Substance abuse co-morbidity in schizophrenia: An inpatient study of course and outcome

BACKGROUND: Differences in opinion exist among researchers in relation to the course and outcome of substance abuse co-morbidity in schizophrenia. AIM: To compare the pattern of remission of symptoms in positive and negative schizophrenics with and without a history of substance abuse. METHODS: Seventy schizophrenics were divided into two groups based on the history of presence or absence of substance abuse/dependence. Thirty-eight patients (54.3%) were diagnosed as having co-morbid alcohol/substance abuse/dependence. Patients were rated at two-weekly intervals on the Positive and Negative Syndrome Scale (PANSS) with one follow-up rating by the end of the third month. Co-morbid substance abusers were predominantly represented by a positive syndrome and non-abusers by a negative syndrome at the time of admission. RESULTS: Psychopathology remitted much faster in the substance-abusing group but after discharge, these patients tend to return to their pre-admission state. CONCLUSION: The following hypothesis is proposed based on the findings of the present study: ‘Short-term inpatient outcome of substance-abusing schizophrenics is significantly better than non-substance abusing schizophrenics because of the faster rate of remission of their symptoms.’ A corollary to the above hypothesis may be evolved—‘through intense inpatient follow-up one may be able to differentiate substance-abusing and non-abusing schizophrenics’.