Psychosis and addiction

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Classification according to ICD-10
F20.- schizophrenia
F10.- Mental and behavioral disorders due to alcohol
F12.- Mental and behavioral disorders due to cannabinoids
ICD-10 online (WHO version 2019)

Among the users of legal and illegal drugs , schizophrenic sufferers form a significant group: In the lifetime prevalence of about half of all patients with schizophrenic psychosis, there is a comorbid substance abuse or dependence.

Especially in patients with an initial manifestation of schizophrenic psychosis, comorbidity rates for substance abuse or dependence of 22–37% can already be described.

Overall, in comparison with the average population, this patient group has a 5 to 10-fold higher risk of developing alcohol abuse and an 8-fold higher risk of developing abuse of another psychotropic substance.

In patients with the double diagnosis of schizophrenic psychosis and substance abuse, the schizophrenic symptoms appear on average 5 to 10 years earlier than in patients without drug use. In this context, drug consumption, with the appropriate disposition, is to be viewed as a decisive condition (“trigger”) for the early onset of psychosis, with close temporal relationships in particular with the consumption of amphetamines and cannabis.

Socio-demographically, patients with this double diagnosis can be characterized as predominantly male, younger than the average age of the schizophrenic patients, with a lower level of schooling and education. With regard to the substances consumed, schizophrenic patients with a corresponding double diagnosis are predominantly classified as “normal” drug users. This means that the type, number and quantity of the substances consumed is largely controlled by the availability of the drug, the available funds, the preferences of the peer group and personal options for obtaining the substance in question. This group of patients in Europe mainly consumes alcohol, followed by cannabis. However, if one considers the age group of the younger double diagnosis patients (<35 years of age), cannabis abuse comes first.

treatment

The treatment of this group of patients is predominantly difficult, as therapy compliance is particularly unstable in this group of patients. Compared to patients without drug problems, this results in a less favorable course of the schizophrenic illness, characterized by continued drug use, more frequent recurrences of schizophrenic psychosis and more inpatient readmissions.

Treatment approaches in which a team takes care of both diseases have proven to be successful. This is known as "integrated treatment" and has replaced sequential (first psychiatry and then addiction clinic) or parallel treatment in psychiatric and addiction departments. So far, two German-language manuals have been published in which specific treatment approaches and therapy programs for this group of patients are presented.

Individual evidence

  1. ^ DA Regier, ME Farmer, DS Rae, BZ Locke, SJ Keith, LL Judd, FK Goodwin: Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) study. In: Journal of the American Medical Association. 264, 1990, pp. 2511-2518.
  2. ^ J. Addington, D. Addington: Impact of an early psychosis program on substance use. In: Psychiatric rehabilitation Journal. 25, 2001, pp. 60-67.
  3. ↑ S. Sevy, DG Robinson, S. Holloway, JM Alvir, MG Woerner, R. Bilder, R. Goldman, J. Lieberman, J. Kane: Correlates of substance misuse in patients with first-episode schizophrenia and schizoaffective disorder. In: Acta psychiatrica scandinavia. 104, 2001, pp. 367-374.
  4. ^ RA Chambers, JH Krystal, DW Self: A neurobiological basis for substance abuse comorbidity in schizophrenia. In: Biological Psychiatry. 50, 2001, pp. 71-83.
  5. ↑ KM Bachmann, F. Moggi, R. Wittig, R. Donati, J. Brodbeck, HP Hirsbrunner: double diagnosis patients. In: W. Böker, HD Brenner (Ed.): Treatment of schizophrenic psychosis . Enke, Stuttgart 2002.
  6. ↑ KT Mueser, PR Yarnold, SD Rosenberg, C. Swett, KM Miles, D. Hill: Substance use disorder in hospitalized severely mentally ill psychiatric patients: prevalence, correlates and subgroups. In: Schizophrenia Bulletin. 26, 2000, pp. 179-192.
  7. ↑ M. Lammertink, F. Löhrer, R. Kaiser, M. Hambrecht, R. Pukrop: Differences in substance abuse patterns: multiple drug abuse alone versus schizophrenia with multiple drug abuse. In: Acta Psychiatrica Scandinavia. 104, 2001, pp. 361-336.
  8. ↑ CG Schütz, M. Sokya: Model psychoses, intoxicating drugs, comorbidity of addiction and schizophrenia - Can schizophrenia research benefit from addiction research? In: M. Sokya, HJ Möller (Ed.): Alcoholism and mental disorders. Springer, Berlin 1997, pp. 97-114.
  9. ↑ F. Löhrer, FR Tuchtenhagen, HJ Kunert, P. Hoff: For the rehabilitation treatment of psychotic substance users - epidemiology, clinic and prognosis. In: Practice Clinical Behavioral Medicine and Rehabilitation. 57, 2002, pp. 71-78.
  10. ^ RE Drake, MF Brunette: Complications of severe mental illness related to alcohol and drug use disorders. In: M. Galanter (Ed.): Recent Developments in Alcoholism: The Consequences of Alcohol. Vol. 14, Plenum Press, New York 1998, pp. 285-299.
  11. ^ R. D'Amelio, B. Behrendt, T. Wobrock: Psychoedukation Schizophrenie und Sucht. Manual for leading patient and family groups. Elsevier, Munich 2006.
  12. ↑ E. Gouzoulis-Mayfrank: Comorbidity psychosis and addiction. From the basics to practice. Steinkopf Verlag, Darmstadt 2007.

literature

  • J. Brodbeck: Diagnosis of comorbidity. In: F. Moggi (ed.): Double diagnoses. Comorbidity of mental disorders and addiction. Verlag Hans Huber, Bern 2002, ISBN 3-456-83699-6 , pp. 125-140.
  • H. Sadowski, F. Niestrat (ed.): Psychosis and addiction, treatment and rehabilitation. Psychiatrie-Verlag, Bonn 2010, ISBN 978-3-88414-503-6 . (Anthology for theory and practice)