Substance abuse and suicidality in schizophrenia: a common risk factor linked to impulsivity

Lifetime substance abuse comorbidity is frequent in schizophrenic patients, but the clinical correlates remain unclear. We have explored the chronolog ical relations between substance abuse and course of schizophrenia, and com pared several clinical characteristics and personality dimensions in 50 sch izophrenic patients with or without lifetime substance abuse or dependence. Abuse occurred mainly after the first prodromal symptoms and just before t he first psychotic episode. Substance-abusing patients were not different f rom non-substance-abusing patients on the Chapman Physical Anhedonia Scale, PANSS total score, negative subscore or depression item, CGI, treatment re sponse and demographic variables. In contrast, substance-abusing patients h ad higher scores on the Barratt Impulsivity Scale (total, cognitive and non -planning scores) and had attempted suicide more often. In patients with sc hizophrenia, as in the general population, substance abuse or dependence ap pears associated with higher impulsivity and suicidality. High impulsivity could facilitate substance abuse as a maladaptative behavior in response to prodromal symptoms. precipitating the onset of a characterized psychosis. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.