Abstract
BackgroundSubstance use disorders (SUDs) occur frequently in patients with psychotic disorders and have been associated with various demographic and clinical correlates. There is an absence of research on the prevalence and clinical correlates of SUDs in psychotic disorders in low-and-middle-income countries (LMICs).AimWe aimed to determine the prevalence and correlates of SUDs in psychotic disorders.SettingPatients attending a large secondary-level psychiatric hospital in Cape Town South Africa.MethodsWe used the Structured Clinical Interview for DSM-IV (SCID-I) to determine psychiatric and substance use diagnoses, depressive, anxiety, obsessive-compulsive and post-traumatic symptoms. We used logistic regression models to determine significant predictors of SUDs.ResultsIn total sample (N = 248), 55.6% of participants had any SUD, 34.3% had cannabis use disorders, 30.6% alcohol use disorders, 27.4% methamphetamine use disorders, 10.4% methaqualone use disorders and 4.8% had other SUDs. There were significant associations with male sex for most SUDs, with younger age and Coloured ethnicity for methamphetamine use disorders, and with lower educational attainment for cannabis use disorders. Anxiety symptoms and suicide attempts were significantly associated with alcohol use disorders; a diagnosis of a substance induced psychosis with cannabis and methamphetamine use disorders. Across most SUDs legal problems and criminal involvement were significantly increased.ConclusionThis study found a high prevalence and wide distribution of SUDs in patients with psychotic disorders, consistent with previous work from high income countries. Given clinical correlates, in individuals with psychotic disorders and SUDs it is important to assess anxiety symptoms, suicidality and criminal involvement.
Highlights
IntroductionDepending on the sample characteristics and setting, the prevalence of substance use disorders (SUDs) in patients with serious mental disorders varies from as low as 10% to as high as 74%.1,2,3 Whereas the variation in prevalence is affected by a variety of factors, meta-analyses of prevalence studies report cannabis use disorders to occur in 27.1%, alcohol use disorders in 20.6% and amphetamine use disorders in 10.4% of patients with major affective and non-affective psychoses.[4,5,6] SUDs have a negative impact on the clinical course and outcome of patients with SMI, and higher rates of re-hospitalisation and poor clinical outcomes are reported in patients with SUDs.[2,7,8]Variation in the prevalence of difference substance use disorders is influenced by factors such as geographical region, setting, phase of illness (first vs. chronic), diagnostic method and other demographic and clinical characteristics
Inclusion criteria included a diagnosis of a psychotic disorder or bipolar I disorder with psychotic features
Lifetime major depressive episodes or anxiety disorders occurred only in 20.6% and 13% of participants, but both depressive and anxiety symptoms were more prevalent and occurred in as many as half the sample with anxiety symptoms occurring in a quarter (25%)
Summary
Depending on the sample characteristics and setting, the prevalence of substance use disorders (SUDs) in patients with serious mental disorders varies from as low as 10% to as high as 74%.1,2,3 Whereas the variation in prevalence is affected by a variety of factors, meta-analyses of prevalence studies report cannabis use disorders to occur in 27.1%, alcohol use disorders in 20.6% and amphetamine use disorders in 10.4% of patients with major affective and non-affective psychoses.[4,5,6] SUDs have a negative impact on the clinical course and outcome of patients with SMI, and higher rates of re-hospitalisation and poor clinical outcomes are reported in patients with SUDs.[2,7,8]Variation in the prevalence of difference substance use disorders is influenced by factors such as geographical region, setting, phase of illness (first vs. chronic), diagnostic method and other demographic and clinical characteristics. Variation in the prevalence of difference substance use disorders is influenced by factors such as geographical region, setting, phase of illness (first vs chronic), diagnostic method and other demographic and clinical characteristics. Some of these clinical characteristics include variations in clinical diagnosis and ethnic grouping, and in some studies stimulant use disorders were more prevalent in patients with affective psychosis,[6] and some but not all studies have shown higher prevalence in patients from some ethnic groups.[9,10,11] In turn, whereas meta-analyses and studies with predominantly schizophrenia spectrum patients http://www.sajpsychiatry.org. There is an absence of research on the prevalence and clinical correlates of SUDs in psychotic disorders in low-and-middle-income countries (LMICs)
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