Psikotik bozukluğu olan yatan erkek hastalarda psikoaktif madde kullanımının klinik değişkenler ile ilişkisi

Year 2020, Volume: 45 Issue: 4, 1783 - 1791, 27.12.2020

Mahmut Onur Karaytuğ , Lut Tamam , Mehmet Emin Demirkol , Zeynep Namlı , Caner Yeşiloğlu

Abstract

Amaç: Çalışmamızda bir bölge ruh sağlığı ve hastalıkları hastanesinde yatarak tedavi gören psikotik bozukluk tanılı hastalarda eşlik eden psikoaktif madde(PAM) kullanımının sosyodemografik özelliklerle ilişkisinin ve klinik özellikler üzerine olası etkilerinin tespit edilmesi amaçlanmıştır.
Gereç ve Yöntem: Çalışmamıza DSM-5’e göre psikotik bozukluk tanısı konmuş, yatarak izlenen 110 hasta dahil edilmiştir. Tüm katılımcıların arşiv-dosya incelemesi ile sosyodemografik veri formuna ve hastaların sigara, alkol, PAM kullanımı, yatış sayısı, hastalık süresi, son yatış süresi, intihar ve başkalarına zarar verme girişimi öyküsü gibi klinik özelliklerine ulaşıldı. Yatış esnasında tespit gerekliliği ve yasal sorun geçmişi araştırıldı.
Bulgular: Psikotik bozukluğu olan 110 hastanın %30,9’unun (N=34), psikoaktif madde kullanmakta olduğu görüldü. Madde kullanan hastaların %17,3‘ünün esrar, %7,3’ünün amfetamin, %0,9’unun kokain, %0,9’unun eroin, %2,7’sinin inhaler ve %1,8’inin çoklu madde tercih ettiği görülmüştür. Psikoaktif madde kullanan hastaların yaş ortalaması, kullandığı antipsikotik sayısı, uygulanan tespit oranı, yasal sorun yaşama, alkol ve sigara kullanımı ve homisid girişimi oranı psikoaktif madde kullanmayanlardan anlamlı olarak farklıydı.
Tartışma: Psikotik bozukluklarda madde kullanım komorbiditesi küçümsenmeyecek oranlarda görülmektedir. Psikoaktif madde kullanan hastalarda daha fazla antipsikotik kombinasyonu kullanılması, yatış sırasında daha çok tespit uygulanması, homosidal girişim ve yasal sorun geçmişinin fazla olması gibi elde edilen sonuçlar, madde kullanımının psikotik bozukluk tanılı hastaların takip ve tedavisini güçleştirdiğini desteklemektedir.

Keywords

psikoz, psikoaktif madde, yatan hasta

The relationship of psychoactive substance use with clinical variables in male inpatients with psychotic disorder

Abstract

Purpose: We aimed to determine the relationship between psychoactive substance (PAS) use and sociodemographic and clinical characteristics in patients with psychotic disorders in a regional mental health and disease hospital.
Materials and Methods: We included 110 inpatients diagnosed with psychotic disorders according to DSM-5 criteria. We investigated clinical records to determine the patients' sociodemographic data and characteristics, such as smoking, alcohol, use of PAS, number of hospitalizations, duration of the disorder and last hospitalization, suicide attempts, and attempted harm to others. We also investigated whether the medical staff applied physical restraints during the hospitalization and the presence of legal problems.
Results: Thirty-four (30.9%) of 110 patients with a psychotic disorder were using psychoactive substances. The preferred substances were 17.3% cannabis, 7.3% amphetamine, 0.9% cocaine, 0.9% heroin, 2.7% inhaler, respectively. We found that the PAS users differed from not users with age, the number of antipsychotics used, the rate of restraints, legal problems, alcohol and smoking, and homicide attempts.
Conclusion: Comorbidity of substance use in psychotic disorders is seen at rates that cannot be underestimated. The results obtained such as using more antipsychotic combinations in patients using psychoactive substances, application of more detection during hospitalization, homocidal intervention and high legal problem history support that substance use makes the follow-up and treatment of patients diagnosed with psychotic disorders difficult.

References

• 1. Martinotti G, Lupi M, Acciavatti T, Cinosi E, Santacroce R, Signorelli MS et al. Novel psychoactive substances in young adults with and without psychiatric comorbidities. Biomed Res Int. 2014;1-7.
• 2. Gregg L, Barrowclough C, Haddock G. Reasons for increased substance use in psychosis. Clin Psychol Rev. 2007;27(4):494-510.
• 3. Barnett JH, Werners U, Secher SM, et al. Substance use in a population-based clinic sample of people with first-episode psychosis. Br J Psychiatry. 2007;190(6):515-20.
• 4. Kavanagh DJ, Waghorn G, Jenner L, Chant DC, Carr V, Evans M et al. Demographic and clinical correlates of comorbid substance use disorders in psychosis: multivariate analyses from an epidemiological sample. Schizophr Res. 2004;66(2-3):115-124.
• 5. Weaver T, Madden P, Charles V, Stimson G, Renton A, Tyrer P et al. Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. Br J Psychiatry. 2003;183(4):304-313.
• 6. Potvin S, Stip E, Roy J, Roy J. Données cliniques , expérimentales et biologiques Schizophrenia and Cannabinoids Clinical , Experimental and Biological Data Schizophrénie et cannabinoïdes : données cliniques , expérimentales et biologiques. 2020;2(2):19-34.
• 7. Güleç MY, Elbay RY, Şayakçı S, Meteris H, Hariri AG, Tezcan AE. Yatan psikiyatri hastalarında madde kullanımı ve hastalıklara göre dağılımı: Retrospektif bir çalışma. Dusunen Adam J Psychiatry Neurol Sci. September 2010:166-73. doi:10.5350/dajpn2010230304
• 8. Gray R, Bressington D, Hughes E, Ivanecka A. A systematic review of the effects of novel psychoactive substances “legal highs” on people with severe mental illness. J Psychiatr Ment Health Nurs. 2016;23(5):267-81. doi:10.1111/jpm.12297
• 9. Baeza I, Graell M, Moreno D, Castro-Fornieles J, Parellada M, González-Pinto A et al. Cannabis use in children and adolescents with first episode psychosis: Influence on psychopathology and short-term outcome (CAFEPS study). Schizophr Res. 2009;113(2-3):129-37. doi:10.1016/j.schres.2009.04.005
• 10. Swartz JA, Lurigio AJ. Screening for serious mental illness in populations with co-occurring substance use disorders: Performance of the K6 scale. J Subst Abuse Treat. 2006;31(3):287-96. doi:10.1016/j.jsat.2006.04.009
• 11. Dubertret C, Bidard I, Adès J, Gorwood P. Lifetime positive symptoms in patients with schizophrenia and cannabis abuse are partially explained by co-morbid addiction. Schizophr Res. 2006;86(1-3):284-90. doi:10.1016/j.schres.2006.05.006
• 12. Kamali M, Mctigue O, Whitty P, Gervin M, Clarke M, Browne S et al. Lifetime history of substance misuse in first-episode psychosis: Prevalence and its influence on psychopathology and onset of psychotic symptoms. Early Interv Psychiatry. 2009;3(3):198-203. doi:10.1111/j.1751-7893.2009.00133.x
• 13. Katz G, Durst R, Shufman E, Bar-Hamburger R, Grunhaus L. Cannabis abuse and severity of psychotic and affective disorders in Israeli psychiatric inpatients. Compr Psychiatry. 2010;51(1):37-41. doi:10.1016/j.comppsych.2009.03.008
• 14. Barrowclough C, Gregg L, Lobban F, Bucci S, Emsley R. The Impact of Cannabis Use on Clinical Outcomes in Recent Onset Psychosis. Schizophr Bull. 2015;41(2):382-90. doi:10.1093/schbul/sbu095
• 15. Compton MT, Furman AC, Kaslow NJ. Lower negative symptom scores among cannabis-dependent patients with schizophrenia-spectrum disorders: Preliminary evidence from an African American first-episode sample. Schizophr Res. 2004;71(1):61-4. doi:10.1016/j.schres.2004.01.005
• 16. Potvin S, Mancini-Marïe A, Fahim C, Mensour B, Stip E. Processing of social emotion in patients with schizophrenia and substance use disorder: An fMRI study. Soc Neurosci. 2007;2(2):106-16. doi:10.1080/17470910701376787
• 17. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13(2):261-76.
• 18. Kostakoğlu E, Batur S, Tiryaki A, Göğüs A. Pozitif ve Negatif Sendrom Ölçeğinin (PANSS) Türkçe uyarlamasının geçerlik ve güvenilirliği. Türk Psikol Derg. 14:23-32.
• 19. Verdoux H, Geddes JR, Takeı N, Murray RM. Dr. Verdoux and Colleagues Reply. Am J Psychiatry. 1998;155(11):1644-5.
• 20. Perkins DO, Gu H, Boteva K, Lieberman JA. Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry. 2005;162(10):1785-804.
• 21. Barnes TRE, Mutsatsa SH, Hutton SB, Watt HC, Joyce EM. Comorbid substance use and age at onset of schizophrenia. Br J Psychiatry. 2006;188(3):237-42.
• 22. Sancak B, Özer Ü, Özgen G, Uzun U. Bir akut psikoz kliniğinde yatan erkek hastalarda psikoaktif madde kullanımı ve klinik değişkenler üzerine etkisi. Bağımlılık Derg. 2014;15:72-167.
• 23. Potvin S, Stip E, Roy J-Y. Schizophrénie et cannabinoïdes: données cliniques, expérimentales et biologiques. Drog santé société. 2004;2(2).
• 24. Kerner B. Comorbid substance use disorders in schizophrenia: a latent class approach. Psychiatry Res. 2015;225(3):395-401.
• 25. Lorabi O, Samalin L, Llorca PM. Comorbidités somatiques et schizophrénie: une interaction multifactorielle complexe. Lett Psychiatre. 2010;6(6):200-6.
• 26. Toufiq J, El Omari F, Sabir M. Drug use in Moroccan schools MedSPAD2009-2010 report. 2011.
• 27. El Omari F, Sabir M, Toufiq J. L’usage de drogues auprès des élèves marocains. Rapp MedSPAD. 2013.
• 28. Fergusson DM. Is there a causal linkage between cannabis use and increased risks of psychotic symptoms? Addiction. 2010;105:1336-7.
• 29. Kristensen K, Cadenhead KS. Cannabis abuse and risk for psychosis in a prodromal sample. Psychiatry Res. 2007;151(1-2):151-4.
• 30. Kuepper R, van Os J, Lieb R, Wittchen H-U, Höfler M, Henquet C. Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. Bmj. 2011;342:d738.
• 31. Margolese HC, Malchy L, Negrete JC, Tempier R, Gill K. Drug and alcohol use among patients with schizophrenia and related psychoses: levels and consequences. Schizophr Res. 2004;67(2-3):157-66.
• 32. Westermeyer J. Comorbid schizophrenia and substance abuse: a review of epidemiology and course. Am J Addict. 2006;15(5):345-55.
• 33. Dilbaz N, Darçın AE. Şizofreni ve madde kullanım bozukluğu eş tanılı hastalarda tedavi. Klin Psikofarmakol Bülteni-Bulletin Clin Psychopharmacol. 2011;21(1):80-90.
• 34. Aich TK, Sinha VK, Khess CRJ, Singh S. Demographic and clinical correlates of substance abuse comorbidity in schizophrenia. Indian J Psychiatry. 2004;46(2):135-139.
• 35. Dixon L, Wohlheiter K, Thompson D. Comprehensive care of schizophrenia. A textbook of clinical management. Lieberman JA, Murray RM (eds). Dunitz 2001.) Oxford University Press; 2012.
• 36. Jann MW, Saklad SR, Ereshefsky L, Richards AL, Harrington CA, Davis CM. Effects of smoking on haloperidol and reduced haloperidol plasma concentrations and haloperidol clearance. Psychopharmacology (Berl). 1986;90(4):468-70.
• 37. Demir Ç, Ceylan E, Önal O, Özgün F. Şizofrenili hastalarda sigara içiminin antipsikotik tedavi etkinliği ve ilaç yan etkileri üzerine etkisi. Klin Psikofarmakol Bülteni. 2002;12(2):69-77.
• 38. Karşıdağ Ç. Şizofreni ve sigara bağımlılığı. Dusunen Adam. 2005;18(1):13-20.
• 39. Uzun Ö, Cansever A, Basoğlu C, Özşahin A. Smoking and substance abuse in outpatients with schizophrenia: a 2-year follow-up study in Turkey. Drug Alcohol Depend. 2003;70(2):187-92.
• 40. Üçok A, Polat A, bozkurt OYA, Meterıs H. Cigarette smoking among patients with schizophrenia and bipolar disorders. Psychiatry Clin Neurosci. 2004;58(4):434-7.
• 41. Araki H, Suemaru K, Gomita Y. Neuronal nicotinic receptor and psychiatric disorders: functional and behavioral effects of nicotine. Jpn J Pharmacol. 2002;88(2):133-18.
• 42. Leonard S, Adler LE, Benhammou K, et al. Smoking and mental illness. Pharmacol Biochem Behav. 2001;70(4):561-70.
• 43. Mihailescu S, Drucker-Colı́n R. Nicotine, brain nicotinic receptors, and neuropsychiatric disorders. Arch Med Res. 2000;31(2):131-44.
• 44. Wise RA, Gardner EL. Functional Anatomy of Substance‐Related Disorders. Biol Psychiatry. 2002:509-22.
• 45. Adler LE, Hoffer LD, Wiser A, Freedman R. Normalization of auditory physiology by cigarette smoking in schizophrenic patients. Am J Psychiatry. 1993;150(12):1856-61.
• 46. Lyon ER. A review of the effects of nicotine on schizophrenia and antipsychotic medications. Psychiatr Serv. 1999;50(10):1346-50.
• 47. Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL et al. Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) study. Jama. 1990;264(19):2511-18.
• 48. Karakus G, Evlice YE, Tamam L. Prevalence of Alcohol and Substance Use Disorder among Psychiatric Inpatients. CUKUROVA Med J. 2012;37(1):37-48.
• 49. Bouskoul M, Akebour K, Gourti M, Adalia I, Manoudia F, Asria F. Comorbidityschizophrenia and Psychoactive Substances Use. IJSR. 2019;8(1):1096-100.
• 50. Migon MN, Coutinho ES, Huf G, Adams CE, Cunha GM, Allen MH. Factors associated with the use of physical restraints for agitated patients in psychiatric emergency rooms. Gen Hosp Psychiatry. 2008;30(3):263-8.