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