UNRECOGNIZED COCAINE USE AMONG SCHIZOPHRENIC-PATIENTS

Objective: Unrecognized stimulant use could lead to the misdiagnosis o f schizophrenia or the misunderstanding of its course and prognosis. T his study was conducted to determine the prevalence of unrecognized st imulant use among patients with a clinical diagnosis of schizophrenia. Method: The subjects were 108 schizophrenic patients admitted consecu tively to a Veterans Affairs psychiatric hospital. Admitting psychiatr ists supplemented routine clinical evaluations with a semistructured i nterview regarding recent and lifetime use of alcohol, cocaine, amphet amine, marijuana, and opiates. A urine specimen was assayed for the fo ur illicit drugs. Results: Of the 103 patients who provided a urine sp ecimen, 37 (36%) used cocaine during the 6 months before admission, in cluding 31 who used the drug in the week before admission. Because of the poor reliability of negative self-reports of recent cocaine use, c linicians failed to recognize cocaine use in one-third of the patients with a urine toxicology positive for cocaine metabolites. Two other g roups of patients were identified; schizophrenic patients without subs tance abuse (including alcohol) and schizophrenic patients with substa nce abuse other than stimulants. Both substance-abusing groups were yo unger than the nonabusing group, but the three groups bad similarly hi gh rates of recent psychotic symptoms, homelessness, and unemployment. Conclusions: Among schizophrenic patients who require hospitalization , clinicians should not rely solely on self-reported stimulant use. Re cognition of stimulant use could be improved through routine urine tox icologies for all psychotic patients. The authors suggest that recogni tion of stimulant use among schizophrenic patients may identify a popu lation with a better prognosis for schizophrenia and different treatme nt needs.