Comorbidity of cocaine abuse and schizophrenia: An examination of clinical functioning across an acute episode (original) (raw)
Related papers
Neurocognitive Characteristics of Individuals With Schizophrenia and Cocaine Dependence
Journal of Nervous and Mental Disease, 2009
Several investigations of cognitive functioning in indivduals with schizophrenia and co-occurring cocaine use have yielded mixed results when compared to samples with schizophrenia only. However, no studies have specifically compared remitted and current cocaine dependence in schizophrenia. Such an analyis could help clarify the degree and type of cognitive impairment associated with cocaine dependence in schizophrenia. Two samples of individuals with schizophrenia-those with current cocaine dependence (SZ-D; n = 72) and those with cocaine dependence in remission (SZ-R; n = 48) were compared on a brief neuropsychological test battery. Parallel current dependent and remitted samples with affective disorder (AD-D; n = 65 and AD-R; n = 55) were also included in the analyses. Results yielded few neuropsychological differences between remitted and current dependent states across the SZ and AD groups. These findings suggest that cognitive impairment may be relatively static in these populations.
Neuropsychological effects associated with recreational cocaine use
Psychopharmacology, 2012
RATIONALE: Recent evidence suggests that recreational cocaine use is on the increase, with the UK reporting one of the highest levels of use in the EU (EMCDDA 2010). Nevertheless, very few studies have addressed the neuropsychological effects associated with non-dependent recreational cocaine use. OBJECTIVES: The current study aimed to assess whether recreational cocaine users show neuropsychological deficits on a battery of tests, previously shown to be sensitive to cocaine-dependent and psychosis-prone individuals. Schizotypal traits were also measured. METHODS: Recreational cocaine users (n = 17) were compared with controls (n = 24) on drug use patterns, the General Health Questionnaire, the Brief Schizotypal Personality Questionnaire (SPQ-B) and four neuropsychological tasks: spatial working memory, intra/extra-dimensional set shifting, the Stocking of Cambridge and the rapid visual processing. RESULTS: Relative to controls, recreational cocaine users produced significantly more...
Neuropsychological functioning and age-related changes in schizophrenia and/or cocaine dependence
2013
Although little is known about the combined effects of Schizophrenia (SZ) and Substance Use Dependence (SUD) in neurocognitive functioning, the current literature points out that performance depends on the specific cognitive domains, the age of individuals and the type of substance of abuse. Our aim is to elucidate, in a sample with SZ and/or cocaine dependent individuals in remission for more than 4 months, their performance in attention, verbal memory and speed of processing, taking into account the possible effect of both age and duration of SUD. The total sample consisted of 95 male patients, aged 20 to 60 years, divided in three groups: one group with SZ and cocaine dependence (SZ+), another group with SZ without cocaine dependence (SZ−) and a third group with cocaine dependence without psychiatric comorbidity (COC). Our results show that those SZ+ who were abstinent for more than four months did not differ from their SZ− counterparts in the neuropsychological functioning. Both SZ groups performed significantly worse than the COC group. A negative impact of age on the neuropsychological performance was found in the SZ+ group, suggesting additive later cognitive deficits in SZ+ patients due to the long-term brain damage of SUD.
Executive functioning in individuals with schizophrenia and/or cocaine dependence
Human Psychopharmacology: Clinical and Experimental, 2013
Objective Although little is known about neurocognition in Dual Diagnosis, it has been suggested that Schizophrenia (SZ) patients with comorbid substance use belong to a subgroup with lower genetic vulnerability to develop SZ and, consequently, they show better executive and social premorbid functioning. The first aim of this study was to assess the executive functioning, and the second one was to explore the effect of age of onset of substance use in neurocognition in SZ patients with cocaine dependence. Methods The total sample consisted of 95 male patients, aged 20 to 60 years, divided in three groups: one group with SZ and cocaine dependence (SZ+; n = 30), another group with SZ without cocaine dependence (SZÀ; n = 30), and a control group with cocaine dependence without psychiatric comorbidity (COC; n = 35). Results We found a better executive functioning in both SZ+ and COC than SZÀ. We observed a worse performance of SZ+ patients compared with COC in cognitive set-shifting regardless the age of onset of consumption. Conclusions The results agree with the hypothesis of a lower genetic vulnerability in SZ+ patients to develop psychosis compared with SZÀ, who develop it without any additional trigger. However, future research is needed to clarify the current knowledge gaps. Copyright
Neuropsychological deficits in chronic cocaine abusers
1991
A basic neuropsychological assessment battery was given to thirty-seven chronic freebase cocaine ("crack") abusers. The following tests were used: Wechsler Memory Scale , Rey-Osterrieth Complex Osterrieth, 1944) (copy and immediate reproduction), Verbal Fluency (semantic and phonologic), Boston Naming Test (Goodglass, Kaplan, & Weintrab, 1983), Wisconsin Card Sorting Test (Heaton, 198 I ) and Digit-symbol from the WISC (Wechsler, 1974). In general, performance was lower than expected according to their age and cductational level. Subjects showed significant impairment in short-term verbal memory and attention subtests. Neuropsychological test scores were correlated with lifetime amount of cocaine used, suggesting a direct relationship between cocaine abuse and cognitive impairment. A pattern of cognitive decline is proposed.
Neuropsychiatric effects of cocaine use disorders
Journal of the National Medical Association, 2005
Individuals who use cocaine report a variety of neuropsychiatric symptoms that are yet to be adequately targeted with treatment modalities. To address this problem requires an understanding of these symptoms and their neurobiological origins. Our paper reviewed the existing data on the neuropsychiatic implications of cocaine. We conducted a Medline search from 1984-2004 using terms, such as "cocaine", "cocaine addiction", "cocaine abuse", "cocaine neuropsychiatry" and "dual diagnosis". The search produced additional reference materials that were used in this review, although we focused on data that have likely clinical implications. The literature evidence suggested that, whereas acute cocaine overdose is potentially fatal, the ingestion of mild-to-moderate doses could result in fatal or nonfatal neuropsychiatric events. Also, chronic cocaine use may be associated with deficits in neurocognition, brain perfusion and brain activation ...
The Neuropsychology of Cocaine Addiction: Recent Cocaine Use Masks Impairment
Neuropsychopharmacology, 2009
Individuals with current cocaine use disorders (CUD) form a heterogeneous group, making sensitive neuropsychological (NP) comparisons with healthy individuals difficult. The current study examined the effects on NP functioning of four factors that commonly vary among CUD: urine status for cocaine (positive vs negative on study day), cigarette smoking, alcohol consumption, and dysphoria. Sixty-four cocaine abusers were matched to healthy comparison subjects on gender and race; the groups also did not differ in measures of general intellectual functioning. All subjects were administered an extensive NP battery measuring attention, executive function, memory, facial and emotion recognition, and motor function. Compared with healthy control subjects, CUD exhibited performance deficits on tasks of attention, executive function, and verbal memory (within one standard deviation of controls). Although CUD with positive urine status, who had higher frequency and more recent cocaine use, reported greater symptoms of dysphoria, these cognitive deficits were most pronounced in the CUD with negative urine status. Cigarette smoking, frequency of alcohol consumption, and dysphoria did not alter these results. The current findings replicate a previously reported statistically significant, but relatively mild NP impairment in CUD as compared with matched healthy control individuals and further suggest that frequent/recent cocaine may mask underlying cognitive (but not mood) disturbances. These results call for development of pharmacological agents targeted to enhance cognition, without negatively impacting mood in individuals addicted to cocaine.
Symptomatic Overlap of Cocaine Intoxication and Acute Schizophrenia at Emergency Presentation
Schizophrenia Bulletin, 1999
Cocaine intoxication and acute abstinence alter brain dopaminergic functioning, resulting in behavioral changes closely mimicking the positive and negative symptoms of schizophrenia. In emergency room settings, recent cocaine abuse can be mistaken for schizophrenia and may cause inappropriate diagnosis and in some instances medical mismanagement. Schizophrenia patients presenting with recent cocaine abuse may also present with significant diagnostic and treatment dilemmas. This study attempts to distinguish between cocaine and schizophrenic psychosis by examining patients who present with both recent cocaine abuse and acute schizophrenia (CA+SZ), cocaine intoxication without schizophrenic illness (CA), and acute schizophrenia with no comorbid substance abuse (SZ) within the first 24 hours after arrival at the Bellevue psychiatric emergency service. Clinical assessment included the Brief Psychiatric Rating Scale, the Schedule for the Assessment of Positive Symptoms, and the Schedule for the Assessment of Negative Symptoms. Both cocaine abusing groups were required to have positive urine toxicology screens for inclusion in the study. Multivariate analysis of variance showed the CA+SZ patients present with a clinical profile that overlaps with CA patients on mood and negative symptom dimensions and overlaps with SZ patients on most positive symptoms. CA+SZ patients differed from both groups, however, by presenting with significantly more hallucinatory experiences than cocaine abusing or schizophrenia patient counterparts. Despite considerable overlap, each group of patients presented with a discernible crosssectional symptom pattern.
FOCUS, 2012
There are high rates of substance use in patients diagnosed with schizophrenia. The objective of this review is to update clinicians about the epidemiology, consequences, assessment and treatment of comorbid substance use disorders and schizophrenia. Alcohol, cannabis and cocaine are among the most frequently abused substances in patients with schizophrenia. Substance abuse can negatively affect the expression and course of schizophrenia, for example by leading to a lower global level of functioning, increased hospitalizations, increased service utilization, and lower compliance with medication. Several models have been proposed to explain the high rates of comorbid substance use disorder in patients with schizophrenia including the self-medication and reward dysfunction hypotheses. There is little evidence to support the self-medication hypothesis. The reward dysfunction hypothesis is gaining support. The high rates and negative consequences warrant a thorough assessment of comorbid substance use disorders when treating patients with schizophrenia. The existing treatments are not particularly effective. Combination pharmacotherapy and behavioral strategies may be superior to either alone in the treatment of schizophrenia with comorbid substance use disorders. Due to the changing nature of DSM definitions of substance abuse and the drugs which are being abused, clinicians must strive to stay up to date on the latest findings related to co-occurring disorders among people with schizophrenia.
Neuropsychiatric Disorders Associated With Cocaine Use
Psychiatric Services, 1992
The widespread abuse ofcocaine during the last decade has resulted in an increasing number of patients presenting to emergency settings for medical and psychiatric care. The Drug Abuse Warning Network (DAWN) reported a 354 percent increase in the number of cocaine-related emergency room visits between the second quarter of 1985 and the last quarter of 1989 (1). Cocaine-related deaths also increased from 554 in 1985 to 2,496 in 1989 (1). Cocaine-associated neuropsychiatric syndromes account for part of the spectrum of toxicity reflected in those statistics. Accurate diagnostic assessment of these syndromes often proves challenging to emergency psychiatry practitioners. In this cotumn we describe the various neuropsychiatric syndromes that can be seen in cocaine abusers presenting for emergency care. A more detailed discussion of this topic can be found elsewhere (2). Initial evaluation The initial evaluation of a patient with suspected cocaine intoxication should include an abbreviated medical examination, measurement of