Academic journal article Alcoholism and Psychiatry Research

Substance Abuse in Patients Hospitalized with First-Episode Psychosis

Academic journal article Alcoholism and Psychiatry Research

Substance Abuse in Patients Hospitalized with First-Episode Psychosis

Article excerpt


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.10

Furthermore, psychoactive substance abuse can remain unrecognized even for a longer time if masked by the clinical picture of the psychotic disorder. So, it is necessary to pay special attention to the abuse issue while collecting the anamnestic and hetero-anamnestic data, and do regularly the toxicological analysis of blood and urine, especially in patients with first-episode psychosis.19,20

Considering the fact that Croatia does not have published epidemiological data on the comorbidity of psychoactive substance abuse and psychotic disorder, the aim of our research is to establish the prevalence of the substance abuse at baseline of the first psychotic episode treatment and to examine a possible influence of the substance abuse on the clinical picture of the disease and the quality of recovery as well.



The study included both female and male subjects (N=58), aged between 18 and 35 years, who were for the first time urgently hospitalized with the diagnosis of acute and transient psychotic disorder at the Department of Psychiatry of the University hospital »Sestre milosrdnice«, Zagreb, from January 2004 to January 2007. The group's age was (mean ± SD = 24.9 ± 6.5) years.

The final sample consisted of 58 subjects (41 men and 17 women). The age of the subjects' group without substance abuse was (mean ± SD = 24. 1 ± 6.68) years, while the age of the group with substance abuse was (mean ± SD = 25.3 ± 6.09) years.


The diagnosis of acute and transient psychotic disorder was made using the criterion of the tenth revision of the International Classification of Diseases (ICD-10).

The subjects were divided into two groups: the group without substance abuse according to ICD-10 (N=35) and the group with substance abuse according to ICD-10 (N=23) in the moment they were admitted to the psychiatric ward. …

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