Drug abuse in schizophrenic patients: clinical correlates and reasons for use.
01 Feb 1991-American Journal of Psychiatry (American Psychiatric Association)-Vol. 148, Iss: 2, pp 224-230
TL;DR: 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.
Abstract: Objective: This study aimed to 1) determine substance abuse prevalence and preference in a diverse sample ofschizophrenic, schizoaffective, and schizophreniform inpatients, 2) cornpare 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. Method: 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 schizophreniforrn 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. Results: Forty (48%) of the patients received diagnoses of drug or alcohol abuse or dependence. The drug-abusing patients primanly used cannabis (N=26), alcohol (N=2 1), and cocaine (N= I 4) 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 ofdrug abuse than the non-d rugabusing patients. Conclusions: 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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The Catholic University of America1, Albert Einstein College of Medicine2, University of Oviedo3, Favaloro University4, University of Groningen5, Ludwig Maximilian University of Munich6, Mental Health Foundation7, Washington University in St. Louis8, Nnamdi Azikiwe University9, Technische Universität München10
TL;DR: Prevalence rates of different physical illnesses as well as important individual lifestyle choices, side effects of psychotropic treatment and disparities in health care access, utilization and provision that contribute to these poor physical health outcomes are reported.
1,895 citations
Cites background from "Drug abuse in schizophrenic patient..."
...knowledge about HIV-related issues contribute to this high HIV prevalence (364,371-376)....
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TL;DR: Cannabis abuse and particularly heavy abuse can be considered a stressor eliciting relapse in patients with schizophrenia and related disorders and possibly a premorbid precipitant.
Abstract: Objective: We sought to examine the relation between cannabis abuse and the symptomatic course of recent-onset schizophrenia and related disorders. Design: A prospective cohort study over a year using monthly Brief Psychiatric Rating Scale assessments. Participants: Cannabis-abusing patients (n=24) were compared with nonabusers (n=69). Eleven patients were mild and 13 were heavy cannabis-abusing patients. Results: Significantly more and earlier psychotic relapses occurred in the cannabis-abusing group (P=.03). This association became stronger when mild and heavy cannabis abuse were distinguished (P=.002). No confounding effect of other variables, eg, other street drugs, was found. In all but one patient, cannabis abuse preceded the onset of the first psychotic symptoms for at least 1 year. Conclusions: Cannabis abuse and particularly heavy abuse can be considered a stressor eliciting relapse in patients with schizophrenia and related disorders and possibly a premorbid precipitant.
633 citations
TL;DR: Evidence suggests that antisocial personality disorder accounts for some increased comorbidity, and there is minimal support for the self-medication model, but the accumulation of multiple risk factors related to mental illness, including dysphoria, may increase the risk of substance use disorder.
625 citations
TL;DR: The lifespan of people with schizophrenia is shortened compared to the general population, and the literature on comorbid physical diseases in schizophrenia to provide a basis for initiatives to fight this unacceptable situation.
Abstract: Objective: The lifespan of people with schizophrenia is shortened compared to the general population. We reviewed the literature on comorbid physical diseases in schizophrenia to provide a basis for initiatives to fight this unacceptable situation.
Method: We searched MEDLINE (1966 – May 2006) combining the MeSH term of schizophrenia with the 23 MeSH terms of general physical disease categories to identify relevant epidemiological studies.
Results: A total of 44 202 abstracts were screened. People with schizophrenia have higher prevalences of HIV infection and hepatitis, osteoporosis, altered pain sensitivity, sexual dysfunction, obstetric complications, cardiovascular diseases, overweight, diabetes, dental problems, and polydipsia than the general population. Rheumatoid arthritis and cancer may occur less frequently than in the general population. Eighty-six per cent of the studies came from industrialized countries limiting the generalizability of the findings.
Conclusion: The increased frequency of physical diseases in schizophrenia might be on account of factors related to schizophrenia and its treatment, but undoubtedly also results from the unsatisfactory organization of health services, from the attitudes of medical doctors, and the social stigma ascribed to the schizophrenic patients.
591 citations
Cites background from "Drug abuse in schizophrenic patient..."
...One is the high frequency of substance abuse in these populations (41, 42)....
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TL;DR: Delta-9-tetrahydrocannabinol is associated with transient exacerbation in core psychotic and cognitive deficits in schizophrenia, and this data do not provide a reason to explain why schizophrenia patients use or misuse cannabis.
566 citations
References
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TL;DR: The Brief Psychiatric Rating Scale (BRS) as mentioned in this paper was developed to provide a rapid assessment technique particularly suited to the evaluation of patient change, and it is recommended for use where efficiency, speed, and economy are important considerations.
Abstract: The Brief Psychiatric Rating Scale was developed to provide a rapid assessment technique particularly suited to the evaluation of patient change. Sixteen symptom constructs which have resulted from factor analyses of several larger sets of items, principally Lorr's Multidimensional Scale for Rating Psychiatric Patients (MSRPP) (1953) and Inpatient Multidimensional Psychiatric Scale (IMPS) (1960), have been included for rating on 7-point ordered category rating scales. The attempt has been to include a single scale to record degree of symptomacology in each of the relatively independent symptom areas which have been identified. Some of the preliminary work which has led to the identification of primary symptom constructs has been published (Gorham & Overall, 1960, 1961, Overall, Gorharn, & Shawver, 1961). While other reports are in preparation, applications of the Brief Scale in both pure and applied research suggest the importance of presenting the basic instrument to the wider scientific audience at this time, together with recommendations for its standard use. The primary purpose in developing the Brief Scale has been the development of a highly efficient, rapid evaluation procedure for use in assessing treatment change in psychiatric patients while at the same time yielding a rather comprehensive description of major symptom characteristics. It is recommended for use where efficiency, speed, and economy are important considerations, while more detailed evaluation procedures, such as those developed by Lorr (1953, 1961) should perhaps be wed in other cases. In order to achieve the maximum effectiveness in use of the Brief Scale, a standard interview procedure and more detailed description of rating concepts are included in this report. In addition, each symptom concept is defined briefly in the rating scale statements themselves. Raters using the scale should become thoroughly familiar with the scale definitions presented herein, after which the rating scale statements should be sufficient to provide recall of the nature and delineation of each symptom area. , To increase the reliability of ratings, it is recommended that patients be interviewed jointly by a team of two clinicians, with the two raters making independent ratings at the completion of the interview. An alternative procedure which has been recommended by some is to have raters discuss and arrive at a
10,457 citations
TL;DR: The relative simplicity, reliability, and validity of the GAS suggests that it would be useful in a wide variety of clinical and research settings.
Abstract: † 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.
4,799 citations
TL;DR: The developed Scale for the Assessment of Negative Symptoms has excellent interrater reliability and the five symptom complexes defined by the scale have good internal consistency, which indicates that the conceptual organization of the scale is also cohesive.
Abstract: • 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.
2,136 citations
TL;DR: 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 as mentioned in this paper.
Abstract: • 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 (
1,663 citations
TL;DR: The Premorbid Adjustment Scale has been found to be useful in identifying patients likely to become chronically hospitalized or at high risk for readmission, and may also serve as a possible predictor of patients with brain abnormalities on a computerized tomography scan.
Abstract: The Premorbid Adjustment Scale (PAS) is a rating scale which was developed to be applicable in a research setting. It is designed to evaluate the degree of achievement of developmental goals at each of several periods of a subject's life before the onset of schizophrenia. A description of the scale and its use is presented, along with a discussion of psychometric properties. The PAS has been found to be useful in identifying patients likely to become chronically hospitalized or at high risk for readmission. It may also serve as a possible predictor of patients with brain abnormalities on a computerized tomography (CT) scan.
1,139 citations