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Introduction. Although several papers reported a wide range of negative outcomes among patients with both schizophrenia and SUD, only a few studies evaluated the impact of SUD on psychopathology and thus on the length of first-hospitalization. Objectives.To compare clinical expression of first-episode of schizophrenia between inpatients with and without SUD, giving close attention to the length of stay.Methods. 130 inpatients at first-episode of schizophrenia were assigned to SUD or not SUD group depending on SUD diagnosis and were assessed through BPRS at admission, during hospitalization and at discharge. Cross-sectional and longitudinal statistical analysis were performed to investigate differences between groups and also a linear regression was used to evaluate relationship between length of stay and BPRS scores.Results. During the hospitalization there was a more marked improvement of BPRS total score in patients without SUD with a lower length of hospitalization (P<0.001). BPRS score during hospitalization was predictor of higher length of stay.Discussion. The higher severity of psychopathology during the hospitalization suggest possible overlaps of substance induced and withdrawal symptoms. Conversely, higher levels of conceptual disorganization during the whole period of hospitalization also support a more severe and pharmacho-resistant expression of schizophrenia among SUD patients.

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