The prevalence and clinical correlates of substance use disorders in patients with psychotic disorders from an Upper-Middle-Income Country - PubMed

Background: Substance use disorders (SUDs) occur frequently in patients with psychotic disorders and have been associated with various demographic and clinical correlates. There is an absence of research on the prevalence and clinical correlates of SUDs in psychotic disorders in low-and-middle-income countries (LMICs).

Aim: We aimed to determine the prevalence and correlates of SUDs in psychotic disorders.

Setting: Patients attending a large secondary-level psychiatric hospital in Cape Town South Africa.

Methods: We used the Structured Clinical Interview for DSM-IV (SCID-I) to determine psychiatric and substance use diagnoses, depressive, anxiety, obsessive-compulsive and post-traumatic symptoms. We used logistic regression models to determine significant predictors of SUDs.

Results: In total sample (N = 248), 55.6% of participants had any SUD, 34.3% had cannabis use disorders, 30.6% alcohol use disorders, 27.4% methamphetamine use disorders, 10.4% methaqualone use disorders and 4.8% had other SUDs. There were significant associations with male sex for most SUDs, with younger age and Coloured ethnicity for methamphetamine use disorders, and with lower educational attainment for cannabis use disorders. Anxiety symptoms and suicide attempts were significantly associated with alcohol use disorders; a diagnosis of a substance induced psychosis with cannabis and methamphetamine use disorders. Across most SUDs legal problems and criminal involvement were significantly increased.

Conclusion: This study found a high prevalence and wide distribution of SUDs in patients with psychotic disorders, consistent with previous work from high income countries. Given clinical correlates, in individuals with psychotic disorders and SUDs it is important to assess anxiety symptoms, suicidality and criminal involvement.

1. 1. Cantor-Graae E, Nordstrom LG, McNeil TF. Substance abuse in schizophrenia: a review of the literature and a study of correlates in Sweden. Schizophrenia research. 2001;48(1):69–82. 10.1016/S0920-9964(00)00114-6 - DOI - PubMed
2. 1. Lambert M, Conus P, Lubman DI, Wade D, Yuen H, Moritz S, et al. . The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis. Acta psychiatrica Scandinavica. 2005;112(2):141–8. 10.1111/j.1600-0447.2005.00554.x - DOI - PubMed
3. 1. Weich L, Pienaar W. Occurrence of comorbid substance use disorders among acute psychiatric inpatients at Stikland Hospital in the Western Cape, South Africa. African journal of psychiatry. 2009;12(3):213–7. 10.4314/ajpsy.v12i3.48496 - DOI - PubMed
4. 1. Koskinen J, Lohonen J, Koponen H, Isohanni M, Miettunen J. Prevalence of alcohol use disorders in schizophrenia–a systematic review and meta-analysis. Acta psychiatrica Scandinavica. 2009;120(2):85–96. 10.1111/j.1600-0447.2009.01385.x - DOI - PubMed
5. 1. Koskinen J, Lohonen J, Koponen H, Isohanni M, Miettunen J. Rate of cannabis use disorders in clinical samples of patients with schizophrenia: a meta-analysis. Schizophrenia bulletin. 2010;36(6):1115–30. 10.1093/schbul/sbp031 - DOI - PMC - PubMed