychoactive substances appeared. After appropriate treatment and improvement of mental condition in both twins, at the end of hospitalization they were compared in view of the course of treatment, as well as other parameters describing their social functioning and quality of life. In addition, cognitive processes were evaluated using a relevant set of psychological tests. This analy¬sis indicated that in the patient with the so called "dual diagnosis", i.e. comorbidity of mental di¬sease and addiction to psychoactive substances, it was necessary to use higher doses of neurolep¬tics in order to improve the mental condition. Furthermore, he exhibited a much lower level of social functioning and quality of life. Evaluation of cognitive processes in both twins, carried out after stabilization of their mental condition, demonstrated much worse results in most of the tests in the twin with the "dual diagnosis" (evaluation of selectivity and attentiveness, spacial and verbal operative memory), as compared to the one who did not use any substances. These conclusions are based on evaluation of only one pair of twins, but the chances of finding and examining a similar pair of twins are minimum.
Keywords: schizophrenia, addiction, dual diagnosis, monozygotic twins

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    ABSTRACT: The observations of the clinicians treating the dual diagnosis patients concerning the influence of the substance abuse on the course of the mental illness are inconsistent. According to some of them the patients suffering from schizophrenia abusing substances present less positive and negative symptoms, according to others the substance abuse highly deteriorates the course of the disease. Especially the use of stimulants, like cocaine has a highly negative effect. Some data from literature show that the only result of substance abuse is the increase of frequency of hospitalizations the impact on different symptoms may be diverse, e.g. alcohol causes an increase of positive symptoms, and it is also responsible for a higher frequency of suicidal attempts. The purpose of the research was to find differences in social functioning, quality of life, cognitive functioning, antypsychotic treatment and the length of treatment between twins suffering from schizophrenia, if one of them is also addicted to psychoactive substances. Patients and methods: Two twin brothers aged 29 were examined. Patients were single, they both had a vocational education. They were both admitted to the hospital because of exacerbation of the illness. One of the patients never used illicit drugs. The other one was addicted to psychoactive substances, which included: cannabis, amphetamine, LSD, heroine, alcohol, benzodiazepines. The onset of schizophrenia happened in the same year in both brothers. They were treated with the same antipsychotics, although the doses used by the dual diagnosis brother were higher: risperidon 6 mg per day (4 mg per day in the brother without addiction), haloperidol 30 mg per day (8 mg in the brother without addiction). Psychological examination was done after the normalization of the acute psychotic symptoms. The neuropsychological assessment included Trail Making Test (TMT-A and TMT-B), Continuous Performance Test (CPT-450), and Stroop Test (part RCNb, and NCWd). Quality of life was measured with the Scale “Q”, and the social functioning with the scale “OUT”. Both patients signed a written consent and the study was accepted by a bioethical committee. Results: In the patient with the dual diagnosis there were worse results in the neuropsychological test (excluding the Stroop Test in which both bothers achieved the same results), he also had worse scores in the scales measuring the quality of life and social functioning. He also needed a longer stay in the hospital to achieve recovery (148 days) in comparison with his brother (18 days). As mentioned above also higher doses of antipsychotics were needed to control the psychotic symptoms. Conclusions: The above analysis showed differences in the course and treatment of schizophrenia in twin patients, when one of them was addicted to psychoactive substances. This single couple of patients cannot be representative for larger groups with dual diagnosis, however the observation of two patients, who are genetically close may be interesting and is quite uncommon. The data in the literature concerning cognitive and social functioning, pharmacological treatment and the outcome of the disease in dual diagnosis patients are still inconsistent, so further research is still required. References [1] Potvin S, Joyal CC, Pelletier J, Stip E, 2008. Contradictory cognitive capacities among substance-abusing patients with schizophrenia: A meta-analysis. Schizophr Res 100(1−3): 242–251. [2] May-Majewski A, Krysta K, Skalbania W, 2002. Opis przypadku pary blizniat jednojajowych z rozpoznaniem schizofrenii paranoidalnej oraz dodatkowo uzaleznienia od substancji psychoaktywnych u jednego z nich. Psychiatr Psychol Klin 3(2): 225–229. [3] Krysta K, Kwiatkowska A, Ziolko E, 2006. Reasons for substance abuse among mentally ill people. Pol J Environ Stud 15(2B) Pt.IV: 1297–1299.
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    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: The observations of the clinicians treating the dual diagnosis patients concerning the influence of the substance abuse on the course of the mental illness are inconsistent. According to some of them the patients suffering from schizophrenia abusing substances present less positive and negative symptoms, according to others the substance abuse highly deteriorates the course of the disease. Especially the use of stimulants, like cocaine has a highly negative effect. Some data from literature show that the only result of substance abuse is the increase of frequency of hospitalizations the impact on different symptoms may be diverse, e.g. alcohol causes an increase of positive symptoms, and it is also responsible for a higher frequency of suicidal attempts. The purpose of the research was to find differences in social functioning, quality of life, cognitive functioning, antypsychotic treatment and the length of treatment between twins suffering from schizophrenia, if one of them is also addicted to psychoactive substances. Patients and methods: Two twin brothers aged 29 were examined. Patients were single, they both had a vocational ed- ucation. They were both admitted to the hospital because of exacerbation of the illness. One of the patients never used illicit drugs. The other one was addicted to psychoactive substances, which included: cannabis, amphetamine, LSD, heroine, alcohol,benzodiazepines. The onset of schizophrenia happened in the same year in both brothers. They were treated with the same antipsychotics, although the doses used by the dual diagnosis brother were higher: risperidon 6 mg per day (4 mg per day in the brother without addiction), haloperidol 30 mg per day (8 mg in the brother without addiction). Psychological examination was done after the normalization of the acute psychotic symptoms. The neuropsychological assessment included Trail Making Test (TMT-A and TMT-B), Continuous Performance Test (CPT-450), and Stroop Test (part RCNb, and NCWd). Quality of life was measured with the Scale “Q”, and the social functioning with the scale “OUT”. Both patients signed a written consent and the study was accepted by a bioethical committee. Results: In the patient with the dual diagnosis there were worse results in the neuropsychological test (excluding the Stroop Test in which both bothers achieved the same results), he also had worse scores in the scales measuring the quality of life and social functioning. He also needed a longer stay in the hospital to achieve recovery (148 days) in comparison with his brother (18 days). As mentioned above also higher doses of antipsychotics were needed to control the psychotic symptoms. Conclusions: The above analysis showed differences in the course and treatment of schizophrenia in twin patients, when one of them was addicted to psychoactive substances. This single couple of patients cannot be representative for larger groups with dual diagnosis, however the observation of two patients, who are genetically close may be interesting and is quite uncommon. The data in the literature concerning cognitive and social functioning, pharmacological treatment and the outcome of the disease in dual diagnosis patients are still inconsistent, so further research is still required. References [1] Potvin S, Joyal CC, Pelletier J, Stip E, 2008. Contradictory cognitive capacities among substance-abusing patients with schizophrenia: A meta-analysis. Schizophr Res 100(1−3): 242–251. [2] May-Majewski A, Krysta K, Skalbania W, 2002. Opis przypadku pary blizniat jednojajowych z rozpoznaniem schizofrenii paranoidalnej oraz dodatkowo uzaleznienia od substancji psychoaktywnych u jednego z nich. Psychiatr Psychol Klin 3(2): 225–229. [3] Krysta K, Kwiatkowska A, Ziolko E, 2006. Reasons for substance abuse among mentally ill people. Pol J Environ Stud 15(2B) Pt.IV: 1297–1299.
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