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

The long-term courses of people with schizophrenia and of those with substance use disorder have been studied separately and extensively. The long-term course of clients with co-occurring schizophrenic and substance use disorders has, however, not been examined. This article reports 10-year outcomes for 130 clients with co-occurring schizophrenic and substance use disorders in the New Hampshire Dual Diagnosis Study. In addition, we report on 6 "recovery outcomes," identified by dual diagnosis clients, as examples of positive coping behaviors. Longitudinal data were modeled using generalized estimating equation (GEE) methods. Participants improved steadily over 10 years in the outcome domains of symptoms, substance abuse, institutionalization, functional status, and quality of life. Further, at the 10-year follow-up, substantial proportions were above cutoffs selected by dual diagnosis clients as indicators of recovery: 62.7% were controlling symptoms of schizophrenia; 62.5% were actively attaining remissions from substance abuse; 56.8% were in independent living situations; 41.4% were competitively employed; 48.9% had regular social contacts with non-substance abusers; and 58.3% expressed overall life satisfaction. These 6 outcomes were only weakly interrelated over time, suggesting that recovery, as defined by clients, is a multidimensional concept. Overall, the 10-year findings on recovery outcomes provide a hopeful long-term perspective for dual diagnosis clients.
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PMID:Ten-year recovery outcomes for clients with co-occurring schizophrenia and substance use disorders. 1652 88

This study examined baseline correlates of substance use in the NIMH Clinical Antipsychotic Trials of Intervention Effectiveness project. Approximately 60% of the sample was found to use substances, including 37% with current evidence of substance use disorders. Users (with and without substance use disorders), compared with nonusers, were significantly more likely to be male, be African-American, have lower educational attainment, have a recent period of homelessness, report more childhood conduct problems, have a history of major depression, have lower negative symptom and higher positive symptom scores on the Positive and Negative Syndrome Scale, and have a recent illness exacerbation. Individuals with comorbid substance use disorders were significantly more likely to be male, report more childhood conduct problems, have higher positive symptom scores on the Positive and Negative Syndrome Scale, and have a recent illness exacerbation. These analyses suggest that substance use disorders in schizophrenia are especially common among men with a history of childhood conduct disorder problems and that childhood conduct disorder problems are potent risk factors for substance use disorders in schizophrenia.
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PMID:Substance use in persons with schizophrenia: baseline prevalence and correlates from the NIMH CATIE study. 1653 33

Conduct disorder (CD) and antisocial personality disorder (ASPD) are established risk factors for substance use disorders in both the general population and among persons with schizophrenia and other severe mental illnesses. Among clients with substance use disorders in the general population, CD and ASPD are associated with more severe problems and criminal justice involvement, but little research has examined their correlates in clients with dual disorders. To address this question, we compared the demographic, substance abuse, clinical, homelessness, sexual risk, and criminal justice characteristics of 178 dual disorder clients living in 2 urban areas between 4 groups: No CD/ASPD, CD Only, Adult ASPD Only, and Full ASPD. Clients in the Adult ASPD Only group tended to have the most severe drug abuse severity, the most extensive homelessness, and the most lifetime sexual partners, followed by the Full ASPD group, compared with the other 2 groups. However, clients with Full ASPD had the most criminal justice involvement, especially with respect to violent charges and convictions. The results suggest that a late-onset ASPD subtype may develop in clients with severe mental illness secondary to substance abuse, but that much criminal behavior in clients with dual disorders may be due to the early onset of the full ASPD syndrome in this population and not the effects of substance use disorders.
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PMID:Conduct disorder and antisocial personality disorder in persons with severe psychiatric and substance use disorders. 1689 56

Since 1997, substance users have received disability benefits only for impairments apart from their substance use disorders. It is hypothesized that substance users currently receiving disability benefits would be more severely compromised, medically and/or psychiatrically, than those not receiving disability. Enrolling a community sample of 330 heroin and cocaine users between January 2002 and January 2004, it was found that individuals who were not receiving disability payments had similar mental health scores, current depressive symptoms scores, and lifetime rates of major depression compared to those receiving payments, but significantly lower rates of bipolar or psychotic disorders and psychiatric hospitalization (p < .01). Physically disabled persons had lower physical function scores and were more likely to be HIV-infected or taking medications regularly (p < .001). The authors conclude that schizophrenia, bipolar disorders, and chronic physical illness, but not major depression, are qualifying substance users for disability benefits. Longitudinal studies of disability status and its effects on the lives of substance users are warranted.
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PMID:Receipt of disability payments by substance users: mental and physical health correlates. 1659 54

As substance use disorders (SUD) are common in schizophrenia patients, we tested the hypothesis that comorbid patients (SUD[+]) have more positive vs. negative symptoms than non-comorbid (SUD[-]) patients. From reports identified by literature-searching we compared Positive and Negative Syndrome Scale (PANSS) ratings in schizophrenia patients with and without SUD using meta-analytic methods. Among 9 comparisons (N=725 subjects), SUD[+] patients were more often men, and abused alcohol>cannabis>cocaine. SUD[+] patients had very significantly higher PANSS-positive, and lower PANSS-negative scores. Comorbid SUD in schizophrenia patients was associated with male sex and higher PANSS positive to lower negative scores. Cause-effect relationships remain to be clarified.
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PMID:Comorbid substance-use in schizophrenia: relation to positive and negative symptoms. 1705 5

This study explores the differential effect of a managed behavioral health Carve-Out (CO) on outpatient treatment quality for persons with schizophrenia (SCHZ) alone and co-occurring substance use disorders (SUD) (SCHZ+SUD). We used claims data from a state Medicaid program and employed a retrospective, quasi-experimental design with logit and difference in difference formula regression models. The results show the CO was associated with greater changes in treatment quality for the SCHZ population, compared to the SCHZ+SUD population. Most pronounced across both populations were decrements in receiving the psychosocial treatments for enrollees in the CO arrangement.
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PMID:Schizophrenia, co-occurring substance use disorders and quality of care: the differential effect of a managed behavioral health care carve-out. 1675 97

To compare the clinical characteristics and psychiatric management of antipsychotic nonadherence among outpatients with schizophrenia who either do or do not have current or past comorbid substance use disorders, a national survey was conducted of psychiatrists engaged in the management of schizophrenia. Respondents reported on the presentation and management of one adult patient who had been under their care for at least 1 year and who had been nonadherent with oral antipsychotic medications at some point in the last year. The response rate was 69.3%. Patients with schizophrenia only (N = 190) were compared with patients with schizophrenia and a history of a co-occurring substance use disorder (N = 105). Approximately one third (35.6%) of antipsychotic nonadherent schizophrenia patients had a comorbid substance use disorder. Denial of illness was the most commonly cited primary reason for antipsychotic nonadherence. Psychiatrists were significantly less likely to discuss with comorbid patients than patients without comorbid substance use linkages between antipsychotic adherence and progress toward personal goals (64.5% vs. 78.9%), and significantly less likely to explore the meaning of taking medication to the patient's identity (59.2% vs. 73.3%). However, psychiatrists were approximately two times more likely to add another antipsychotic for patients with substance use disorders (22.8% vs. 11.0%). There were no perceived differences between the two groups in effectiveness of interventions to manage medication nonadherence. Comorbid substance use disorders are common among psychiatric outpatients with schizophrenia who are nonadherent with antipsychotic medications. Some psychological approaches tend to be used less often with patients with comorbid substance use disorders, although when they are used, psychiatrists report they are no less effective than they are for schizophrenia patients without comorbid substance use disorders. These findings suggest that some psychological interventions may tend to be underutilized in the management of medication nonadherence among patients with comorbid schizophrenia and substance use disorders.
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PMID:Substance abuse and the management of medication nonadherence in schizophrenia. 1677 65

The developing brain is susceptible to the effects of exogenous cannabinoids both during the perinatal period through maternal cannabis use and in young adolescent users. Emerging data from human and animal perinatal exposure studies demonstrate a subtle rather than gross effect of cannabis upon later functioning including; specific cognitive deficits especially in visuospatial function; impulsivity, inattention and hyperactivity; depressive symptoms; and substance use disorders. From animal studies motor control systems, neuroendocrine function and nociception may additionally be affected. Fetal studies indicate that these outcomes may be through cannabinoid mediated influences on the ontogeny of, especially dopamine and opioid, neurotransmitter systems. The effect of cannabinoids in the adolescent suggest long-term deleterious outcomes in cognition, depressive symptoms, schizophrenia and substance use disorders. Much of these data support a neurodevelopmental effect, however, predisposing genetic and/or environmental factors cannot be excluded from human studies. Gender specific differences have been observed in both human and animal studies implying sex hormone and related factors may interact with cannabinoids in neurodevelopment. Further understanding how cannabinoids influence neurodevelopment will inform public debate about the health effects of cannabis but also open avenues in discerning how modulation of the endocannabinoid system may assist in the development of therapeutic tools for a variety of neuropsychiatric disorders.
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PMID:Cannabis and neurodevelopment: implications for psychiatric disorders. 1678 14

This study reports on a fifteen-year longitudinal analysis of the characteristics of assaultive patients in one public-sector mental health care system. The data were gathered within the context of the Assaulted Staff Action Program (ASAP), a crisis intervention service for staff victims. The fifteen-year findings were consistent with previous worldwide research on assaultive patients and included both older male patients with schizophrenia and younger personality-disordered patients as high-risk assailants. Both groups had appreciable histories of violence toward others, personal victimization, and substance use disorders. The role of these three clinical variables in association with subsequent assaults, the role of trauma in female assailants, and the consistency of the fundamental characteristics of assaultive patients during several service system initiatives were examined. Implications for research and intervention are discussed.
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PMID:Characteristics of assaultive psychiatric patients: fifteen-year analysis of the Assaulted Staff Action Program (ASAP). 1697 13

Serious mental illnesses (SMIs) such as schizophrenia, bipolar disorder, and major depression are prevalent among individuals with substance use disorders, particularly those in drug treatment programs. No screening tool has yet become the gold standard for identifying SMI among individuals with substance use disorders. One candidate instrument, the K6 screening scale, is brief, easy to administer and score, and has performed well, detecting SMI in studies using general population samples. We used data from the National Survey on Drug Use and Health to examine the K6's psychometric properties in a subsample of persons with substance use disorders and found that the K6 accurately screened for severe psychological distress associated with SMI among individuals with substance use disorders and across different psychiatric disorders.
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PMID:Screening for serious mental illness in populations with co-occurring substance use disorders: Performance of the K6 scale. 1699 91


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