The prevalence and clinical correlates of substance use disorders in patients with psychotic disorders from an Upper-Middle-Income Country

Abstract

Background: Substance use disorders (SUDs) occur frequently in patients with psychotic disorders and have been associated with various demographic and clinical correlates. There is an absence of research on the prevalence and clinical correlates of SUDs in psychotic disorders in low-and-middle-income countries (LMICs).Aim: We aimed to determine the prevalence and correlates of SUDs in psychotic disorders.Setting: Patients attending a large secondary-level psychiatric hospital in Cape Town South Africa.Methods: We used the Structured Clinical Interview for DSM-IV (SCID-I) to determine psychiatric and substance use diagnoses, depressive, anxiety, obsessive-compulsive and post-traumatic symptoms. We used logistic regression models to determine significant predictors of SUDs.Results: In total sample (N = 248), 55.6% of participants had any SUD, 34.3% had cannabis use disorders, 30.6% alcohol use disorders, 27.4% methamphetamine use disorders, 10.4% methaqualone use disorders and 4.8% had other SUDs. There were significant associations with male sex for most SUDs, with younger age and Coloured ethnicity for methamphetamine use disorders, and with lower educational attainment for cannabis use disorders. Anxiety symptoms and suicide attempts were significantly associated with alcohol use disorders; a diagnosis of a substance induced psychosis with cannabis and methamphetamine use disorders. Across most SUDs legal problems and criminal involvement were significantly increased.Conclusion: This study found a high prevalence and wide distribution of SUDs in patients with psychotic disorders, consistent with previous work from high income countries. Given clinical correlates, in individuals with psychotic disorders and SUDs it is important to assess anxiety symptoms, suicidality and criminal involvement.

Prevalence and Demographic Correlates of Substance Use among Adults with Mental Illness in Eastern Cape, South Africa: A Cross-Sectional Study

“…The Epidemiologic Catchment Area Study, a large study carried out in the United States, found a prevalence rate of co-morbidity of 29% [12]. A study done in the Western Cape of South Africa showed a prevalence rate of 55.6% [13]. All of the studies had a confidence interval of 95%.…”

Prevalence of cannabis use in people with psychosis in KwaZulu-Natal, South Africa

“…24,25 Data from South Africa (SA) and other African countries have shown similar findings, with unemployment, being single, an inpatient status, and recurrent admissions being additional factors associated with cannabis use. 5,15,16,19,26,27 Hence we note a high comorbidity between cannabis use and psychosis, and that the dual diagnosis of a cannabis use and psychotic disorder is a poor prognostic factor. A study conducted in India had similar findings where cannabis use had a high prevalence for psychotic disorder and this co-occurrence is a poor prognostic factor.…”

“…Temmingh and Mall, in their Western Cape cohort, reported a lower prevalence of 34.3%, which may be because of their assessing for substance use disorder rather than cannabis use. 15 In the Western Cape Province (SA), 57% of adolescents presenting with FEP were reported to be cannabis users. 21 Paruk et al 20 reported the prevalence of cannabis use at 68.8% in adolescents with FEP in KZN, while Burns et al 36 reported 35% prevalence of comorbid cannabis use in their adult FEP sample.…”

“…19,20,21 A Cape Town study found the most common substance use disorder associated with psychosis was cannabis use disorder, with a prevalence of 34.3%. 15 Recent studies show that the use of high potency cannabis increases the risk of FEP and subsequent schizophrenia, and that psychosis and prodromal schizophrenia symptoms may also exacerbate cannabis use. 22 Genetics and environmental factors play a role in this bidirectional relationship between psychosis and cannabis use.…”

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The literature suggests a high prevalence of comorbid cannabis use among people with psychotic disorders, 15,16 with the concurrent use of other substances, for example alcohol, also Background: There is a high prevalence of cannabis use in patients with schizophrenia spectrum and other psychotic disorders, with comorbid cannabis use in this population being associated with poorer long-term outcomes.Aim: To determine the prevalence of cannabis use in patients with a schizophrenia spectrum and other psychotic disorders.Setting: The study was conducted at a psychiatric hospital in Durban,

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