Courses of substance use and schizophrenia in the dual-diagnosis patients: is there a relationship?
BACKGROUND
Interrelationship of schizophrenia and substance use is complex and multifactorial. Examining the influence of various psychoactive substances on course of patients with pure dual-diagnosis schizophrenia may help to solve this riddle.


OBJECTIVE
To examine the relationship of the courses of substance use and schizophrenic symptomatology in substance abusing "dual-diagnosis" patients with schizophrenia.


METHODS
Outpatient Deaddiction and Treatment Center of a tertiary care hospital with a retrospective design.


METHODS
Twenty-two substance abusing dual-diagnosis patients with schizophrenia were investigated regarding the course of substance use (abuse/dependence, use, non-use) and that of schizophrenia (psychotic, non-psychotic, in remission). A graphical representation of course of schizophrenia and substance abuse was made and their relationship studied by superimposition of respective graphs.


METHODS
The Friedman two-way analysis of variance of ranks was applied to see the relationship between time spent by patients while on and off various substances.


RESULTS
In five cases, the onset of schizophrenia preceded the onset of substance use. In seven out of 22 subjects, the schizophrenic exacerbation was clearly preceded by increase in substance abuse in the preceding two-twelve months. In none of the subjects decrease in substance use led to a decrease or increase in schizophrenic symptoms.


CONCLUSIONS
Although substance use disorder preceded the onset of schizophrenic illness in the majority, and increase in substance abuse preceded schizophrenic exacerbation in one-third of dual-diagnosis patients, overall there was no evidence that the course of substance use was associated with that of schizophrenia after both disorders were diagnosed.
Goswami
S
S
Drug De-addiction and Treatment Centre, Department of Psychiatry, PGIMER, Chandigarh 160012, India. ddtc@glide.net.in
Singh
G
G
Mattoo
S K
SK
Basu
D
D
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000437:Alcoholism / Q000453:epidemiology; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D018450:Disease Progression; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology*; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology*; D013997:Time Factors