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Abstract
Neurological and psychiatric symptoms are consequences of substance abuse in schizophrenia and non-schizophrenia patients. The present case–control study examined changes in substance abuse/dependence, and neurological and psychiatric symptoms in substance abusers with [dual diagnosis (DD) group, n = 26] and without schizophrenia [substance use disorder (SUD) group, n = 24] and in non-abusing schizophrenia patients (SCZ group, n = 23) undergoing 12-week treatment with the atypical antipsychotic, quetiapine. Neurological and psychiatric symptoms were evaluated with the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, the Extrapyramidal Symptoms Rating Scale, and the Barnes Akathisia Rating Scale. At endpoint, DD and SCZ patients were receiving significantly higher doses of quetiapine (mean = 554 and 478 mg/day, respectively), relative to SUD patients (mean = 150 mg/day). We found that SUD patients showed greater improvement in weekly dollars spent on alcohol and drugs and SUD severity, compared to DD patients. At endpoint, there was no significant difference in dollars spent, but DD patients still had a higher mean SUD severity. Interestingly, DD patients had significantly higher parkinsonism and depression than SCZ patients at baseline and endpoint. On the other hand, we found that SUD patients had significantly more akathisia at baseline, improved more than SCZ patients, and this was related to cannabis abuse/dependence. Finally, SUD patients improved more in Positive and Negative Syndrome Scale positive scores than DD and SCZ patients. Taken together, our results provide evidence for increased vulnerability to the adverse effects of alcohol and drugs in schizophrenia patients. They also suggest that substance abuse/withdrawal may mimic some symptoms of schizophrenia. Future studies will need to determine the role quetiapine played in these improvements.
Highlights
Schizophrenia is the most disabling psychiatric disorder, according to the Global Burden of Disease study (Eaton et al, 2008)
The present study aimed to examine changes in substance use, as well as neurological symptoms and psychiatric symptoms in substance abusers with and without schizophrenia and in nonabusing schizophrenia patients undergoing 12-week treatment with quetiapine We found that substance use disorder (SUD) patients had a higher mean SUD severity, spent significantly more dollars weekly on alcohol and drugs at baseline and showed greater improvement in these variables, compared to dual diagnosis (DD) patients
At endpoint, there was no significant difference in dollars spent, but DD patients still had a higher mean SUD severity
Summary
Schizophrenia is the most disabling psychiatric disorder, according to the Global Burden of Disease study (Eaton et al, 2008). Important contributors to disability in schizophrenia are psychiatric (e.g., positive, negative, and depressive symptoms) and neurological symptoms (e.g., parkinsonism, dyskinesia, and akathisia; Patterson et al, 1998; Villalta-Gil et al, 2006; Aubin et al, 2009). Compounding these problems is the nearly 50% lifetime prevalence of substance use disorder (SUD) associated with schizophrenia (Regier et al, 1990). There is evidence that DD patients have more neurological and psychiatric symptoms than non-abusing schizophrenia patients (Bersani et al, 2005; Potvin et al, 2007, 2009; Harrison et al, 2008)
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