Substance Use and Duration of Untreated Psychosis in KwaZulu-Natal, South Africa

By Davis, Glen P.; Tomita, Andrew et al. | South African Journal of Psychiatry, February 2016 | Go to article overview

Substance Use and Duration of Untreated Psychosis in KwaZulu-Natal, South Africa


Davis, Glen P., Tomita, Andrew, Baumgartner, Joy Noel, Mtshemla, Sisanda, Nene, Siphumelele, King, Howard, Susser, Ezra, Burns, Jonathan K., South African Journal of Psychiatry


Introduction

Substance use and co-morbid psychiatric disorders contribute significantly to the global burden of disease. (1) Co-occurrence of these disorders is common, and studies have shown that substance use is associated with poorer treatment outcomes of psychotic disorders. (2)

Another predictor of poorer outcomes for psychotic disorders is the duration of untreated psychosis (DUP), or the period of treatment delay between onset of psychotic symptoms and treatment initiation. (3) DUP has been associated with greater negative symptom severity, greater functional impairment, and a more chronic long-term course of the disorder. (4) In addition to its effect on clinical outcomes, longer DUP has been shown to be associated with reduced social functioning independent of symptoms, (5) higher social disability, (6) and reduced quality of life of affected patients. (7)

Although substance use and DUP both predict poorer outcomes for psychotic illness, the impact of substance use on DUP has not been clearly elucidated, particularly in South Africa where the prevalence of substance-use disorders is so high. (8)

Historically, substance use in South Africa was limited to locally produced alcohol, tobacco and cannabis. (8) Over the past 20 years, the confluence of political, economic and social transformations of the post-apartheid era have been accompanied by an increase in South Africa's vulnerability to substance use through increased availability and diversity of illicit drugs: Rapid modernisation, societal liberalisation, weakened border control and expansion of international trade have led to an escalation of drug trafficking and abuse. (8,9)

Cross-sectional surveys have documented co-morbid substance use and psychiatric disorders in the Western Cape (WC) Province of South Africa. A study of 95 young adult substance users in three inpatient substance-use treatment centres in Cape Town examined the frequency and nature of co-morbid psychopathology. The most common first substances used were cannabis (51.6%) and crystal methamphetamine (17.9%), and the most common co-morbid psychopathologies were anti-social personality disorder (87.4%) and conduct disorder (67.4%). (10) Another survey of 298 inpatients at a psychiatric hospital in the WC showed that co-morbid substance-use disorder was diagnosed in 51%. Amongst the 8% diagnosed with a substance-induced psychiatric disorder, 1% was diagnosed with a substance-induced mood disorder and 7% with a substance-induced psychotic disorder. (11)

Whilst these studies provide insight into prevalence rates of substance use amongst psychiatric patients in the WC Province, they are not generalisable to other regions of South Africa, which differ ethnically and socio-economically from the rest of the country in ways that may influence substance-use trends. (12)

There are very few studies of substance use amongst psychiatric patients in KwaZulu-Natal (KZN) Province, a particularly vulnerable region to substance-related problems because of its high incidence of HIV and AIDS, unemployment and poverty compared to the national average. (13,14) The objective of the current study is to describe substance-use patterns amongst patients at a regional psychiatric hospital in KZN, South Africa. Specifically, we sought to determine the type of substances used by patients with severe mental illness and describe the demographic risk factors for substance use amongst psychiatric patients. We further sought to examine substance use as a potential factor predicting the DUP.

Methods

Participants

This cross-sectional descriptive study of substance use surveyed individuals diagnosed with severe mental illness undergoing treatment at a provincial psychiatric hospital in Pietermaritzburg, South Africa, a regional referral psychiatric hospital in KZN. All consecutive individuals admitted into inpatient services (July 2012 to October 2013) who met study criteria were approached and invited to participate in the study. …

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