Elsevier

Schizophrenia Research

Volume 66, Issues 2ā€“3, 1 February 2004, Pages 125-135
Schizophrenia Research

First episode schizophrenia-related psychosis and substance use disorders: acute response to olanzapine and haloperidol

https://doi.org/10.1016/j.schres.2003.08.001Get rights and content

Abstract

Background: Co-occurring substance use disorders, mostly involving alcohol, cannabis or cocaine, occur commonly in patients with schizophrenia and are associated with increased morbidity and mortality. Available but limited data suggest that substance use disorders (especially cannabis use disorders) may also be common in first-episode patients and appear linked to a poor outcome in these patients. Strategies to curtail substance use form an important dimension of the treatment program for both first-episode and chronic patients. We report on rates of co-occurring substance use disorders in patients within their first episode of schizophrenia-related psychosis from a multicenter, international treatment trial of olanzapine vs. haloperidol. Methods: The study involved 262 patients (of 263 who were randomized and who returned for a post-randomization evaluation) within their first episode of psychosis (schizophrenia, schizoaffective disorder or schizophreniform disorder) recruited from 14 academic medical centers in North America and Western Europe. Patients with a history of substance dependence within 1 month prior to entry were excluded. Results: Of this sample, 97 (37%) had a lifetime diagnosis of substance use disorder (SUD); of these 74 (28% of the total) had a lifetime cannabis use disorder (CUD) and 54 (21%) had a lifetime diagnosis of alcohol use disorder (AUD). Patients with SUD were more likely to be men. Those with CUD had a lower age of onset than those without. Patients with SUD had more positive symptoms and fewer negative symptoms than those without SUD, and they had a longer duration of untreated psychosis. The 12-week response data indicated that 27% of patients with SUD were responders compared to 35% of those without SUD. Patients with AUD were less likely to respond to olanzapine than those without AUD. Discussion: These data suggest that first-episode patients are quite likely to have comorbid substance use disorders, and that the presence of these disorders may negatively influence response to antipsychotic medications, both typical and atypical antipsychotics, over the first 12 weeks of treatment.

Section snippets

Study sample

The study was a double-blind, randomized, multisite, international 2-year study of olanzapine vs. haloperidol in 262 patients with first-episode psychosis (meeting DSM-IV criteria for schizophrenia, schizoaffective disorder or schizophreniform disorder) recruited from 14 academic medical centers in North America and Western Europe. (Note: 263 were randomized and 262 returned for a post-randomization evaluation). The sample was ascertained from patients (age 16 to 40) who presented to clinical

Results

Of the sample of 262 patients, 97 (37%) had a lifetime DSM-IV substance use disorder (SUD) diagnosis; 20 patients (7.6%) had a lifetime DSM-IV substance use disorder diagnosis with evidence of current use (prior to hospitalization). If assessed by particular substance, 74 (28%) of the patients had a lifetime cannabis use disorder (CUD); 54 (21%) had a lifetime diagnosis of alcohol use disorder (AUD); 17 (6%) had a lifetime diagnosis of cocaine use disorder; 12 (5%) had a lifetime diagnosis of

Discussion

Data from this study support the notion reported by other investigators Grech et al., 1999, Kovasznay et al., 1997 that patients within their first episode of schizophrenia-related psychosis quite commonly exhibit co-occurring substance use disorders. This is true for this international sample, even though patients were excluded from the study if they had a recent history of substance dependence. Thus, while 38% of the patients had a lifetime diagnosis of substance use disorder, only 7% had a

Acknowledgements

This work was supported in part by USPHS grants MH49891, MH52373, AA49104, DA13196 (Dr. Green), grants MH00537, MH33127 (Dr. Lieberman) and Lilly Research Laboratories.

References (57)

  • M. Birchwood et al.

    Early intervention in psychosis: the critical period hypothesis

    British Journal of Psychiatry

    (1998)
  • M.B. Bowers et al.

    Psychotogenic drug use and neuroleptic response

    Schizophrenia Bulletin

    (1990)
  • W. Brewer et al.

    Cannabis use in never medicated high-risk and first episode psychosis patients: relationship to cognition

  • B. Buhler et al.

    Precipitation and determination of the onset and course of schizophrenia by substance abuse-a retrospective and prospective study of 232 population-based first illness episodes

    Schizophr

    (2002)
  • R. Cantwell et al.

    Prevalence of substance misuse in first-episode psychosis

    British Journal of Social Psychiatry

    (1999)
  • C. Curry et al.

    The intensity, prevalence, and client characteristics of cannabis use in first onset psychosis

  • L. Dixon et al.

    Acute effects of drug abuse in schizophrenic patients: clinical observations and patients' self reports

    Schizophrenia Bulletin

    (1990)
  • R.E. Drake et al.

    Complications of severe mental illness related to alcohol and drug use disorders

  • R.E. Drake et al.

    Substance abuse comorbidity

  • M.B. First et al.

    Structured Clinical Interview for DSM IV-Axis I Disorders

    (1996)
  • A. Grech et al.

    Influence of cannabis on the outcome of psychosis

    Schizophrenia Research

    (1999)
  • A.I. Green et al.

    Clozapine for comorbid substance use disorder and schizophrenia: do patients with schizophrenia have a reward-deficiency syndrome that can be ameliorated by clozapine?

    Harvard Review of Psychiatry

    (1999)
  • A.I. Green et al.

    Treatment of schizophrenia and comorbid substance use disorder

    Current Drug Targets. CNS & Neurologiscal Disorders

    (2002)
  • G.L. Haas et al.

    Delay to first antipsychotic medication in schizophrenia: impact on symptomatology and clinical course of illness

    Journal of Psychiatric Research

    (1998)
  • B. Ho et al.

    Untreated initial psychosis: its relation to quality of life and symptom remission in first-episode schizophrenia

    American Journal of Psychiatry

    (2000)
  • M.S. Hurlburt et al.

    Effects of substance abuse on housing stability of homeless mentally ill persons in supported housing

    Psychiatric Services

    (1996)
  • E.J. Khantzian

    A self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence

    American Journal of Psychiatry

    (1985)
  • E.J. Khantzian

    The self-medication hypothesis of substance use disorders: a reconsideration and recent applications

    Harvard Review of Psychiatry

    (1997)
  • Cited by (0)

    1

    HGDH Research Group: This paper was based (in part) on results from the study of the Comparative Efficacy And Safety Of Atypical And Conventional Antipsychotic Drugs In First-Episode Psychosis by the HGDH Study Group sponsored by Eli Lilly and Company. The HGDH research group consists of Drs. Jeffrey A. Lieberman and Diana Perkins, Dept. of Psychiatry Univ. of North Carolina School of Medicine, NC, USA; Drs. Joseph P. McEvoy, Cecil Charles and Richard Keefe, John Umstead Hospital, Duke University Health System, NC, USA; Drs. Robert B. Zipursky and Zafiris J. Daskalakis, Dept. of Psychiatry, University of Toronto School of Medicine, Ontario, Canada; Dr. Alan I. Green, Massachusetts Mental Health Center, Harvard Medical School, MA, USA; Dr. Charles B. Nemeroff, Dept. of Psychiatry, Emory University School of Medicine, GA, USA; Prof. Robin Murray and Dr. Tonmoy Sharma, Institute of Psychiatry, UK; Dr. Raquel E. Gur, Dept. of Psychiatry Univ. of Pennsylvania Medical Center, PA, USA; Drs. Bruce Cohen and Franca Centorrino, McLean Hospital, Harvard Medical School, Belmont MA, USA; Prof. Dr. R.S. Kahn, University Hospital, Utrecht, The Netherlands; Drs. Wayne Goodman and John Kuldau, Dept. of Psychiatry, Univ. of Florida, FL, USA; Drs. Anthony J. Rothschild and Jayendra K. Patel, Dept. of Psychiatry, Univ. of Massachusetts Medical Center, MA, USA; Dr. Stephen M. Strakowski, Dept. of Psychiatry, Univ. of Cincinnati, OH, USA; Dr. Ira Glick, Dept. of Psychiatry, Stanford University School of Medicine, CA, USA; Dr. John De Quardo, Dept. of Psychiatry, Univ. of Michigan Medical Center, MI, USA; Drs. Gary Tollefson, Todd Sanger, Mauricio Tohen, Lilly Research Laboratories, IN, USA.

    View full text