Substance Abuse and Onset of Psychotic Illness

Kovasznay, Beatrice; Bromet, Evelyn J.; Schwartz, Joseph; Ram, Ranganathan; Lavelle, Janet; Brandon, Lisa

doi:10.1176/ps.44.6.567

Cited by 23 publications

(31 citation statements)

References 17 publications

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“…In comparison with non-abusing schizophrenic patients, dual-diagnosis patients have been found to be more depressed, more thought-disordered, and to have more positive and negative symptoms [39,40]. …”

Section: Discussionmentioning

confidence: 99%

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Volonteri

Gaspari

et al. 2006

Clin Pract Epidemiol Ment Health

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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.

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Section: Discussionmentioning

confidence: 99%

Untitled

Volonteri

Gaspari

et al. 2006

Clin Pract Epidemiol Ment Health

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“…Several explanations for this finding are possible. Epidemiologic findings show that the role of substance abuse in schizophrenia is complex (18)(19)(20)(21)(22)(23)(24). Substance abuse may exacerbate psychotic and affective symptoms in schizophrenics, leading to frequent crises (20,(25)(26)(27).…”

Section: Discussionmentioning

confidence: 99%

A Study on Recidivism in the Psychiatric Emergency Room

Dhossche¹,

Ghani²

1998

Ann. of Clinical Psychiatry

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Our goal in this retrospective study was to assess empirical risk factors for repeat visits to the psychiatric emergency room. This information may be useful for targeted prevention and cost-effective service planning. Over a 7-month period, 400 (18%) of 2212 patients were repeat visitors, accounting for 36% of all visits. A diagnosis of a psychotic disorder at the first visit was a risk factor for a repeat visit, especially in young patients. Substance abuse, as suggested by positive urine toxicology, decreased the likelihood of recidivism, but positive toxicology screens in young schizophrenic patients increased the chances of a repeat visit. In a 1-month consecutive sample of 311 patients, unemployment and homelessness were stronger correlates than a clinical diagnosis of schizophrenia. These findings support previous evidence that psychiatric emergency services are often used by underprivileged patients. We suggest that a rational preventive approach to reduce recidivism in psychiatric emergency services may include substance abuse treatment and case management for young schizophrenics and community outreach projects for socially disadvantaged patients. Compliance of recidivist patients poses a difficult task for case managers and community psychiatrists. More studies are needed to assess the efficacy of these interventions.

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“…Furthermore, substance use disorders in adolescents are associated with both poor outcome and treatment nonadherence (DelBello et al 2007). Although the onset of substance use disorders precedes the onset of bipolar disorder in a majority of bipolar adults (Kovasznay et al 1993; Winokur et al 1995; Feinman and Dunner 1996; Strakowski et al 1996; Strakowski et al 1998; DelBello et al 1999), relatively few adolescents with bipolar disorder have substance use disorders when first diagnosed (Wilens et al 1999; Wilens et al 2004; DelBello et al 2007). Rates of co-occurring substance use disorders increase, however, to approximately 40% following the onset of bipolar disorder in adolescents, thus providing a “window of opportunity” for early intervention and the implementation of prevention strategies.…”

Section: Introductionmentioning

confidence: 99%

Neuroanatomic Comparison of Bipolar Adolescents With and Without Cannabis Use Disorders

Jarvis

DelBello

Mills

et al. 2008

Journal of Child and Adolescent Psychopharmacology

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Objective Co-occurrence of substance use and bipolar disorders is both common and associated with poor treatment response and greater functional impairment than either disorder alone. The neurophysiological correlates of this co-morbidity however, remain unclear. In this pilot study, we compared brain morphometry between bipolar adolescents with co-occurring cannabis use disorders (CUD) and bipolar adolescents without any substance use disorder. Methods Whole-brain structural magnetic resonance imaging (MRI) scans were obtained from 14 bipolar adolescents. Seven study participants were diagnosed with CUD before and/or shortly after their MR scan was obtained, and 7 subjects were free of any substance use disorder at the time of their MR scan as well as during longitudinal follow up. Morphologic differences were calculated using voxel-based morphometry implemented using statistical parametric mapping software (SPM2). Results Bipolar adolescents with co-occurring CUD demonstrated decreased gray matter volume (GMV) in the left fusiform gyrus and increased GMV in the right caudate and precentral gyrus, as well as increased gray matter density in the right middle occipital and fusiform gyri and cerebellar vermis. Conclusions Bipolar adolescents with CUD demonstrate evidence of greater structural abnormalities than adolescents with bipolar disorder alone in frontal and temporal cortical regions, as well as in subcortical areas linked with emotion and motivational regulation. Although the limited prescan exposure to marijuana in these adolescents tentatively suggests that these findings may reflect underlying differences, the direct effect of cannabis exposure may also be involved.

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Substance Abuse and Onset of Psychotic Illness

Cited by 23 publications

References 17 publications

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A Study on Recidivism in the Psychiatric Emergency Room

Neuroanatomic Comparison of Bipolar Adolescents With and Without Cannabis Use Disorders

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