Substance Abuse in Patients Hospitalized with First-Episode Psychosis
Mufic, Ana Kovak, Karlovic, Dalibor, Jagodic, Tanja, Kostanjsak, Lidija, Katinic, Krizo, Vidrih, Branka, Alcoholism
Summary - The aim of the paper is to determine the prevalence of substance abuse in patients with first-episode psychosis urgently admitted to hospital treatment. The aim is also to examine the influence of substance abuse on the clinical picture of the disease and recovery. Both gender patients, aged 18-35 yrs, were included in the study. They were admitted to hospital treatment with the diagnosis of acute and transient psychosis in the period from 2004 and 2007. We compared a group of patients with substance abuse, according to ICD- 10, with a group without the abuse taking into consideration socio-demographic data, psychiatric heredity, earlier mental disorders, treatment attendance circumstances, clinical picture of the disease and the obtained remission. Alcohol and cannabinoid abuse as well as combinations of several addiction substances were represented most. The results show a statistically significant difference in the prevalence of psychoactive substance abuse regarding the patients' gender, and a statistically significant difference in the suicidality and aggression in patients with first-episode psychosis. There was no statistically significant difference between patients with and without substance abuse considering their marital status, parenthood, employment, professional qualifications, psychiatric heredity, earlier mental disorders, prevailing symptoms in the clinical picture, treatment attendance circumstances and the quality of recovery. The results of the study suggest a high prevalence of psychoactive substance abuse in patients with first-episode psychosis as well as the existence of differences in the clinical picture of the patients with the abuse in comparison with those without substance abuse.
Keywords: abuse; addiction; substances; prevalence; first-episode psychosis
Data on the prevalence of substance abuse in the psychiatric population vary considerably in the literature; they depend on the definition of the problem, therapeutic environment, demographic factors and diagnosis.1 Numerous studies have shown that the comorbidity rate of the psychoactive substance abuse or addiction and the psychiatric disease is especially high in patients suffering from a psychotic disorder. So, illegal drug abuse in schizophrenic patients is two to five times greater in comparison to general population.2-7 According to the American NLMH Epidemiological Catchment Area study, as many as 47% of the patients with the diagnosis of schizophrenia or schizophreniform disorders meet the criteria for some kind of substance abuse.8
According to data published so far, substance abuse in patients with first-episode psychosis is twice bigger in comparison to general population.9 There are several hypotheses which try to explain the greater prevalence of psychoactive substance abuse in patients suffering from schizophrenia. The particularly prominent ones are the hypothesis of common biological basis of schizophrenia and drug addiction10 and the one of the abuse as a form of self-medication. The latter theory explains the substance abuse as an attempt to reduce the symptoms of the disease, in the first place of affective deficits and social isolation, but also of anxiety due to the presence of positive symptoms.11-13
Substance abuse is connected with a worse disease prognosis, mostly with more frequent acute exacerbation, a bigger number of hospitalizations as well as their longer duration.14,15 In schizophrenic patients with alcohol abuse positive symptoms are more expressed.16 The abuse is also connected with weaker therapy adherence17 and bad social functioning of schizophrenic patients.18,15
The comorbidity of psychotic disorder and substance abuse represents, besides therapeutic, a diagnostic problem as well, since, in some cases, it is very difficult to differentiate, from a differential-diagnostic point of view, a psychotic disorder with comorbid substance abuse from a psychosis caused by the psychoactive substance abuse. …