Shorter hospital stays and more rapid improvement among patients with schizophrenia and substance disorders

Objective: Length of stay and treatment response of inpatients with acute s chizophrenia were examined to determine whether: differences existed betwee n those with and without comorbid substance-related problems, Methods: The sample comprised 608 patients with a diagnosis of schizophrenia or schizoaf fective disorder treated on hospital units with integrated dual diagnosis t reatment. They were rated on admission and discharge by a psychiatrist usin g a structured clinical instrument. Patients with no substance-related prob lems were compared with those with moderate to severe problems using t test s, chi square tests, and analysis of variance. Results: When analyses contr olled for age, gender, and other clinical variables, dually diagnosed patie nts were found to have improved markedly faster compared with patients with out a dual diagnosis. Their hospital stays were 30 percent shot-res on both voluntary and involuntary units. They also showed somewhat greater symptom atic improvement and no increase in 18-month readmission rates. On admissio n the dual diagnosis group was more likely to be younger, male, and homeles s and more Likely to be a danger to self and others. Severity of psychosis was the same at admission for the two groups, but the dually diagnosed pati ents were rated as less psychotic at discharge. Conclusions: Dually diagnos ed patients with schizophrenia appear to stabilize faster during acute hosp italization than those without a dual diagnosis. The authors hypothesize th at substance abuse may temporarily amplify symptoms or that these patients may have a higher prevalence of better-prognosis schizophrenia. The availab ility of integrated dual-focus inpatient treatment and a well-developed out patient system may also have helped these patients recover more rapidly.