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Unrecognized cocaine use among schizophrenic patients
A Shaner1, M E Khalsa, L Roberts
1West Los Angeles VA Medical Center, CA 90073.
The American Journal of Psychiatry
|May 1, 1993
Summary
Unrecognized stimulant use is common in schizophrenia patients, often missed by clinicians. Routine urine toxicology screens are recommended for better diagnosis and treatment of these individuals.
Area of Science:
- Psychiatry
- Clinical Psychology
- Neuroscience
Background:
- Unrecognized stimulant use can lead to misdiagnosis and misunderstanding of schizophrenia's course.
- Accurate diagnosis is crucial for effective treatment and prognosis of schizophrenia.
Purpose of the Study:
- To determine the prevalence of unrecognized stimulant use in patients diagnosed with schizophrenia.
- To highlight the importance of identifying stimulant use for accurate schizophrenia assessment.
Main Methods:
- 108 consecutive schizophrenic patients admitted to a psychiatric hospital were studied.
- Routine clinical evaluations were supplemented with interviews on substance use and urine toxicology screening.
Main Results:
- 36% of patients used cocaine in the 6 months prior to admission; 31% used it in the week before.
- Clinicians missed one-third of cocaine use cases due to unreliable self-reporting.
- Substance-abusing schizophrenic patients were younger but shared similar rates of psychosis, homelessness, and unemployment with non-abusing patients.
Conclusions:
- Clinicians should not rely solely on self-reported stimulant use in hospitalized schizophrenic patients.
- Routine urine toxicology screening for all psychotic patients can improve stimulant use recognition.
- Identifying stimulant use may reveal a subgroup of schizophrenic patients with a better prognosis and distinct treatment needs.