Comorbidity of cocaine abuse and schizophrenia: An examination of clinical functioning across an acute episode (original) (raw)
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.
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
Neurocognitive functioning in recently abstinent, cocaine-abusing schizophrenic patients
Journal of substance abuse, 2000
This report examined a broad range of cognitive functioning in a group of recently abstinent, cocaine-abusing schizophrenic patients (CA + SZ). Measures of selective and sustained attention, learning and memory, and executive functioning were administered to CA + SZ patients within 72 h of last cocaine use. A comparison group of non-substance-abusing schizophrenic patients (SZ) presenting for inpatient psychiatric treatment were also examined in an identical time frame. We hypothesized that the neurobiological impact of cocaine abuse and acute abstinence would cause CA + SZ to manifest deficits in all domains of cognitive functioning relative to non-abusing SZ patients. Results revealed that CA + SZ displayed significant memory impairment relative to their non-abuser SZ counterparts. No group differences, however, were detected on any other neurocognitive measure. CA + SZ were able to selectively process digit strings during the presence and absence of distracting stimuli, sustain a...
Schizophrenia research, 2017
Cannabis and cocaine are the most common illicit drugs for which people are treated in addiction services in Latin America. Much research has suggested that the use of cannabis increases the risk of schizophrenia; there is less evidence concerning cocaine. The aim of the present study was to establish the relative prevalence of schizophrenia in people treated for cannabis use and cocaine use disorders in Chile. A sample of 22,615 people treated for illicit drug use disorders was obtained from a national registry of addiction service users in Chile. Clinical diagnoses were established at admission to substance use treatment programs or at any point during the period of treatment. Prevalence rates of schizophrenia and related disorders, and affective disorders were calculated for the groups of people with cocaine use disorders, and cannabis use disorders. Odds ratios (OR) for schizophrenia and for affective disorders were calculated for cannabis users using the group of people treated...
The American journal of drug and alcohol abuse, 2017
Previous meta-analytical research examining cocaine and methamphetamine separately suggests potentially different neuropsychological profiles associated with each drug. In addition, neuroimaging studies point to distinct structural changes that might underlie differences in neuropsychological functioning. This meta-analysis compared the effect sizes identified in cocaine versus methamphetamine studies across 15 neuropsychological domains. Investigators searched and coded the literature examining the neuropsychological deficits associated with a history of either cocaine or methamphetamine use. A total of 54 cocaine and 41 methamphetamine studies were selected, yielding sample sizes of 1,718 and 1,297, respectively. Moderator analyses were conducted to compare the two drugs across each cognitive domain. Data revealed significant differences between the two drugs. Specifically, studies of cocaine showed significantly larger effect-size estimates (i.e., poorer performance) in verbal wo...
Psychiatry Research, 2014
The aim of this study is to compare the clinical characteristics of three groups of patients in treatment for cocaine dependence: patients without any psychotic symptoms (NS), patients with transient psychotic symptoms (PS) and patients with cocaine-induced psychotic disorder (CIPD). An observational and retrospective study of 150 cocaine-dependent patients undergoing treatment in the Drug Unit of the Psychiatry Department of University Hospital Vall d'Hebron in Barcelona (Spain) using these three groups, NS, PS and CIPD, was performed. All patients were evaluated with the PRISM interview. ANOVA, χ 2 tests and multivariate multinomial regression analysis were used to perform statistical analyses. Seven patients with a primary psychotic disorder were discharged. Forty-six patients (32.1%) did not report any psychotic symptoms. Ninety-seven patients (67.9%) presented with a history of any cocaine-induced psychotic symptom and were considered as the cocaine-induced psychotic (CIP) group. Among them, 39 (27.3%) were included in the PS group and 58 (40.6%) were included in the CIPD group. A history of imprisonment was found significantly more frequently in the PS group than in the NS group. The distribution of age at onset of dependence, lifetime cannabis abuse or dependence and imprisonment were significantly different between the NS and CIPD groups. We conclude that in cocainedependent patients, clinicians should be advised about the risk of development of psychotic symptoms. The presence of some psychotic symptoms could increase the potential risks of disturbing behaviours.
Prevalence and risk factors of psychotic symptoms in cocaine-dependent patients
Actas espanolas de psiquiatria, 2012
OBJECTIVES Cocaine consumption can induce transient psychotic symptoms expressed as paranoia or hallucinations. This work reviews that evidence and tries to obtain data regarding frequency of psychotic symptoms or cocaine induced psychosis (CIP), risks or associated factors. METHOD Systematic review of studies found in PubMed database published until January 2011 where cocaine induced paranoia was present. RESULTS Cocaine induced paranoia has a particular clinical presentation. It needs to be clearly identified due to its harmful consequences. The prevalence is between 12% in clinical studies and 100% in experimental studies. The following are considered potential risk factors: age of first use and length, amount of substance, route of administration, body mass index, genetic factors, personal vulnerability and comorbidity with AXIS I (psychosis, ADHD) and AXIS II disorders (antisocial personality disorder). CONCLUSIONS It is needed to research with larger samples of cocaine users o...
Psychiatric comorbidity in young cocaine users: induced versus independent disorders
Addiction, 2008
Aims To examine the psychiatric status of young cocaine users using a validated instrument for the evaluation of psychiatric comorbidity, emphasizing the distinction between independent and induced psychiatric conditions. Design Cross-sectional study. Setting Barcelona, Spain. Participants A cohort of 139 young (18-30 years) adult current regular cocaine users. Measurements The Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV, which produces diagnoses according to DSM-IV criteria, including Axis II antisocial and borderline personality disorders). Findings Nearly 42.5% of the subjects presented psychiatric comorbidity. The most common Axis I diagnoses were mood disorders (26.6%) and anxiety disorders (13%). Increasing age, having ever received treatment for drug use and freebase cocaine use were associated with substance-induced disorders diagnoses relative to primary Axis I disorders. Conclusions This study has shown a relatively high prevalence of psychiatric comorbidity in cocaine users recruited in non-clinical settings. Future studies examining potential differential factors associated with primary versus substance-induced disorders are necessary to optimize the implementation of more suitable approaching programmes for young regular cocaine users.
Risk factors for cocaine-induced psychosis in cocaine-dependent patients
European Psychiatry
Cocaine consumption can induce transient psychotic symptoms, expressed as paranoia or hallucinations. Cocaine induced psychosis (CIP) is common but not developed in all cases. This is the first European study on the relationship between CIP, consumption pattern variables and personality disorders. We evaluated 173 cocaine-dependent patients over 18 years; mostly males, whose average age was 33.6 years (SD = 7.8). Patients attending an outpatient addictions department were enrolled in the study and subsequently systematically evaluated using SCID I and SCID II interviews for comorbid disorders, a clinical interview for psychotic symptoms and EuropASI for severity of addiction. A high proportion of cocaine dependent patients reported psychotic symptoms under the influence of cocaine (53.8%), the most frequently reported being paranoid beliefs and suspiciousness (43.9%). A logistic regression analysis was performed, finding that a model consisting of amount of cocaine consumption, presence of an antisocial personality disorder and cannabis dependence history had 66.2% sensitivity 75.8% specificity predicting the presence of CIP. In our conclusions, we discuss the relevance of evaluating CIP in all cocaine dependent-patients, and particularly in those fulfilling the clinical profile derived from our results. These findings could be useful for a clinical approach to the risks of psychotic states in cocaine-dependent patients.