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Abstract

Several studies suggest a high comorbidity of substance abuse and schizophrenia, associated with higher frequency of relapse, more positive symptoms and depression, cognitive impairment, poorer outcome and treatment response. A high incidence of substance abuse is also observed in first-episode patients. Among patients with substance abuse, the onset precedes the onset of psychosis of several years in most cases.All the patients with a first episode of schizophrenia, at first admission to the Psychiatric Service of Diagnosis and Treatment of Ospedale Maggiore of Milan during the years 1990 to 2004, have been included in our study.The clinical evaluation has been obtained considering the following items of Brief Psychiatric Rating Scale (BPRS): conceptual disorganization, depressed mood, hostility, hallucinations, unusual content of thought.The results showed that 34.7% of first-episode schizophrenic patients had a lifetime history of substance abuse. The age of onset of schizophrenia is significantly lower for drug abusers than for patients without any type of abuse and for alcohol abusers (p < 0.005). In multi drug abusers, cannabis resulted the most frequently used (49%), followed by alcohol (13%), and cocaine (4%). Substance abusers have obtained a significant higher score in "thought disturbance" item (p < 0.005) and in "hostility" item (p < 0.005) compared to non substance abusers. Non drug abusers showed lower mean scores of "hostility" item compared to cocaine abusers and multi drug abusers (p < 0.005).Our findings seem to indicate that substance abuse in the early course of illness determines an earlier onset of schizophrenia and increases severity of some psychotic symptoms like "hallucination" and "unusual content of thought". Therefore persons incurring a risk of schizophrenia may be warned of the possible relation between substances and psychosis and have to be counselled against the use of them.

A retrospective analysis of cannabis use in a cohort of mentally ill patients in Sri Lanka and its implications on policy development

“…Regarding cannabis use, many of the published studies are from industrialized nations. Still it is observed that the number of female cannabis users is less compared to male users (many studies report percentages between 16% - 22% for females in their samples)[6,32,36,37]. Arendt et al[6] who followed up 535 patients treated for first episode psychosis report that male sex and younger age to be risk factors in developing subsequent SSD.…”

“…It is interesting to note that among females also, the cannabis users were more likely to be diagnosed with SSD than non using females. Mauri et al[37] who assessed the history of substance abuse in first episode schizophrenia patients, report that 80% of the sample had life time cannabis use. The number of male substance abusing schizophrenic patients was significantly more than the number of female patients.…”

Comorbid substance use disorders in schizophrenia: A latent class approach

“…Patients with schizophrenia and comorbid substance use disorders were less likely to adhere to treatment and more likely to have adverse disease outcomes (McLean et al, 2012; Murthy and Chand, 2012). But even during the first episode of schizophrenia, substance users had more severe psychotic symptoms and an earlier age of onset compared to non-users (Mauri et al, 2006; Picci et al, 2013; Schimmelmann et al, 2012). In patients with a dual diagnosis, high rates of substance use disorders were found in first- and second-degree relatives of the patients, suggesting that genetic risk factors for substance use disorders and an adverse family environment could have contributed to the onset and severity of substance use disorders in patients with a dual diagnosis (Comtois et al, 2005; Wilson et al, 2013).…”

Brain Metabolism in Substance-Induced Psychosis and Schizophrenia: A Preliminary PET Study

“…Cannabis seems to be the most illicit drug abused in schizophrenic patients and its role as a relevant risk factor for developing schizophrenia has been deeply discussed [2]. Furthermore, a negative outcome has been associated with persisting comorbid substance use: more frequent and longer periods of hospitalization, higher relapse rates even in first-episode patients, aggressiveness, unemployment, elevated EPS rates, and lower medication compliance have been observed [3]. …”