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Schizophrenia is highly comorbid with substance use disorders (SUD) but large epidemiological cohorts exploring the prevalence and prognostic significance of SUD are lacking.
To investigate the prevalence of SUD in patients with schizophrenia in Finland and Sweden, and the effect of these co-occurring disorders on risks of psychiatric hospitalization and mortality.
45,476 individuals with schizophrenia from two independent national cohort studies, aged <46 years at cohort entry, were followed during 22 (1996-2017, Finland) and 11 years (2006-2016, Sweden). We first assessed SUD prevalence (excluding smoking). Then we performed Cox regression on risk of psychiatric hospitalization and mortality in patients with schizohrenia and SUD compared with those without SUD.
The prevalence of SUD in specialized healthcare ranged from 26% (Finland) to 31% (Sweden). Multiple drug use and alcohol use disorders were the most prevalent SUD, followed by cannabis use disorders. Any SUD comorbidity, and particularly multiple drug use and alcohol use, were associated with 50% to 100% increases in hospitalization and mortality compared to individuals without SUD. Elevated mortality risks were observed especially for deaths due to suicide and other external causes. All results were similar across countries.
Co-occurring SUD, and particularly alcohol and multiple drug use, are associated with high rates of hospitalization and mortality in patients with schizophrenia. Preventive interventions should prioritize detection and tailored treatments for these co-morbidities, which often remain underdiagnosed and untreated.
Conflict of interest
ML: Genomi Solutions Ltd, Nursie Health Ltd, Sunovion, Orion Pharma, Janssen-Cilag, Finnish Medical Foundation, Emil Aaltonen Foundation. HT, EMR, AT: Eli Lilly, Janssen–Cilag. JT: Eli Lilly, Janssen-Cilag, Lundbeck, Otsuka.
This chapter presents the major mental health topics of concern in pregnant patients and offers guidelines in the management of these patients in the emergency setting. Suicidal and violent symptoms should be assessed in any patient presenting with emotional, psychological, or social stress. Unipolar disorders, such as major depression, and bipolar disorders comprise the mood disorders. They tend to have an age of onset that coincides with the peak years of childbearing. The management of depression in pregnancy depends upon the severity and course of illness, presence of depression before pregnancy, treatment before or during pregnancy, available resources, and the patient's level of support. Like the mood disorders, anxiety disorders remain problematic during pregnancy; pregnancy is not protective against these symptoms. Patients with a positive domestic violence screen should be referred for treatment. Treatment varies from formal domestic violence consultations to safe havens.
The neuroimaging window into the brain structure and physiology of alcohol and other substances abuse disorders has already provided a wealth of insight into the characterization of common and specific neuropathology. Magnetic resonance (MR) neuroimaging is uniquely suited for the delineation of the nature of alcohol and substance abuse induced neuropathology. Alcoholism is a lifelong disorder that interacts with the dynamic changes that occur in the brain throughout the life span from adolescence to senescence. Functional MR studies of craving during abstinence could provide predictors of prognosis for relapse and recovery. There are potential beneficial effects of many abused substances. Opiates are used to reduce pain; psychostimulants, including nicotine, are used to maintain alertness in dangerous battle conditions. Marijuana is used for nausea control and appetite stimulation; and alcohol in moderation has cardiovascular and cerebrovascular protective properties demonstrable with neuroimaging.
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