Symptoms and lifetime treatment experiences in psychotic patients with and without substance abuse

Abstract

The main objective of this study was to compare symptom load and lifetime treatment experiences between psychotic patients with substance abuse problems and psychotic patients without substance abuse problems. This is a cross-sectional study of 48 patients (26 inpatients and 22 outpatients) in a clinic for early intervention in psychosis. Patients' were grouped into two categories based on whether they had a substance abuse problem or not. Twenty-one (43.8%) had a substance abuse problem and 27 (56.2%) had not. We used the Positive and Negative Symptom Scale (PANSS) scale to measure symptoms and several scales to measure substance abuse. Parametric tests (independent t-tests) were used to compare continuous variables, and chi-square tests were used to compare frequencies. Positive symptoms, negative symptoms, general psychopathology symptoms and the total score of psychotic symptoms did not differ significantly between the groups with psychosis alone and psychosis with substance abuse. The delusion subscore was significantly higher in the group with psychosis alone (t = -2.3, df = 41, P < 0.05), and the anxiety subscore was significantly higher in the group with psychosis with substance abuse (t = -2.3, df = 41, P < 0.05). There were no significant differences in the subscores for negative symptoms. The absence of differences in psychotic symptoms between the two groups with psychosis does not imply a strong relationship between psychotic symptoms and substance abuse. These results do not support the self-medication hypothesis. The higher rates of institutionalization among substance abusers may be explained by mechanisms other than exacerbations of psychotic symptoms, as there are few differences in symptoms among abusers and non-abusers.

Impact of Substance Use Disorder on Presentation of Schizophrenia

“…Although some studies showed no significant difference between schizophrenia patients with substance use and non-use [53], most studies have found that comorbid substance use disorder in schizophrenia is associated with lower and less severe negative symptoms [23,24,46,54]. However, significantly increased severity of depression [52,55] manic [52] and anxiety [53] scores were also found in this sub set of patients. Women were found to have greater depression than men [35].…”

“…There is fair bit of heterogeneity in the findings on positive symptoms. While several studies show a significantly increased severity of positive symptoms [23,24,26,31,46,52] in schizophrenia patients with substance use disorder, some studies have found that these patients have significantly lower positive symptoms [53] and some have shown a lack of significant difference between schizophrenia patients with substance use and non-use [27,54]. This heterogeneity may be explained by variations in the onset of substance use and psychotic episode.…”

Drugs of abuse among acute psychiatric and medical admissions: laboratory based identification of prevalence and drug influence

“…In summary, these studies find that current substance use disorders are highly prevalent (commonly 40 -50%) and have adverse clinical implications, such as poorer outcome, higher rates of admission and shorter length of hospital stay (73,77,79). There are, however, many methodological differences between these studies, with regard to study population, sample size and definition and measurement of substance use disorders (Table A1).…”

Treatment and recovery as perceived by patients with substance addiction

“…2002). Furthermore, a substantial number of patients in general psychiatric health care have substance addiction in addition to other psychiatric diagnoses (Möller & Linaker 2004). Because the majority of these patients share problems, and thus several similar treatment needs, it is possible that perceptions of treatment and recovery among inpatients in psychiatric health care and substance addiction treatment have resemblances.…”