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Drug abuse in schizophrenic patients: Clinical correlates and reasons for use
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This study aimed to 1) determine substance abuse prevalence and preference in a diverse sample of schizophrenic, schizoaffective, and schizophreniform inpatients, 2) compare drug-abusing and non-drug-abusing patients on demographic and clinical variables during the acute and stabilization phases of their hospital course, and 3) obtain data from patients on reasons for drug abuse and on acute state-related changes during periods of intoxication.
Eighty-three psychotic inpatients consecutively admitted to a New York City teaching hospital were evaluated. Sixty-eight had schizophrenia, 12 had schizoaffective disorder, and three had schizophreniform disorder diagnosed according to the Structured Clinical Interview for DSM-III-R. Each patient received ratings on the Brief Psychiatric Rating Scale, the Global Assessment Scale, and the Scale for the Assessment of Negative Symptoms at admission and at discharge, an evaluation of premorbid adjustment, and an extensive interview on drug and alcohol use.
Forty (48%) of the patients received diagnoses of drug or alcohol abuse or dependence. The drug-abusing patients primarily used cannabis (N = 26), alcohol (N = 21), and cocaine (N = 14) and reported that they abused drugs to get "high," to relieve depression, and to relax. They had significantly fewer positive and negative symptoms at discharge, better sexual adjustment and worse school performance during adolescence, and more family histories of drug abuse than the non-drug-abusing patients.
Schizophrenic patients who abuse drugs may represent a subgroup of patients with better prognoses and less severe clinical characteristics of schizophrenia, but their drug abuse may adversely affect global outcome.
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... Many patients report that alcohol temporarily relieves chronic psychotic symptoms, such as delusions of reference and hallucinations (Freed, 1975;Hansell & Willis, 1977). Most patients describe the use of drugs or alcohol to "get high," relax, or alleviate boredom, and patients frequently report that drug use stimulates and energizes them (Dixon, Haas, Weiden, Sweeney, & Frances, 1991;Test, Wallisch, Allness, & Ripp, 1989). From the patient's perspective, self-medication is an attractive explanation for substance abuse behavior, and one that is frequently used by a wide variety of people who abuse drugs or alcohol (e.g., Kushner, Sher, & Beitman, 1990). ...
... If more symptomatic patients were more likely to abuse drugs or alcohol, this would support the self-medication hypothesis. However, studies of symptomatology in substance abusing schizophrenia patients have produced contradictory findings (e.g., Barbee et al, 1989;Cleghorn et al, 1991;Dixon et al, 1991;Negrete, Knapp, Douglas, & Smith, 1986;Sevy, Kay, Opler, & van Praag, 1990). Thus, the self-medication hypothesis appears to be of limited value in explaining the high rate of substance abuse in schizophrenia patients. ...
... Etiologically, substance abuse in schizophrenia patients appears to be determined by both the availability of drugs and alcohol in the patient's peer group and, to a lesser extent, genetic factors as well. Family studies have found that schizophrenia patients with a history of substance abuse-dependence do not differ from nonabusing patients in the number of relatives with a schizophrenia-spectrum disorder, but that the abusing patients have more relatives with histories of substance abuse and affective disorders (Dixon et al., 1991;Gershon et al., 1988). Thus, environmental and biological factors appear to contribute to the high rate of substance abuse in schizophrenia, whereas patients describe euphoric or other relaxing effects of drugs as reasons for abusing drugs. ...
The problem of substance abuse disorders in schizophrenia patients is reviewed, including the prevalence of comorbid disorders, assessment, hypothesized mechanisms underlying abuse, and the clinical effects of abuse on the course of illness and cognitive functioning. The principles of treatment for dual-diagnosis schizophrenia patients are outlined, and the limitations of existing interventions are noted. Gaps in current knowledge about the impact of substance abuse on schizophrenia and its treatment are identified, and suggestions are made regarding promising avenues of research in this area.
... Out of 200 patients we could find the comorbidity of substance use in 70.5% patients which closely matched with the comorbidity of 63% in the study conducted by Lawrie SM et al (1995) [7] . Various studies like Dixon L et al (1991) [8] reported 48%, Habibisaravi R et al (2015) [9] reported 52.2%, Chouljian TL et al (1995) [10] reported 30-40%, Aich KT et al (2004) [11] reported 54.3% & Miller FT (1989) [12] reported 50% prevalence rate of substance use in psychosis in their studies. ...
... Out of 200 patients we could find the comorbidity of substance use in 70.5% patients which closely matched with the comorbidity of 63% in the study conducted by Lawrie SM et al (1995) [7] . Various studies like Dixon L et al (1991) [8] reported 48%, Habibisaravi R et al (2015) [9] reported 52.2%, Chouljian TL et al (1995) [10] reported 30-40%, Aich KT et al (2004) [11] reported 54.3% & Miller FT (1989) [12] reported 50% prevalence rate of substance use in psychosis in their studies. ...
... The substance use found in our study was tobacco, alcohol & cannabis. Similar substances (tobacco, alcohol, cannabis & opioid) was found in the study conducted by Aich KT et al (2004) [11] .Whereas substance found in study of Dixon et al (1991) [8] and Habibisaravi R et al (2015) [9] were stimulants, cannabis, alcohol, cocaine, hallucinogen, sedative-hypnotics & opioids etc. This may be because in our region even in general population commonest substances abused were tobacco, alcohol & cannabis. ...
Abstract:
Introduction: The co-occurrence of Psychosis and Substance use is prevalent and is associated with significant clinical and social problems. More than three fourths of all schizophrenic patients smoke cigarettes;30-50 % may meet diagnostic criteria for alcohol abuse or dependence. Aims & Objectives: 1.To evaluates the Prevalence and Pattern of Substance use in the patients with Psychotic disorders & to co-relate with various socio-demographic factors. 2. To find severity of Psychosis & substance use & to find correlation between them. Materials & Method: This cross-sectional study was carried out at, Psychiatry OPD, PDU Gov. Medical College & Hospital, Rajkot. Systematic randomization sampling method with fraction of 8 was used for case selection and total 200 patients were approached. BPRS, FTND & LDQ was used as instrument. Results &Discussion: We could find the comorbidity of substance use in 70.5% patients. The substance we found in our study was tobacco (68%), Alcohol (6%) & Cannabis (1%). There was statistically significant difference in prevalence of substance use co-morbidity with socio-demographic variables like gender, education, occupation& socioeconomic class. Conclusion: The Study suggests need for sensitization of psychiatrists to evaluate and treat co-morbid substance dependence in the patients with Psychosis. Keywords: Substance use, Dual Diagnosis, Psychosis.------------------------------------------------------------------------------------------------------------------Date of Submission: 12-06-2018 Date Of Acceptance: 27-06-2018
... Thus, most of the publications used the Premorbid Adjustment Scale (PAS), or a variation of it, to compare premorbid functioning between SSD+ vs. SSD- (Cannon-Spoor et al., 1982;Rabinowitz et al., 2007aRabinowitz et al., , 2007bVan Mastrigt et al., 2004). Fourteen of these used one version of the PAS; in 11 of these, the PAS was used as the only measure of premorbid adjustment (Arndt et al., 1992;Carr et al., 2009;Compton et al., 2011;Dixon et al., 1991;Frascarelli et al., 2016;Larsen et al., 2006;Ringen et al., 2008Ringen et al., , 2013Van Mastrigt et al., 2004;Wade et al., 2005;Weibell et al., 2019), although two of them completed their analysis with a measure of premorbid IQ (Leeson et al., 2012;Rodríguez-Sánchez et al., 2010), a third one added a measure of premorbid cognitive functioning (Sevy et al., 2001), and a fourth one included a measure of general premorbid functioning using the Global Functioning Scale (GAF) (Rabinowitz et al., 1998). Four works used IQ as the only premorbid measure (Benaiges et al., 2013;Coulston et al., 2007;DeRosse et al., 2010;Ferraro et al., 2013 Premorbid functioning assessed with the PAS (domains or age periods not specified; data not provided). ...
... In some cases, an overall score was obtained for each dimension, without considering the age group (Rodríguez-Sánchez et al., 2010;Weibell et al., 2019). In other cases, only one of the dimensions was analyzed (Leeson et al., 2012;Sevy et al., 2001), and in most of them results were obtained for only some developmental stages (Arndt et al., 1992;Compton et al., 2011;Dixon et al., 1991;Ringen et al., 2008Ringen et al., , 2013Leeson et al., 2012). Although this may be plausible for the adulthood period, according to the scale's own instructions, it is not recommended in those cases in which the disease appears before age 19. ...
... Only four works had as their main goal to study the premorbid functioning in relation to substance use (Arndt et al., 1992;Compton et al., 2011;Ferraro et al., 2013;Ringen et al., 2008). In contrast, in most of the remaining works, premorbid functioning was included as one more factor to assess along with other clinical variables such as onset age of psychosis, history of hospital admissions, duration of untreated psychosis, or level of psychotic symptomatology (Carr et al., 2009;Dixon et al., 1991;Larsen et al., 2006;Leeson et al., 2012;Salyers and Mueser, 2001;Sevy et al., 2001;Van Mastrigt et al., 2004). Other aims of the works reviewed were to study cognitive functioning in SSD+ and SSDsubjects at the moment of the assessment, and the relation with clinical aspects such as substance use, community functioning or predictive aspects of clinical course (Benaiges et al., 2013;Coulston et al., 2007;DeRosse et al., 2010;Frascarelli et al., 2016;Rabinowitz et al., 1998;Ringen et al., 2013;Rodríguez-Sánchez et al., 2010;Wade et al., 2005). ...
Premorbid functioning has been related with several clinical features and prognosis of schizophrenia spectrum disorders. Comorbidity with substance use is highly prevalent and usually hinders clinical improvement in this kind of psychiatric disorders. This systematic review analyzes the differences in the premorbid functioning of subjects with a schizophrenia spectrum disorder with substance use (SSD+, dual psychosis) or without it (SSD-). Systematic review (PRISMA guidelines), including search in electronic databases (MEDLINE, Web of Science, and Cochrane Library). 118 published works were considered of which only 20 met our inclusion criteria. Although there is a great variability in methodologies, diagnoses included, and substances used, studies using the Premorbid Functioning Scale to assess the academic and/or social domains found that SSD+ subjects had a poorer academic but better social premorbid functioning than those with SSD-. Current evidence is not conclusive, so additional studies are required to integrate intervening factors in order to clarify the clinical implications of premorbid functioning to improve the course and therapeutic response of patients.
... Studies have reported that between 15% and 50% of SZ patients use cocaine [16,22]. It has been reported that cocaine can reduce the negative symptoms of SZ and is often used to relieve depression [23]. ...
Personalized treatment is the focus of researchers and comes into prominence for both genetic sciences and neurotechnology. Recently, clinical practice tries to follow the idea and principles of personalized medicine. Besides predicting an individual’s sensibility or predisposition for developing schizophrenia, pharmacogenetic and pharmacogenomic approaches attempt to define and acknowledge important indicators of clinical response to antipsychotics namely their efficacy and adverse effects. Particularly in the treatment of schizophrenia, clinicians are very helpless in resistant cases, and clinical pharmacogenomics contributes in a revolutionary way. With both phenotyping, namely Therapeutic Drug Monitoring (TDM) and genotyping, “big expectations” emerged both with the right drug, the right dose, and the right time. Both pharmacokinetic genotyping, CYP400 enzyme activity, and pharmacodynamic genotyping could be measured. The chapter handles schizophrenia with neurobiological views and covers personalized treatment approaches from various perspectives. Personalized treatment in the diagnosis and treatment of schizophrenia is presented first. Following comorbid schizophrenia in addition to the use of various substances, psychopharmacology of schizophrenia and the mechanism of action of antipsychotic drugs are presented. Genetics and epigenetics in schizophrenia are studied in detail and in silico application and computational approaches covering the feature extraction process and destructive impact of the metaverse are shared lastly.
... Moreover, compared to controls, elevated trait negative affectivity was found to be stable in individuals with schizophrenia (SZ; and offspring and family members of SZ even after a 90-day follow-up assessment (Blanchard & Panzarella, 1998), and the trait was strongly related to self-reported substance use problems in SZ (Blanchard et al., 1999). Given that most frequently reported motives for substance use in SZ is to alleviate negative affects such as anxiety or tension (Dixon et al., 1990(Dixon et al., , 1991Krausz et al., 1996;Mueser et al., 1995), both high level of negative affectivity and negative urgency (which is a subdomain of negative affectivity and a strategic tendency to urgently subdue emotional pain or avoid emotional/social stimuli; Settles et al., 2012) would be closely related to SUD in psychiatric disorders in general (Hoptman & Ahmed, 2016;Hoptman et al., 2014). ...
Objective
Substance abuse comorbidity is highly prevalent and is linked to detrimental outcomes in individuals with psychotic disorder, but the role of personality traits as the underlying mechanism is being increasingly underscored. This study aimed to profile temperamental risks of comorbid substance use disorder in psychotic disorders by performing meta-analyses on personality trait differences between psychotic disorders with comorbidity (dual diagnosis; DD) and without it (psychotic disorders; PSD). Methods: A systematic review of English articles using PubMed, MEDLINE, Scopus, Google Scholar, and ProQuest Dissertation and Theses. Only original empirical studies including participants with diagnosis of psychotic disorders based on structured diagnostic interviews, with and without substance use disorder evaluated with reliable and valid tests were included. Articles were independently extracted by two authors using predefined data fields, including study quality indicators. All pooled analyses were based on random-effect models. Thirteen studies (N = 885) met our inclusion criteria. All effect-size estimates were calculated based on means and standard deviations of included measures. Separate effect size estimates were obtained for four traits in the UPPS model (negative urgency, low premeditation, low perseverance, sensation seeking), four traits in the HS model (unconscientious disinhibition, negative affect, disagreeable disinhibition, positive affect) and trait anhedonia. Results: Negative urgency (four studies with 262 participants; ES = 0.59; 95% confidence interval [CI] [0.34, 0.84]), low premeditation (five studies with 349 participants; ES = 0.60; 95% CI [0.39, 0.80]), sensation seeking (seven studies with 550 participants; ES = 0.63; 95% CI [0.17, 1.09]) and unconscientious disinhibition (five studies with 291 participants; ES = 0.36; 95% CI [0.13, 0.59]) were elevated in DD than PSD. Heterogeneity of sensation seeking was significant (I ² = 86.2%). Conclusions: The findings of the current meta-analysis highlight a unique profile of impulsive and externalizing trait personality domains pertaining to DD. The study emphasizes the importance of emotion regulation interventions targeting impulsivity or negative affect (i.e. negative urgency, low premeditation) in substance abuse comorbidity patients.
Objective: No evidence-based intervention effectively reduces cannabis use in young adults with psychosis (YAP). To generate hypotheses about why, a scoping review was conducted to synthesize evidence about motivations for cannabis use and reduction/cessation for YAP and the psychosocial interventions trialed to identify possible gaps between motivations and interventive strategies. Methods: A systematic literature search was conducted in December, 2022. Reviews of titles and abstracts (N = 3,216) and full-texts (n = 136) resulted in 46 articles. Results: YAP use cannabis for pleasure, to reduce dysphoria, and for social and recreational reasons; motivations for cessation include insight about cannabis-psychosis interactions, incompatibility with goals and social roles, and support from social networks. Interventions with at least minimal evidence of efficacy include motivational interviewing, cognitive-behavioral strategies, and family skills training. Conclusions: Authors recommend additional research on mechanisms of change and motivational enhancement therapy, behavioral activation, and family-based skills interventions matched to YAP motivations for use/cessation.
In bipolar disorder, manic or depressive episodes and mixed states are frequently marked by psychotic symptoms. Moreover, psychosis may occur after substance use disorder, often intervening with the effect of making the clinical picture indistinguishable from that of a primary psychosis. Cannabinoids, stimulants, hallucinogens, alcohol and poly-use most commonly develop psychosis induced by the non-medical use of substances. Among substance use disorder users, it has not yet been ascertained whether opioids exert a psychotic effect. Still, some authors have supported the view that opioids have antidepressant, antipanic and antipsychotic effects. It has also been hypothesized that affective disorders, coupled with genetic disposition rather than affective disturbance or psychosis, result in bipolar psychosis or schizoaffective disorder, respectively. In the history of chronic psychotics, heroin use is relatively infrequent. Chronic use of psychotogenic substances and autonomous chronicity of psychotic symptoms may root in a bipolar substrate. Substance use among people with schizophrenia cannot always be justified in terms of dysphoria. Still, the number of depressive symptoms can significantly influence the risk rate for alcohol, cannabinoid use or poly-use. Dual disorder psychotic heroin-addicted patients usually enter treatment with more severe psychopathological aspects and a shorter, less severe addiction history than their non-psychotic peers suggesting that these patients are likely to benefit from opioid medication. These data indirectly confirm the antipsychotic effects of opioids and Khantzian’s self-medication hypothesis. For further confirmation, patients affected by chronic psychosis and anxiety disorders tend to progress from a psychiatric disorder to a substance use disorder. In contrast, patients with mood disorders are initially affected by drug addiction. As far as dual disorder is concerned, it is advisable to employ agents that do not heavily affect dopamine metabolism in an inhibitory way since the worsening of use hampers the effectiveness upon psychotic symptoms. On the other hand, when the tie with substances is more robust, their use may amplify as a direct consequence of dopamine antagonism, as a compensatory mechanism effective throughout the reward pathway. Novel antipsychotics seem to permit equivalent effectiveness on psychotic symptoms without promoting drug use, at least to the same extent, and might have anticraving properties.KeywordsVulnerabilityNeurotransmitter pathwayChronic psychosisSchizoaffective disorderProneness to substance use disorderProneness to psychosisDopamine metabolismSelf-medication hypothesisNegative symptomsTherapeutic proposals
An updated third edition of this award-winning book provides a comprehensive overview of the complex associations between cannabis and mental illness. Organised into easy to navigate sections, the book has been fully revised to feature eight entirely new chapters covering important novel aspects. Marijuana and Madness incorporates new research findings on the potential use of cannabinoids, and synthetic cannabinoids, in an array of mental illnesses, balanced against the potential adverse effects. The associations between cannabis and psychosis, developing putative models of 'cannabis induced' psychosis and pathways to schizophrenia are all covered. The book importantly discusses the impact of exposure to cannabis at various stages of neurodevelopment (in utero, in childhood, and during adolescence) and it thoroughly reviews the treatments for cannabis dependence and health policy implications of the availability of increasingly high potency cannabis. This book will quickly become an essential resource for all members of the mental health team.
Schizophrenia is a chronic psychotic disorder characterized by the presence of psychotic symptoms (hallucinations, delusions), negative symptoms (decreased expressiveness), and cognitive symptoms (lack of executive function). The exact etiology of schizophrenia is unknown, although it is thought to be linked to increased dopaminergic activity in the mesolimbic neuronal pathway and decreased dopaminergic activity in the prefrontal cortical pathway. Treatment of schizophrenia includes both pharmacological and psychosocial intervention. Nonpharmacological treatments are effective in treating the negative and cognitive symptoms of schizophrenia and increasing patient adherence to medications. The first-generation “conventional” antipsychotic drugs are high-affinity antagonists of dopamine D2 receptors that are most effective against psychotic symptoms and atypical agents differ pharmacologically from previous antipsychotic agents in their lower affinity for dopamine D2 receptors Clozapine and risperidone both are atypical antipsychotics. Clozapine has weak D2 blocking action. It mainly acts by blocking 5-HT2, alpha-adrenergic, and D4 receptors. Risperidone acts by blocking 5-HT, alpha-adrenergic and D2 receptors. It is a more potent D2 blocker than clozapine and can cause extrapyramidal symptoms at a high dose. Aggravation of seizures more with olanzapine and fewer chances with risperidone. Clozapine is a high potential atypical antipsychotic to cause metabolic side effects, while risperidone is a low potential antipsychotic to cause metabolic side effects. Clozapine is used in the treatment of resistant schizophrenia and risperidone is the most potent atypical antipsychotic agent available in long-acting injectable form.
This book was originally published in 2004 and concerns developmental neurobiology. In the decade preceding publication, developmental neurobiology made important strides towards elucidating the pathophysiology of psychiatric disorders. Nowhere has this link between basic science and clinical insights become clearer than in the field of schizophrenia research. Each contributor to this volume provides a fresh overview of the relevant research, including directions for further investigation. The book begins with a section on advances in developmental neurobiology. This is followed by sections on etiological and pathophysiological developments, and models that integrate this knowledge. The final section addresses the clinical insights that emerge from the developmental models. This book will be valuable to researchers in psychiatry and neurobiology, students in psychology, and all mental health practitioners.
• One-month prevalence results were determined from 18571 persons interviewed in the first-wave community samples of all five sites that constituted the National Institute of Mental Health Epidemilogic Catchment Area Program. US population estimates, based on combined site data, were that 15.4% of the population 18 years of age and over fulfilled criteria for at least one alcohol, drug abuse, or other mental disorder during the period one month before interview. Higher prevalence rates of most mental disorders were found among younger people (<age 45 years), with the exception of severe cognitive impairments. Men had higher rates of substance abuse and antisocial personality, whereas women had higher rates of affective, anxiety, and somatization disorders. When restricted to the diagnostic categories covered in international studies based on the Present State Examination, results fell within the range reported for European and Australian studies.
† The Global Assessment Scale (GAS) is a rating scale for evaluating the overall functioning of a subject during a specified time period on a continuum from psychological or psychiatric sickness to health.In five studies encompassing the range of populations to which measures of overall severity of illness are likely to be applied, the GAS was found to have good reliability. GAS ratings were found to have greater sensitivity to change over time than did other ratings of overall severity or specific symptom dimensions. Former inpatients in the community with a GAS rating below 40 had a higher probability of readmission to the hospital than did patients with higher GAS scores.The relative simplicity, reliability, and validity of the GAS suggests that it would be useful in a wide variety of clinical and research settings.
• Hospital records of 72 drug abusers with psychoses (DAP) were analyzed to clarify the relationship between drug abuse and psychosis. Comparison groups included schizophrenics and atypical schizophrenics without drug abuse and drug abusers without psychoses (DA). Compared with DAP in whom psychoses lasted less than six months before admission (DAP-short), drug abusers with psychoses of a longer duration (DAP-long) had more symptoms, more premorbid personality disorders, and greater familial risks of schizophrenia and affective disorder. The DAP-long group resembled atypical schizophrenia for clinical features and family history, whereas the DAP-short group resembled DA for some clinical features and family history. The results indicate that there are several subgroups of DAP. The importance of clinical features and family history in identifying subgroups of DAP was stressed.
• Recently, a renaissance of interest in "negative symptoms," eg, affective flattening or impoverishment of speech and language, has occurred. Although some investigators believe that these symptoms are important indicators of outcome, of response to treatment, and perhaps of a distinct, underlying pathologic process, research on the negative-symptom syndrome in schizophrenia has been handicapped because no standard instrument existed to assess it. This investigation reports on the developed Scale for the Assessment of Negative Symptoms. When symptoms are defined by objective behavioral indices, they have excellent interrater reliability. Furthermore, the five symptom complexes defined by the scale (affective flattening, alogia, avolition, anhedonia, and attentional impairment) have good internal consistency, which indicates that the conceptual organization of the scale is also cohesive.
It is possible that some "postpsychotic depressions" may be a toxic effect of antipsychotic drugs. Out of a total of 94 schizophrenic patients, 28 developed a mild akinesia and 32 never developed extrapyramidal symptoms. Those who developed akinesia became less psychotic, but they also experienced a significant, although modest, increase in depression ratings. Successful treatment of the akinesia resulted in significant improvements in depression, somatic concern, anxiety, emotional withdrawal, blunted affect, and motor retardation on both physicians' and nurses' ratings. A high association between akinesia and both objectively rated and subjectively experienced sedative effect indicates that an 'akinetic depression' is not likely if the patient does not look or feel drowsy. The 32 nonakinetic patients also became less psychotic, but not more depressed.
The use of marijuana as the independent variable produced a serious exacerbation of a psychotic process in four schizophrenic patients whose illness was otherwise well controlled with antipsychotic medication. Each patient served as his own control--the sole substance abused was marijuana and antipsychotic medication intake remained constant. Each time marijuana use at moderate levels began, there was exacerbation and deterioration. The author suggests that marijuana use is a special hazard to schizophrenic patients and that physicians should alert such high-risk patients to the possible untoward interaction between their illness and marijuana.