PSYCHOSIS AND SUBSTANCE-ABUSE - CAUSE, EFFECT OR COINCIDENCE

An association between substance abuse and major psychiatric illness i s increasingly well recognised, but most studies have been conducted i n the USA and have focussed upon patients with schizophrenia rather th an other disorders. We conducted a survey of 38 consecutively admitted patients with DSM-III-R functional psychoses. A semi-structured subst ance abuse interview was administered and a urine specimen for drug me tabolite screening requested. The prevalence of cigarette smoking (63 %) and current illicit drug use (26%) were higher than general populat ion norms. The 16 subjects with schizophrenia and related disorders we re more likely to smoke cigarettes than the 22 patients with an affect ive disorder (p=0.008, odds ratio 8.4, 95% CI 1.3-69.6), and showed te ndencies to more illicit drug and alcohol consumption. Illicit drug us ers were more likely to have a forensic history and less likely to hav e entered further education. Substance abuse is common among patients with psychoses, particularly in those with schizophrenia and related d isorders. All psychotic patients should have a detailed drug history t aken, and therapeutic attempts made to reduce consumption.