Schizophrenia and addictions: Exploratory study among 106 patients followed in consultation

Objective. - Schizophrenic patients are more affected by addictions than the general population. Tobacco, alcohol and cannabis are the most used substances among this specific population. The association between schizophrenia and addictive disorders has a negative impact on the clinical evolution of mental illness, social and life-threatening issues. In France, medico-psychological centers (CMP) are specific institutions that offer outpatients care. There is no French data describing substances consumption in schizophrenic patients who benefit from ambulatory care. We aim to investigate tobacco, alcohol or cannabis use in a sample of outpatient with schizophrenia. Method. - This exploratory study was conducted among 106 schizophrenic outpatients (fulfilling the DSM-IV criteria). An evaluation of their addictive behavior (alcohol ingestion, smoking, cannabis consumption) was undertaken. The variables were assessed with validated questionnaires. We used Fagerstrom scale and dependence scale according to the DSM-IV criteria for tobacco use, an AUDIT, a CAGE scale and a dependence scale according to the DSM-IV criteria for alcohol use, a CAST questionnaire for cannabis use, and lastly, a questionnaire on socio-demographic characteristics survey. Statistical tests were performed using Epi Info (TM) software (p < 0.05). Results. - The mean age of participants was 47 [+/- 12] years, 66 % were men. Among the population of 106 schizophrenic outpatients, 64,1 % used tobacco and men were significantly more often smokers. More than one-half, 52,8 % of our population had a tobacco dependence according to the DSM-IV, and 82,4 % of the smokers were concerned. Moreover, 49,1 % of the population and 76,5 % of the smokers have developed a physical dependence to tobacco. Approximately 89,6 % used alcohol. A misuse of alcohol was revealed for 21,7 % by the AUDIT scale and 24,5 % by the CAGE scale. According to DSM-IV, 13,2 % were dependent on alcohol, and 11,3 % had a physical dependence. Based on CAST scale, 9,4 % of the outpatients with schizophrenia were dependent on cannabis. Substances use and abuse were highly comorbid (p < 0.05). All of cannabis users were tobacco smokers, with more probabilities to be concerned by tobacco dependence. Patients with a dependence of alcohol were mainly associated to tobacco or cannabis dependence. Conclusion. - These results give a first description of substances use and misuse within a population of schizophrenic outpatients. Patients with schizophrenia are particularly vulnerable to addictive behaviors compared to the general population, especially concerning tobacco and alcohol, whereas cannabis consumption is in the lower range for a schizophrenic population. This prospective analysis shows the importance of a screening of addictions of schizophrenic patients, in the early care. Thereby, an appropriate and global care could be proposed. (C) 2018 Elsevier Masson SAS. All rights reserved.