Esquizofrenia y sustancias psicotropas de consumo frecuente en nuestro medio
DOI:
https://doi.org/10.20882/adicciones.552Palabras clave:
Esquizofrenia, abuso de sustancias, diagnostico dualResumen
El presente estudio trata de evaluar la prevalencia de los distintos trastornos por uso de algunas sustancias de uso común en nuestro medio, en una muestra de pacientes esquizofrénicos tratados y estudiar la presencia de perfiles sociodemográficos y clínicos asociados al abuso de sustancias. Para ello se estudiaron 72 pacientes con esquizofrenia de los cuales se recogieron variables sociodemográficas y clínicas, siendo evaluados mediante el cuestionario de detección de tóxicos de la OMS, la escala del síndrome positivo y negativo (PANSS). Durante el año previo 27 pacientes (37,5%) presentaron consumos regulares con patrón desadaptativo y el 54,2% (39 pacientes) cumplían criterios diagnósticos de trastorno por uso de sustancias actual o en el pasado. No se observaron asociaciones significativas para la mayoría de las variables estudiadas. El sexo masculino, estar en situación de desempleo, haber tenido mas problemas judiciales y la baja adherencia a la medicación fueron las únicas características que diferenciaron al grupo de pacientes con un diagnóstico comórbido.Citas
(1) Cuffel BJ. Comorbid substance use disorders: prevalence, patterns of use, and course. New Dir Ment Health Serv 1996; 70: 93-105.
(2) Mueser KT, Bellack AS, Blanchard JJ. Comorbidity on schizophrenia and substance abuse: implications for treatment. Journal of Consulting and Clinical Psycology 1992; 60: 845-856.
(3) Cohen T, Jackson A.M. Dual Diagnosis: substance abuse and psychiatric illness. Philadelphia: Hanley & Belfus Inc 1996. p.129.
(4) Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK. Comorbidity of mental disorders with alcohol and other drug abuse. JAMA 1990; 264: 2511-2518.
(5) Schneier FR, Siris SG. A review of psychoactive substance use and abuse in schizophrenia: patterns of drug choice. J Nerv Ment Dis 1987; 175: 641-652.
(6) El-Guebali N, Hodgins DC. Schizophrenia and substance abuse: prevalence issues. Can J Psychiatry 1992; 37:704-710.
(7) Ardnt S, Tyrrell G, Flaum M, Andreasen NC. Comorbidity of substance abuse and schizophrenia. Psychol Med 1992; 22: 379-388.
(8) Drake RE, Osher FC, Noordsy DL. Diagnosis of alcohol use disorders in schizophrenia. Schizophr Bull 1990;16: 57-67.
(9) Dixon L, Haas G, Weiden PJ, Sweeney J, Frances AJ. Drug abuse in schizophrenic patients: clinical correlates and reasons for use. Am J Psychiatry 1991;148:224.230.
(10) Ritzler BA, Strauss JS, Vanord A, Kokes RF . Prognostic implications of various drinking patterns in psychiatric patients. Am J Psychiatry 1977; 134: 546-549.
(11) D’mello DA, Boltz MK, Msibi B . Relationship between concurrent substance abuse in psychiatric patients and neuroleptic dosage. Am J Drug Alcohol Abuse 1995; 21: 257-265.
(12) Caton CL, Gralnick A, Bender S, Simon R. Young chronic patients and substance abuse. Hosp Community Psychiatry 1989; 40: 1037-1040.
(13) Smith J, Hucker S . Schizophrenia and substance abuse. Br J Psychiatry 1994; 165: 13-21.
(14) Cuffel BJ, Sumway M, Choulijan TL, MacDonald T . A longitudinal study of substance use and community violence in schizophrenia. J Nerv Ment Dis 1994; 182:704-708.
(15) DeQuardo JR, Carpenter CF, Tandon R . Patterns of substance abuse in schizophrenia: nature and significance. J Psychiatr Res 1994; 28: 267-275.
(16) Drake RE, Wallach MA. Substance abuse among the chronic mentally ill. Hosp Community Psychiatry 1989; 40: 1041-1046.
(17) Bowers MB, Mazure M, Craig J, Jatlow P. Psychotogenic drug use and neuroleptic response. Schizophr Bull 1990; 16: 81-85.
(18) Verdoux H, Mury M, Besancon G, Bourgeois M. Comparative study of substance dependence comorbidity in bipolar, schizophrenic and schizoaffective disorders. Encephale 1996;22: 95-101.
(19) Allebeck P, Adamsson C, Engström A, Rydberg U. Cannabis and schizophrenia: A longitudinal study of cases trated in Stockholm County. Acta Psychiatr Scand 1993; 88: 21-24.
(20) Knudsen P, Wilmar R. Cannabis and neuroleptics agents in schizophrenia. Acta Psychatr Scan 1984; 69: 162-174.
(21) Sokolski KN, Cummings JL, Abrams BI, DeMet EM, Katz LS, Costa JF. Effects of substance abuse on hallucination rates and treatments responses in chronic psychiatric patients. J Clin Psychiatry 1994; 55: 380-
(22) Cleghorn JM, Kaplan RD, Szechtman B, Szechtman H, Brown GM, Franco S. Substance abuse and shizophrenia: effects on symptoms but not on neurocognitive function. J Clin Psychiatry 1991; 52: 26-30.
(23) Barbee JG, Clark PD, Crapanzano MS, Heintz GC, Kehoe CE. Alcohol and substance abuse among schizophrenic patients presenting to an emergency psychiatric service. J Nerv Ment Dis 1989; 177: 400-407.
(24) Negrete JC, Knapp WP, Douglas DE . Cannabis affects de severity of schizophrenic symptoms: results of a clinical survey. Psycol Med 1986; 16: 515-520.
(25) Shaner A, Khalsa ME, Roberts L, Wilkins J, Anglin D, Hsieh S. Unrecognised cocaine use among schizophrenic patients. Am J Psychiatry 1993; 150: 758-762.
(26) Sevy S, Kay SR, Opler LA, Van Praag HM. Significance of cocaine history in schizophrenia. J Nerv Ment Dis 1993; 178: 642-648.
(27) Dixon L, Haas G, Weiden PJ, Sweeney J, Frances AJ. Acute effects of drug abuse in schizophrenic patients: clinical observations and patient’s self reports. Schizophr Bull 1990; 16: 69-79.
(28) Andreasen NC . Negative symptoms in schizophrenia: definition and reliability. Arch Gen Psychiatry 1982; 39: 784-788.
(29) Soyka M, Albus M, Kathmann N, Finelli A, Hofstetter S, Holzbach R, Immler B, Sand P. Prevalence of alcohol and drug use in schizophrenic inpatients. Eur Arch Psychiatry Clin Neurosci 1993; 242: 362-372.
(30) Brunette MF, Mueser KT, Xie H, Drake RE. Relatioships between symptoms of schizophrenia and substance abuse. J Nerv Ment Dis 1997; 185: 13-20.
(31) Shaner A, Eckman TA, Roberts LJ, Wilkins JN, Tucker D, Tsuang JW, Mintz J. Disability income, cocaine use and repeated hospitalization among schizophrenic cocaine abusers: a goverment sponsored revolving door?. New Engl J Med 1995; 333: 777-783.
(32) Hamera E, Schneider JK, Deviney S. Alcohol, cannabis, nicotine and caffeine use and symptom distress in schizophrenia. J Nerv Men Dis 1995; 183: 559-565.
(33) Kay SR, Opler LA (1987). The positive-negative dimension in schizophrenia: its validity and significance. Psychiatr Dev, 1987; 2:79.
(34) Peralta V, Cuesta MJ. La validación de la escala de síndromes positivo y negativo (PANSS).Actas Luso-Esp Neurol Psiquiatr Cienc afines 1994; 22: 171-177.
(35) Montgomery SA, Asberg M . A new depression scale designed to be sensitive to change. Brit J Psychiat 1979; 134: 382-389.
(36) Smart HG, Hughes PH, Johnston LD . Methodologie pour des enquetes sur l’usage des drogues chez les etudiants. Publiciten Offset, nº 50, Geneve, OMS 1980.
(37) CIE-10 .Trastornos Mentales y del Comportamiento. Versión multiaxial para adultos . OMS, Madrid; 1996. p.155-162
(38) Schneier FR, Siris SG. A review of psychoactive substance use and abuse in schizophrenia: patterns of drug choice. J Nerv Ment Dis 1987; 175: 641-652.
(39) Mueser KT, Yarnold PR, Levinson DF, Singh H, Bellack AS, Kee K, Morrison RL, Yadalan KG. Prevalence of substance abuse in schizophrenia: demographic and clinical correlates. Schizophr Bull 1990; 16: 31-52
(40) Khantzian EJ . The self medication hipothesis of addictive disorders: focus on heroin and cocaine dependence. Am J Psychiatry 1985; 142: 1259-1264.
(41) Plan Nacional sobre drogas. Memoria 1996. Madrid: ed. Ministerio del Interior, 1997. p. 22-23
(42) Lambert M, Haasen C, Mass R, Krausz M . Consumption patterns and motivation for use of addictive drugs in schizophrenic patients. Psychiatr
Prax 1997; 24: 185-189.
(43) Baigent M, Holme G, Hafner RJ . Self reports of the interaction between substance abuse and schizophrenia. Aust N Z J Psychiatry 1995; 29: 69-74.
(44) Donovan DM. Assesment of addictive behaviors: implications of an emerging biopsychosocial model. En Assesment of addictive behaviors . New York: Ed Donovan DM, Marlatt GA.1998.
(45) Test MA, Yallisch LS, Allness DJ, Ripp K. Substance abuse in young adults with schizophrenic disorders. Shizophr Bull 1989; 15: 465-476.
(46) Modestín J, Nussbaumer C, Angst K, Scheidegger P, Hell D. Use of potentially abusive psychotropic substances in psychiatric inpatients. Eur Arch Psychiatry Clin Neurosci 1997; 3: 146-153.