Co-Occurring Psychotic and Addictive Disorders

Abstract

Psychosis and substance abuse are intimately related. Psychotic spectrum illnesses commonly co-occur with substance use disorders (SUDs), and many substances of abuse can cause or exacerbate psychotic symptoms along a temporal spectrum from acute to chronic presentations. Despite the common co-occurrence between psychotic spectrum illnesses and SUDs, they are often under-recognized and undertreated, leading to poor treatment outcomes. Accurate detection and diagnosis of individuals with psychotic illness co-occurring with addictive disorders is key to properly treat such disorders. This article will review the nature of the relationship between psychosis and substance abuse by examining prevalence rates of each disorder alone and their rates of co-occurrence, the neurobiological basis for substance abuse comorbidity in schizophrenia spectrum disorders, key and salient aspects related to accurate diagnosis along a continuum from acute to subacute to chronic conditions, and pitfalls associated with diagnostic dilemmas. A case example will be used to highlight key points related to diagnostic challenges.

Psychological disturbances in adolescents with acute voluntary poisoning

“…Another entity with an increased frequency in the analyzed group is the behavioral disorder associated with the chronic consumption of substances of abuse. It is difficult to define whether a pre-existing psychiatric pathology favors the development of addiction or the consumption of substances of abuse causes changes in the functioning of the nervous system (12), but behavioral disorders associated with the consumption increase the risk of acute intoxication and suicide, patients requiring specialist counseling (13).…”

Changes in psychiatry residents’ attitudes towards individuals with substance use disorders over the course of residency training

“…Stigmatizing attitudes from clinicians decrease help‐seeking and worsen psychological distress among individuals diagnosed with mental illness . Although psychiatrists treat individuals with psychotic spectrum disorders and SUDs frequently, they often under‐recognize and under‐treat these individuals, leading to poor outcomes …”

Comorbidity of psychotic disorder and substance use disorder in a psychiatry inpatient unit: A retrospective study

“…Ayrýca, ilk atak psikoz olgularýnda madde kötüye kullanýmýnýn, bir tetikleyici olabileceði ve bu olgularýn %20-35'inde madde kötüye kullanýmý öyküsünün mevcut olduðu bildirilmektedir (2 Bu iki bozukluk bir arada olduðunda, ortaya çýkýþ þeklinden baðýmsýz olarak, çoðunlukla yetersiz tanýnýr ve etkin þekilde tedavi edilmez. Her iki bozukluða ayrý ayrý sahip olan hastalara kýyasla, bu bozukluklarý bir arada taþýyan hastalarda prognoz genellikle daha olumsuzdur ve hastalýk daha þiddetli seyretme eðilimindedir (4). Ayrýca bu birliktelik varlýðýnda; hastalýklarýn tekrarlama olasýlýðý, psikososyal iþlevsellik, tedaviye uyum, hastaneye yatýþ, þiddet, özkýyým, yasal sorunlar, týbbi hastalýklar, acil servis ve yataklý birimlerin kullanýmý gibi pek çok alanda uzunlamasýna seyir daha kötü olabilir (4,5).…”

“…Her iki bozukluða ayrý ayrý sahip olan hastalara kýyasla, bu bozukluklarý bir arada taþýyan hastalarda prognoz genellikle daha olumsuzdur ve hastalýk daha þiddetli seyretme eðilimindedir (4). Ayrýca bu birliktelik varlýðýnda; hastalýklarýn tekrarlama olasýlýðý, psikososyal iþlevsellik, tedaviye uyum, hastaneye yatýþ, þiddet, özkýyým, yasal sorunlar, týbbi hastalýklar, acil servis ve yataklý birimlerin kullanýmý gibi pek çok alanda uzunlamasýna seyir daha kötü olabilir (4,5). Buna ek olarak, bu bozukluklardan birinin tedavisindeki baþarýsýzlýk, diðer hastalýðýn uzunlamasýna seyir ve þiddetini de olumsuz etkileyebilir (6).…”