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Query: UMLS:C0036341 (schizophrenia)
 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Substance use disorders (SUDs) are highly prevalent and are associated with poor outcomes among individuals with schizophrenia. Integrating treatments for both disorders improves outcomes. Numerous individual pharmacologic and psychosocial treatments have shown effectiveness at reducing substance use in individuals with a primary diagnosis of schizophrenia and co-occurring substance use disorders. Of these treatments, medications such as certain atypical antipsychotics and naltrexone, and psychosocial treatments such as contingency management, seem to be particularly promising. The development and evaluation of psychopharmacologic and psychosocial treatments for SUDs in schizophrenia would benefit from a better understanding of the neurobiological mechanisms underlying the effectiveness of such treatments. Several theories have been put forth to explain the heightened risk for SUDs in schizophrenia. Of these, brain reward circuitry dysfunction, hypothesized to be etiologically important in SUDs, may be an especially salient target for treatments aimed at the reduction of substance use in patients with schizophrenia. We review current pharmacologic and psychosocial treatments for SUDs in schizophrenia, and theoretical mechanisms underlying the increased risk for SUDs in this population. We propose that effective treatments may in part work through the modulation of brain reward circuitry dysfunction.
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PMID:Treatment of substance use disorders in schizophrenia: a unifying neurobiological mechanism? 1609 82

It is commonly thought and taught that most psychiatric disorders other than dementia are much less prevalent among the elderly than among younger adults. This perception is based on a relatively small number of published epidemiologic investigations of the incidence and prevalence of mental illnesses in elderly populations. Most of these studies have had a number of methodologic problems, including improper definitions and diagnostic criteria for older persons. A likely consequence of these misconceptions is that clinically significant and potentially treatable mental illnesses might be overlooked, misdiagnosed, and mistreated in elderly patients. Studies in community samples suggest that many older adults who experience clinically significant psychopathology do not fit easily into our existing nomenclature, and yet are disabled. There is a need to develop aging-appropriate diagnostic criteria for major psychiatric disorders. In this article, we discuss the potential causes of this diagnostic confusion. Four specific classes of disorders-mood (specifically depressive) disorders, schizophrenia (and related psychotic disorders), anxiety disorders, and substance use disorders-are discussed as examples. Finally, we suggest some future steps for clarifying this diagnostic confusion.
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PMID:Aging-related diagnostic variations: need for diagnostic criteria appropriate for elderly psychiatric patients. 1610 43

The rate of comorbid substance use disorder in patients with schizophrenia is 3 times higher than that in the general population. Men with schizophrenia appear to be particularly vulnerable to substance use disorders. Substances commonly abused in patients with schizophrenia include alcohol, cannabis, and cocaine. Although the basis of comorbidity is unclear, a number of theories have been proposed, including the possibility of a deficiency in the dopamine-mediated mesocorticolimbic brain reward circuit. Data suggest that substance abuse may complicate and worsen the course of schizophrenia. Early intervention with appropriate pharmacotherapy may prove beneficial and potentially improve the long-term course of the disorder. Conventional antipsychotics have not been overly useful in this patient population, but some atypical antipsychotics have been shown to reduce the use of alcohol, cannabis, cocaine, and tobacco in patients with schizophrenia. Further research is required, but early evidence suggests that at least some atypical antipsychotics may prove to be therapeutically effective in the treatment of patients with schizophrenia and comorbid substance use disorder.
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PMID:Schizophrenia and comorbid substance use disorder: effects of antipsychotics. 1610 80

National attention continues to focus on the need to improve care for individuals with co-occurring mental illnesses and substance use disorders, as emphasized in the 2003 President's New Freedom Commission Report on Mental Health and recent publications from the Substance Abuse and Mental Health Services Administration (SAMHSA). These reports document the need for best practice recommendations that can be translated into routine clinical care. Although efforts are underway to synthesize literature in this area, few focused recommendations are available that include expert opinion and evidence-based findings on the management of specific co-occurring disorders, such as schizophrenia and addiction. In response to the need for user-friendly recommendations on the treatment of schizophrenia and addiction, a consensus conference of experts from academic institutions and state mental health systems was organized to 1) frame the problem from clinical and systems-level perspectives; 2) identify effective and problematic psychosocial, pharmacological, and systems practices; and 3) develop a summary publication with recommendations for improving current practice. The results of the consensus meeting served as the foundation for this publication, which presents a broad set of recommendations for clinicians who treat individuals with schizophrenia. "Integrated treatment" is the new standard for evidence-based treatment for this population and recommendations are given to help clinicians implement such integrated treatment. Specific recommendations are provided concerning screening for substance use disorders in patients with schizophrenia, assessing motivation for change, managing medical conditions that commonly occur in patients with dual diagnoses (e.g., cardiovascular disease, liver complications, lung cancer, HIV, and hepatitis B or C infections) and selecting the most appropriate medications for such patients to maximize safety and minimize drug interactions, use of evidence-based psychosocial interventions for patients with dual diagnoses (e.g., Dual Recovery Therapy, modified cognitive-behavioral therapy, modified motivational enhancement therapy, and the Substance Abuse Management Module), and key pharmacotherapy principles for treating schizophrenia, substance use disorders, and comorbid anxiety, depression, and sleep problems in this population. Finally the article reviews programmatic and systemic changes needed to overcome treatment barriers and promote the best outcomes for this patient population. An algorithm summarizing the consensus recommendations is provided in an appendix.
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PMID:Improving the care of individuals with schizophrenia and substance use disorders: consensus recommendations. 1618 72

The aim of this study is to assess the rates of nicotine problems diagnosed by psychiatrists, the characteristics of psychiatric patients who smoke, and the services provided to them in routine psychiatric practice. Data were obtained by asking psychiatrists participating in the American Psychiatric Institute for Psychiatric Research and Education's Practice Research Network to complete a self-administered questionnaire to provide detailed sociodemographic, clinical, and health plan information on three of their patients seen during routine clinical practice. A total of 615 psychiatrists provided information on 1,843 patients, of which 280 (16.6%) were reported to have a current nicotine problem. Of these, 9.1% were reported to receive treatment for nicotine dependence. Patients with nicotine problems were significantly more likely to be males, divorced or separated, disabled, and uninsured, and have fewer years of education. They also had significantly more co-morbid psychiatric disorders, particularly schizophrenia or alcohol/substance use disorders; a lower Global Assessment Functioning score; and poorer treatment compliance than their counterparts. The results suggest a very low rate of identification and treatment of nicotine problems among patients treated by psychiatrists, even though psychiatric patients who smoke seem to have more clinical and psychosocial stressors and more severe psychiatric problems than those who do not smoke. Programs should be developed to raise the awareness and ability of psychiatrists to diagnose and treat patients with nicotine problems, with a particular emphasis on the increased medical and psychosocial needs of psychiatric patients who smoke.
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PMID:Identification and treatment of patients with nicotine problems in routine clinical psychiatry practice. 1625 81

We assessed the quality of care for substance use disorders (SUDs) among 8,083 patients diagnosed with serious mental illness from the VA mid-Atlantic region. Using data from the National Patient Care Database (2001-2002), we assessed the percentage of patients receiving a diagnosis of SUD, percentage beginning SUD treatment 14 days or earlier after diagnosis, and percentage receiving continued SUD care 30 days or less. Overall, 1,559 (19.3%) were diagnosed with an SUD. Of the 1,559, 966 (62.0%) initiated treatment and 847 (54.3%) received continued care. Although patients diagnosed with bipolar disorder were more likely to receive a diagnosis of SUD than those diagnosed with schizophrenia or schizoaffective disorder (22.7%, 18.9%, and 17.7%, respectively; chi(2) = 26.02, df = 2, p < .001), they were less likely to initiate (49.1%, 70.7%, and 68.6%, respectively; chi(2) = 59.29, df = 2, p < .001) or continue treatment (39.9%, 63.2%, and 62.2%, respectively; chi(2) = 72.25, df = 2, p <. 001). Greater efforts are needed to diagnose and treat SUDs in patients with serious mental illness, particularly for those with bipolar disorder.
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PMID:Quality of care for substance use disorders in patients with serious mental illness. 1637 54

Cognitive therapy was originally developed as a short-term approach to the treatment of depression. In recent years, it has been applied, either alone or in combination with pharmacotherapy, to a wide range of mental disorders, from anxiety, eating, and substance use disorders to personality, bipolar, and schizophrenic disorders. In this article, how to use cognitive therapy for treating psychiatric outpatients will be illustrated. Also, clinical decision analysis, a quantitative method for synthesizing the best research evidence and the patient's preference, will be highlighted in the acute and maintenance treatment of recurrent depression.
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PMID:[Clinical cognitive therapy]. 1638 95

The purpose of this study was to examine the associations of early-onset methamphetamine (MAMP) use in early adolescence with psychiatric morbidity in adolescents with MAMP use by gender. A total of 299 adolescents with MAMP use in Taiwan were recruited from two juvenile detention centers in Kaohsiung and Taipei from September 1998 to March 2002. Using the Kiddie epidemiological version of the Schedule for Affective Disorders and Schizophrenia (K-SADS-E), each adolescent was interviewed by a child psychiatrist to determine what psychiatric conditions, including substance use disorders (SUDs) and other psychiatric comorbidities might be associated with the early-onset (15 years old or below) MAMP use according to gender. In females, early-onset MAMP use was significantly associated with the diagnoses of depressive disorder, conduct disorder and amphetamine use disorder. In males, however, early-onset MAMP use was only significantly associated with amphetamine use disorder. Gender differences exist in the association between early-onset MAMP use and psychiatric morbidity. The association between early-onset MAMP use and psychiatric morbidity may have important implications for public health policy and treatment for adolescents with MAMP use.
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PMID:The associations of early-onset methamphetamine use with psychiatric morbidity among Taiwanese adolescents. 1639 34

Little is known about the treatment needs of clients found in residential detoxification programs who have comorbid schizophrenia-spectrum and substance use disorders. This study (N = 166) compares the service use patterns of comorbid detoxification clients with schizophrenia-spectrum disorders (CDT-S) to two other client groups: (1) comorbid detoxification clients with other mental health disorders (CDT-O), and (2) comorbid clients in residential mental health facilities with schizophrenia-spectrum disorders (CMH-S). Results show that CDT-S clients were much less likely to receive subsequent mental health treatment than CMH-S clients. Findings indicate that detoxification programs may be important settings in which to identify clients with schizophrenia who have unmet mental health treatment needs.
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PMID:Clinical characteristics and service utilization patterns of clients with schizophrenia-spectrum disorders in public residential detoxification settings. 1642 2

While it is widely known that patients with schizophrenia-spectrum psychoses and co-occurring substance use disorders are more difficult to manage, there is limited data on the course of their psychiatric symptoms when they remain in treatment over time. This prospective 12-month study evaluated changes in psychiatric symptoms and substance use to ascertain if the co-existence of substance use disorders influences ratings of psychiatric symptoms at follow-up. 147 outpatients in a continuing care program were assessed at intake and followed prospectively for 12 months. Psychiatric symptoms were measured at baseline and 12-month follow-up using the Positive and Negative Syndrome Scale (PANSS) and Hamilton Depression Rating Scale (HAM-D). Subjective psychological distress was rated with the Brief Symptom Inventory (BSI) and quality of life by the Satisfaction with Life Domains Scale (SDLS). Drug and alcohol use was measured with the Addiction Severity Index (ASI). 50.3% of patients were diagnosed with dual disorders (DD) (current and lifetime). The most common primary substances of abuse were alcohol (35.6%) and cannabis (35.1%). DD subjects had higher baseline PANSS positive scores but experienced a greater reduction at 12 months compared to single diagnosis (SD) patients. Severity of substance abuse as measured by ASI composite scores did not decrease significantly between baseline and 12 months. DD patients with schizophrenia and related psychoses treated for their psychiatric illness showed a reduction in PANSS scores over 12 months, even when their substance use remained largely unchanged. However, co-morbidity cases continued to show higher depression and anxiety ratings. Ongoing substance abuse appears to be related to levels of depression as 62.5% of DD-current versus 34.7% of SD patients had HAM-D scores in the depressed range at 12-month follow-up. Implications for treatment are discussed.
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PMID:A 12-month prospective follow-up study of patients with schizophrenia-spectrum disorders and substance abuse: changes in psychiatric symptoms and substance use. 1646 Sep 17


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