open access

Vol 18, No 3 (2021)
Research paper
Published online: 2021-07-13
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Schizophrenia and substance use disorder: a retrospective study of a dual diagnosis patients cohort

Fabiana Ventura1, Mariana Jesus1, César Mendes1, Carla Silva1
DOI: 10.5603/PSYCH.2021.0021
·
Psychiatria 2021;18(3):182-189.
Affiliations
  1. Centro Hospitalar Coimbra, Coimbra, Portugal

open access

Vol 18, No 3 (2021)
Prace oryginalne - nadesłane
Published online: 2021-07-13

Abstract

Introduction: Approximately 47% of patients with Schizophrenia have criteria for a dual diagnosis. The consumption
of illicit substances, particularly cannabis, is quite prevalent in these patients, being associated with an
increase in mortality and morbidity and worse social outcomes. This study aims to understand the relationship
between Schizophrenia and substance use disorders (SUD).

Material and methods: A retrospective study was designed, including patients diagnosed with schizophrenia
admitted to the Psychiatric Ward between January 2017 and June 2019.

Results: 205 patients were included, 49 women (23.9%) and 156 men (76.1%). Of these, 29.1% consumed
psychoactive substances at the first hospitalization, mainly cannabis (24.1%), with higher prevalence in men.
The average age at the first admission was significantly lower for substance users than for non-users. The presence
of consumption in the first hospitalization, the number of hospitalizations and treatment adherence were associated
with the maintenance of consumption after the first hospitalization. The presence of consumption at the
first hospitalization is a significant predictor of its maintenance. Patients who do not adhere to treatment were
more likely to maintain consumption. The number of future hospitalizations was associated with early age at the
first hospitalization, non-compliance to treatment and maintenance of consumption after the first hospitalization.

Conclusions: We verify that the consumption of psychoactive substances is associated with the early age at the
first hospitalization, whit the reduced compliance to treatment and the increased number of hospitalizations.
Comorbid substance use disorders should be treated as early as possible to minimize the long-term effects of
substance use on patients with schizophrenia in Dual Diagnosis programs.

Abstract

Introduction: Approximately 47% of patients with Schizophrenia have criteria for a dual diagnosis. The consumption
of illicit substances, particularly cannabis, is quite prevalent in these patients, being associated with an
increase in mortality and morbidity and worse social outcomes. This study aims to understand the relationship
between Schizophrenia and substance use disorders (SUD).

Material and methods: A retrospective study was designed, including patients diagnosed with schizophrenia
admitted to the Psychiatric Ward between January 2017 and June 2019.

Results: 205 patients were included, 49 women (23.9%) and 156 men (76.1%). Of these, 29.1% consumed
psychoactive substances at the first hospitalization, mainly cannabis (24.1%), with higher prevalence in men.
The average age at the first admission was significantly lower for substance users than for non-users. The presence
of consumption in the first hospitalization, the number of hospitalizations and treatment adherence were associated
with the maintenance of consumption after the first hospitalization. The presence of consumption at the
first hospitalization is a significant predictor of its maintenance. Patients who do not adhere to treatment were
more likely to maintain consumption. The number of future hospitalizations was associated with early age at the
first hospitalization, non-compliance to treatment and maintenance of consumption after the first hospitalization.

Conclusions: We verify that the consumption of psychoactive substances is associated with the early age at the
first hospitalization, whit the reduced compliance to treatment and the increased number of hospitalizations.
Comorbid substance use disorders should be treated as early as possible to minimize the long-term effects of
substance use on patients with schizophrenia in Dual Diagnosis programs.

Get Citation

Keywords

schizophrenia, dual diagnosis, substance use disorder, cannabis

About this article
Title

Schizophrenia and substance use disorder: a retrospective study of a dual diagnosis patients cohort

Journal

Psychiatria (Psychiatry)

Issue

Vol 18, No 3 (2021)

Article type

Research paper

Pages

182-189

Published online

2021-07-13

DOI

10.5603/PSYCH.2021.0021

Bibliographic record

Psychiatria 2021;18(3):182-189.

Keywords

schizophrenia
dual diagnosis
substance use disorder
cannabis

Authors

Fabiana Ventura
Mariana Jesus
César Mendes
Carla Silva

References (37)
  1. United Nations Office on Drugs and Crime. World Drug Report. United Nations publication 2020.
  2. Regier DA, Farmer ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA. 1990; 264(19): 2511–2518.
  3. Hunt GE, Large MM, Cleary M, et al. Prevalence of comorbid substance use in schizophrenia spectrum disorders in community and clinical settings, 1990-2017: Systematic review and meta-analysis. Drug Alcohol Depend. 2018; 191: 234–258.
  4. Abdel-Baki A, Ouellet-Plamondon C, Salvat É, et al. Symptomatic and functional outcomes of substance use disorder persistence 2 years after admission to a first-episode psychosis program. Psychiatry Res. 2017; 247: 113–119.
  5. Green AI, Khokhar JY. Addiction and schizophrenia: A translational perspective. Schizophr Res. 2018; 194: 1–3.
  6. Benaiges I, Prat G, Adan A. Health-related quality of life in patients with dual diagnosis: clinical correlates. Health Qual Life Outcomes. 2012; 10: 106.
  7. Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências: Direção de Serviços de Monitorização e Informação / Divisão de Estatística e Investigação. Relatório Anual 2018. A situação do país em matéria de drogas e toxicodependências. SICAD 2019.
  8. Toxicodependências. Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências 2019.
  9. Khokhar JY, Dwiel LL, Henricks AM, et al. The link between schizophrenia and substance use disorder: A unifying hypothesis. Schizophr Res. 2018; 194: 78–85.
  10. Myles H, Myles N, Large M. Cannabis use in first episode psychosis: Meta-analysis of prevalence, and the time course of initiation and continued use. Aust N Z J Psychiatry. 2016; 50(3): 208–219.
  11. Associação Portuguesa de Patologia Dual. Doença psiquiátrica e adicção. Chiado editora, Lisboa 2016.
  12. Hjorthøj C, Larsen MO, Starzer MS, et al. Annual incidence of cannabis-induced psychosis, other substance-induced psychoses and dually diagnosed schizophrenia and cannabis use disorder in Denmark from 1994 to 2016. Psychol Med. 2021; 51(4): 617–622.
  13. Areal LB, Herlinger AL, Pelição FS, et al. Crack cocaine inhalation induces schizophrenia-like symptoms and molecular alterations in mice prefrontal cortex. J Psychiatr Res. 2017; 91: 57–63.
  14. Vaucher J, Keating BJ, Lasserre AM, et al. Cannabis use and risk of schizophrenia: a Mendelian randomization study. Mol Psychiatry. 2018; 23(5): 1287–1292.
  15. Marconi A, Di Forti M, Lewis CM, et al. Meta-analysis of the association between the level of cannabis use and risk of psychosis. Schizophr Bull. 2016; 42(5): 1262–1269.
  16. Belbasis L, Köhler CA, Stefanis N, et al. Risk factors and peripheral biomarkers for schizophrenia spectrum disorders: an umbrella review of meta-analyses. Acta Psychiatr Scand. 2018; 137(2): 88–97.
  17. Foti DJ, Kotov R, Guey LT, et al. Cannabis use and the course of schizophrenia: 10-year follow-up after first hospitalization. Am J Psychiatry. 2010; 167(8): 987–993.
  18. Ortiz-Medina MB, Perea M, Torales J, et al. Cannabis consumption and psychosis or schizophrenia development. Int J Soc Psychiatry. 2018; 64(7): 690–704.
  19. Barnes TRE, Mutsatsa SH, Hutton SB, et al. Comorbid substance use and age at onset of schizophrenia. Br J Psychiatry. 2006; 188: 237–242.
  20. Lowe DJE, Sasiadek JD, Coles AS, et al. Cannabis and mental illness: a review. Eur Arch Psychiatry Clin Neurosci. 2019; 269(1): 107–120.
  21. Volkow ND, Michaelides M, Baler R. The neuroscience of drug reward and addiction. Physiol Rev. 2019; 99(4): 2115–2140.
  22. Wise RA, Koob GF. The development and maintenance of drug addiction. Neuropsychopharmacology. 2014; 39(2): 254–262.
  23. Thoma P, Daum I. Comorbid substance use disorder in schizophrenia: a selective overview of neurobiological and cognitive underpinnings. Psychiatry Clin Neurosci. 2013; 67(6): 367–383.
  24. Petersen SM, Toftdahl NG, Nordentoft M, et al. Schizophrenia is associated with increased risk of subsequent substance abuse diagnosis: A nation-wide population-based register study. Addiction. 2019; 114(12): 2217–2226.
  25. Adan A, Arredondo AY, Capella MD, et al. Neurobiological underpinnings and modulating factors in schizophrenia spectrum disorders with a comorbid substance use disorder: A systematic review. Neurosci Biobehav Rev. 2017; 75: 361–377.
  26. Li R, Ma X, Wang G, et al. Why sex differences in schizophrenia? J Transl Neurosci (Beijing). 2016; 1(1): 37–42.
  27. Phan SV. Medication adherence in patients with schizophrenia. Int J Psychiatry Med. 2016; 51(2): 211–219.
  28. García S, Martínez-Cengotitabengoa M, López-Zurbano S, et al. Adherence to antipsychotic medication in bipolar disorder and schizophrenic patients: A systematic review. J Clin Psychopharmacol. 2016; 36(4): 355–371.
  29. Hunt GE, Bergen J, Bashir M. Medication compliance and comorbid substance abuse in schizophrenia: impact on community survival 4 years after a relapse. Schizophr Res. 2002; 54(3): 253–264.
  30. Drake RE, Essock SM, Shaner A, et al. Implementing dual diagnosis services for clients with severe mental illness. Psychiatr Serv. 2001; 52(4): 469–476.
  31. Marquez-Arrico JE, Río-Martínez L, Navarro JF, et al. Coping strategies in male patients under treatment for substance use disorders and/or severe mental illness: influence in clinical course at one-year follow-up. J Clin Med. 2019; 8(11).
  32. Correll CU, Citrome L, Haddad PM, et al. The use of long-acting injectable antipsychotics in schizophrenia: evaluating the evidence. J Clin Psychiatry. 2016; 77(suppl 3): 1–24.
  33. Kane JM, Correll CU. Optimizing treatment choices to improve adherence and outcomes in schizophrenia. J Clin Psychiatry. 2019; 80(5).
  34. Archibald L, Brunette MF, Wallin DJ, et al. Alcohol use disorder and schizophrenia or schizoaffective disorder. Alcohol Res. 2019; 40(1).
  35. Hartz SM, Pato CN, Medeiros H, et al. Genomic Psychiatry Cohort Consortium. Comorbidity of severe psychotic disorders with measures of substance use. JAMA Psychiatry. 2014; 71(3): 248–254.
  36. Sagud M, Mihaljevic Peles A, Pivac N. Smoking in schizophrenia: recent findings about an old problem. Curr Opin Psychiatry. 2019; 32(5): 402–408.
  37. Caponnetto P, Polosa R, Caponnetto P, et al. Tobacco smoking, related harm and motivation to quit smoking in people with schizophrenia spectrum disorders. Health Psychol Res. 2020; 8(1): 9042.

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