title: Precipitation and determination of the onset and course of schizophrenia by substance abuse--a retrospective and prospective study of 232 population-based first illness episodes.
abstract: Onset and lifetime prevalence of substance abuse were assessed retrospectively using the IRAOS interview in a population-based, controlled sample of 232 first episodes of schizophrenia (ABC sample). Subjects with schizophrenia were twice as likely as controls to have a lifetime history of substance abuse at the age of first admission (alcohol abuse: 23.7 versus 12.3%; drug abuse: 14.2 versus 7.0%). 88% of the patients with drug abuse took cannabis. The sequence of substance abuse and schizophrenia was studied on the timing of abuse onset and illness onset, the latter as based on various definitions: first sign of the disorder, first psychotic symptom and first admission. 62% of the patients with drug abuse and 51% of those with alcohol abuse began the habit before illness onset (=first sign of the disorder). Abuse onset and illness onset occurred highly significantly within the same month (drug abuse in 34.6%, alcohol abuse in 18.2%). Unexpectedly, no temporal correlation was found between abuse onset and the onset of the first psychotic episode. We concluded that a small proportion of schizophrenias might have been precipitated by substance--mainly cannabis--abuse. Long-term effects of early substance abuse were studied prospectively at six cross-sections over five years from first admission on in a subsample of 115 first episodes of schizophrenia. Abusers showed significantly more positive symptoms and a decrease in affective flattening compared with controls. Five-year outcome as based on treatment compliance, utilization of rehabilitative measures and rate of employment was also poorer for patients with than without early substance abuse.
authors.affiliation: Schizophrenia Research Unit, Central Institute of Mental Health, J5, D-68159, Mannheim, Germany.
authors.forename: Babette
authors.initials: B
authors.lastname: Bühler
authors.forename: Martin
authors.initials: M
authors.lastname: Hambrecht
authors.forename: Walter
authors.initials: W
authors.lastname: Löffler
authors.forename: Wolfram
authors.initials: W
authors.lastname: an der Heiden
authors.forename: Heinz
authors.initials: H
authors.lastname: Häfner
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000437:Alcoholism / Q000453:epidemiology; D002648:Child; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015985:Precipitating Factors; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D012559:Schizophrenia / Q000453:epidemiology*; D012565:Schizophrenic Psychology; D012917:Social Adjustment; D018709:Statistics, Nonparametric; D019966:Substance-Related Disorders / Q000453:epidemiology*