Schizophrenia & Substance Use - A Q methodological study

An abstract from the February issue of Mental Health and Substance Use: dual diagnosis:

Self-reported reasons for substance use in schizophrenia: a Q methodological investigation

Mental Health and Substance Use: dual diagnosis, Volume 2, Issue 1 February 2009, pages 24-39.

By Lynsey Gregg, Gillian Haddock, and Christine Barrowclough

Division of Clinical Psychology, School of Psychological Sciences, University of Manchester, UK

Abstract:

Large numbers of people with a diagnosis of schizophrenia use drugs and alcohol, resulting in poorer symptomatic and functional outcomes for many.

Aims: To examine the reasons that people with a diagnosis of schizophrenia give for their own alcohol and drug use.

Method: Q methodology was used to examine reasons for use. Forty-five people with a diagnosis of schizophrenia or schizoaffective disorder and comorbid substance misuse completed the sorting procedure.

Results: Analysis of the Q Sorts revealed three distinct groups of substance users:

1. those who predominantly used for social and enhancement reasons, to 'chill out and have a good time with others';
2. those who used to regulate negative affect and alleviate positive symptoms, to 'cope with distressing emotions and symptoms';
3. those who used substances to augment themselves and intensify their experiences, to 'feel bigger, better and inspired'.
   

Conclusion: People with a diagnosis of schizophrenia who use substances explain their substance use in different ways. The identification of subgroups of users may be useful in the development of interventions aimed at reducing substance use in this group.

Posting of this abstract is for the purposes of research into schizophrenia and dual diagnosis.

I thank the Lancashire Care Library & Information Service for bringing this article to my attention.

Suicide risk in schizophrenia: learning from the past to change the future

The abstract of a review paper published in the March 16, 2007, edition of Annals of General Psychiatry:

By Maurizio Pompili, Xavier F. Amador, Paolo Girardi1, Jill Harkavy-Friedman, Martin Harrow, Kalman Kaplan, Michael Krausz, David Lester, Herbert Y Meltzer, Jiri Modestin, Lori P. Montross, Preben Bo Mortensen, Povl Munk-Jørgensen, Jimmi Nielsen, Merete Nordentoft, Pirjo Irmeli Saarinen, Sidney Zisook, Scott T Wilson and Roberto Tatarelli

Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5–13% of [individuals living with schizophrenia] die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that [people living with schizophrenia] who [are] more likely to commit suicide [are] young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal [individuals with schizophrenia] usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal patients with schizophrenia, yet some researchers argue that insight into the illness does not increase suicide risk.

Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening [these individuals] for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures.

This review paper is the results of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as
well as the development of a set of guidelines for reducing suicide risk among schizophenia patients.

I have taken the liberty to edit the abstract to remove the word schizophrenic.

To read the entire paper, click here (PDF).

Thanks go to the Lancashire Care Library & Information Service for bringing this paper to my attention.