Psychosocial Treatment of Patients With Schizophrenia and Substance Abuse Disorders

Department of Psychiatry, School of Medicine, Harbor-UCLA Medical Center and University of California at Los Angeles, Los Angeles, CA, USA.
Current Pharmaceutical Design (Impact Factor: 3.45). 02/2004; 10(18):2249-61. DOI: 10.1097/01.adt.0000186367.15415.0d
Source: PubMed


Approximately half of patients with schizophrenia have a lifetime diagnosis of substance abuse disorders. These dual diagnosis patients are more likely to have poorer outcomes, including more severe psychiatric symptoms with increased hospitalizations, higher utilization of services and frequent homelessness. Assessment and treatment of dually diagnosed patients has evolved over the last twenty years. To date, the strongest evidence for effective management of dual diagnosis patients has been utilization of integrated treatment services, which combines both mental health and substance abuse treatments concurrently. Strategies commonly used include a combination of pharmacological treatment, intensive case management, motivational interviewing, individual and group psychotherapy, and family participation. This chapter summarizes the treatment options available for this population.

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    • "Due to the limited resources available to the SACs, it is recommended that group CBT be offered, as it is clinically effective but significantly cheaper than individual CBT. Self-help groups not only provide strong social support to patients, but also structured daily living [19], which, in turn, can improve social functioning and vocational status. Similarly, structured behavioural and social-skills training are also promising avenues for the improvement of psychosocial functioning [20,21], employment [20] and concentration [22]. "

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    • "On average, people with alcohol or drug use have approximately 30% more physical diagnoses per case than non-substance users (Adrian and Barry, 2003). Regular and modest use of alcohol and drugs is associated with an increased potential for comorbidities such as human immunodeficiency virus (HIV) and Hepatitis B and C infections, as well as other infectious diseases (Drake and Wallach, 1993; Tsuang and Fong, 2004). Dickey et al (2002) reported that the odds ratios for having diabetes, heart disease, asthma, skin infections, cancer, respiratory disorders and gastrointestinal disorders were higher in patients with co-occurring mental illness and substance abuse compared to patients with severe mental illness and no substance abuse diagnosis. "
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    ABSTRACT: OBJECTIVE: Treatment of schizophrenia in patients with comorbid substance use (alcohol/illicit drug use, abuse or dependence) presents challenges for public health systems. Substance use in people with schizophrenia is up to four times greater than the general population and is associated with medication nonadherence and poor outcomes. Therefore, continuous antipsychotic treatment in this population may pose more of a challenge than for those with schizophrenia alone. Many clinical trials and treatment recommendations in schizophrenia do not take into consideration substance use as people with comorbid substance use have typically been excluded from most antipsychotic trials. Nonetheless, antipsychotic treatment appears to be as efficacious in this population, although treatment discontinuation remains high. The objective of this review was to highlight the importance and utility of considering long-acting injectable antipsychotics for patients with schizophrenia and comorbid substance use. METHODS: We did a literature search using PubMed with key words schizophrenia and substance use/abuse/dependence, nonadherence, antipsychotics, long acting injectables, relapse, and psychosocial interventions. We limited our search to human studies published in English and 4,971 articles were identified. We focused on clinical trials, case reports, case series, reviews and meta-analyses resulting in 125 articles from 1975-2011. RESULTS: Our review suggests the potential role of long-acting injectables for people with comorbid substance use and schizophrenia in leading to improvements in psychopathology, relapse prevention, fewer rehospitalizations, and better outcomes. CONCLUSIONS: While more research is needed, long-acting antipsychotics should be considered an important option in the management of people with schizophrenia and comorbid substance use.
    Full-text · Article · Jul 2012 · Journal of Dual Diagnosis
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    • "The percentage of smokers was quite high in our patient population (57.5%), but this was expected, as it is well known that psychiatric patients are more vulnerable to nicotine-dependence and rates of smoking are about two- to fourfold higher in patients with psychiatric disorders [14-16]. Conversely, the percentage of drug abusers was quite low, even though it has been reported that the prevalence of comorbidity of psychosis and substance abuse has been rising during the last 10–20 years and substance use disorders are overrepresented in subjects with schizophrenia and bipolar and bipolar spectrum disorders [17-19]. Consistent with literature reports [20-22], the prevalence of smokers, drug or alcohol abusers in males was statistically higher than in females. "
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    ABSTRACT: The PERSEO study (psychiatric emergency study and epidemiology) is a naturalistic, observational clinical survey in Italian acute hospital psychiatric units, called SPDCs (Servizio Psichiatrico Diagnosi e Cura; in English, the psychiatric service for diagnosis and management). The aims of this paper are: (i) to describe the epidemiological and clinical characteristics of patients, including sociodemographic features, risk factors, life habits and psychiatric diagnoses; and (ii) to assess the clinical management, subjective wellbeing and attitudes toward medications. A total of 62 SPDCs distributed throughout Italy participated in the study and 2521 patients were enrolled over the 5-month study period. Almost half of patients (46%) showed an aggressive behaviour at admission to ward, but they engaged more commonly in verbal aggression (38%), than in aggression toward other people (20%). A total of 78% of patients had a psychiatric diagnosis at admission, most frequently schizophrenia (36%), followed by depression (16%) and personality disorders (14%), and no relevant changes in the diagnoses pattern were observed during hospital stay. Benzodiazepines were the most commonly prescribed drugs, regardless of diagnosis, at all time points. Overall, up to 83% of patients were treated with neuroleptic drugs and up to 27% received more than one neuroleptic either during hospital stay or at discharge. Atypical and conventional antipsychotics were equally prescribed for schizophrenia (59 vs 65% during stay and 59 vs 60% at discharge), while atypical drugs were preferred in schizoaffective psychoses (72 vs 49% during stay and 70 vs 46% at discharge) and depression (41 vs 32% during stay and 44 vs 25% at discharge). Atypical neuroleptics were slightly preferred to conventional ones at hospital discharge (52 vs 44%). Polypharmacy was in general widely used. Patient attitudes toward medications were on average positive and self-reported compliance increased during hospital stay. Results confirm the widespread use of antipsychotics and the increasing trend in atypical drugs prescription, in both psychiatric in- and outpatients.
    Full-text · Article · Feb 2007 · Annals of General Psychiatry
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