Original Research

The prevalence and clinical correlates of substance use disorders in patients with psychotic disorders from an Upper-Middle-Income Country

Henk S. Temmingh, Sumaya Mall, Fleur M. Howells, Goodman Sibeko, Dan J. Stein
South African Journal of Psychiatry | Vol 26 | a1473 | DOI: https://doi.org/10.4102/sajpsychiatry.v26i0.1473 | © 2020 Henk S. Temmingh, Sumaya Mall, Fleur M. Howells, Goodman Sibeko, Dan J. Stein | This work is licensed under CC Attribution 4.0
Submitted: 07 October 2019 | Published: 28 July 2020

About the author(s)

Henk S. Temmingh, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
Sumaya Mall, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; and, Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
Fleur M. Howells, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; and, Neuroscience Institute of South Africa, Cape Town, South Africa
Goodman Sibeko, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
Dan J. Stein, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; and, Neuroscience Institute of South Africa, Cape Town, South Africa; and, MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa


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Abstract

Background: Substance use disorders (SUDs) occur frequently in patients with psychotic disorders and have been associated with various demographic and clinical correlates. There is an absence of research on the prevalence and clinical correlates of SUDs in psychotic disorders in low-and-middle-income countries (LMICs).

Aim: We aimed to determine the prevalence and correlates of SUDs in psychotic disorders.

Setting: Patients attending a large secondary-level psychiatric hospital in Cape Town South Africa.

Methods: We used the Structured Clinical Interview for DSM-IV (SCID-I) to determine psychiatric and substance use diagnoses, depressive, anxiety, obsessive-compulsive and post-traumatic symptoms. We used logistic regression models to determine significant predictors of SUDs.

Results: In total sample (N = 248), 55.6% of participants had any SUD, 34.3% had cannabis use disorders, 30.6% alcohol use disorders, 27.4% methamphetamine use disorders, 10.4% methaqualone use disorders and 4.8% had other SUDs. There were significant associations with male sex for most SUDs, with younger age and Coloured ethnicity for methamphetamine use disorders, and with lower educational attainment for cannabis use disorders. Anxiety symptoms and suicide attempts were significantly associated with alcohol use disorders; a diagnosis of a substance induced psychosis with cannabis and methamphetamine use disorders. Across most SUDs legal problems and criminal involvement were significantly increased.

Conclusion: This study found a high prevalence and wide distribution of SUDs in patients with psychotic disorders, consistent with previous work from high income countries. Given clinical correlates, in individuals with psychotic disorders and SUDs it is important to assess anxiety symptoms, suicidality and criminal involvement.


Keywords

substance use; schizophrenia; psychosis; clinical correlates; low-and-middle-income countries

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