Psychosis and substance abuse.

Susana Vaz Carneiro, Mário Borrego


The objective of this retrospective study covering a period of 4 years (2001-2004), is to characterize and chart the clinical profiles of acute patients in the psychiatric inpatients ward of Hospital S. Francisco Xavier diagnosed with psychosis and substance abuse. During this period, 422 patients diagnosed with nonaffective psychosis (292, 295, 297 and 298, according to ICD9) were admitted. An analysis of the clinical profiles of these inpatients shows that a high percentage (42%) have psychotic pathologies and an history of substance abuse. These are predominantly young males. Schizophrenic patients with an history of substance abuse reached 40%. A particularly relevant finding in view of the fact that substance abuse leads to worse prognostics. Cannabinoids are by far the most widely abused substance, followed by alcohol. There are also 7.2% psychosis due to drug use in which the drug of choice was cannabis. In the light of current scientific knowledge, this is very relevant fact since the use of cannabinoids appears to be a risk factor for the onset of schizophrenia. It was observed that, often, due importance is not given to this association since few nodrug assays are carried out and when they are, they don't cover all drugs. Therefore, this study should alert medical staff to the high prevalence of substance abuse amongst psychotic patients, and to the necessity for a proactive stance in the detection of substance abuse in order to facilitate the development of better therapeutic projects which take into consideration this comorbidity and seek to promote psychoeducation of patients.

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