Mauri M C, Volonteri L S, De Gaspari I F, Colasanti A, Brambilla M A, Cerruti L
Clinical Psychiatry, Neuropsychopharmacology Unit, University of Milan, IRCCS Fondazione Ospedale Maggiore Policlinico, Via F,Sforza 35, 20122 Milano, Italy.
Clin Pract Epidemiol Ment Health. 2006 Mar 23;2:4. doi: 10.1186/1745-0179-2-4.
Several studies suggest a high comorbidity of substance abuse and schizophrenia, associated with higher frequency of relapse, more positive symptoms and depression, cognitive impairment, poorer outcome and treatment response. A high incidence of substance abuse is also observed in first-episode patients. Among patients with substance abuse, the onset precedes the onset of psychosis of several years in most cases. All the patients with a first episode of schizophrenia, at first admission to the Psychiatric Service of Diagnosis and Treatment of Ospedale Maggiore of Milan during the years 1990 to 2004, have been included in our study.The clinical evaluation has been obtained considering the following items of Brief Psychiatric Rating Scale (BPRS): conceptual disorganization, depressed mood, hostility, hallucinations, unusual content of thought.The results showed that 34.7% of first-episode schizophrenic patients had a lifetime history of substance abuse. The age of onset of schizophrenia is significantly lower for drug abusers than for patients without any type of abuse and for alcohol abusers (p < 0.005). In multi drug abusers, cannabis resulted the most frequently used (49%), followed by alcohol (13%), and cocaine (4%). Substance abusers have obtained a significant higher score in "thought disturbance" item (p < 0.005) and in "hostility" item (p < 0.005) compared to non substance abusers. Non drug abusers showed lower mean scores of "hostility" item compared to cocaine abusers and multi drug abusers (p < 0.005). Our findings seem to indicate that substance abuse in the early course of illness determines an earlier onset of schizophrenia and increases severity of some psychotic symptoms like "hallucination" and "unusual content of thought". Therefore persons incurring a risk of schizophrenia may be warned of the possible relation between substances and psychosis and have to be counselled against the use of them.
多项研究表明，药物滥用与精神分裂症的共病率很高，这与更高的复发频率、更多的阳性症状和抑郁、认知障碍、更差的预后及治疗反应相关。在首发患者中也观察到药物滥用的高发生率。在药物滥用患者中，多数情况下药物滥用的起病先于精神病性症状数年。我们的研究纳入了1990年至2004年期间首次入住米兰马焦雷医院诊断与治疗精神科的所有首发精神分裂症患者。临床评估采用简明精神病评定量表（BPRS）的以下项目：概念紊乱、抑郁情绪、敌意、幻觉、思维内容异常。结果显示，34.7%的首发精神分裂症患者有药物滥用史。药物滥用者的精神分裂症起病年龄显著低于无任何类型滥用的患者及酒精滥用者（p<0.005）。在多药滥用者中，大麻是最常使用的药物（49%），其次是酒精（13%）和可卡因（4%）。与非药物滥用者相比，药物滥用者在“思维紊乱”项目（p<0.005）和“敌意”项目（p<0.005）上得分显著更高。与可卡因滥用者和多药滥用者相比，非药物滥用者的“敌意”项目平均得分更低（p<0.005）。我们的研究结果似乎表明，疾病早期的药物滥用会导致精神分裂症更早起病，并增加一些精神病性症状如“幻觉”和“思维内容异常”的严重程度。因此，可能患精神分裂症的人可能会被告知药物与精神病之间的可能关系，并应得到关于避免使用药物的咨询。
