Over half of psychotic disorder patients in a South African hospital had a substance use disorder | Research

The takeaway

In a South African psychiatric hospital, 55.6% of patients with psychotic disorders also had a substance use disorder, with cannabis being the most common at 34.3%.

Psychiatrists working with dual-diagnosis patients, public health researchers focused on low- and middle-income countries, and policymakers developing mental health services.

34.3% of psychotic disorder patients had cannabis use disorder

What the researchers found

Among 248 patients with psychotic disorders, cannabis use disorders (34.3%) were the most prevalent, followed by alcohol (30.6%) and methamphetamine (27.4%). Male sex predicted most substance use disorders, and anxiety symptoms and suicide attempts were linked to alcohol use disorders.

Why it matters

Most data on substance use in psychotic disorders comes from high-income countries. This study from South Africa found similarly high rates, suggesting the co-occurrence is a global phenomenon requiring integrated treatment approaches.

The numbers in context

248 patients studied. 55.6% had any SUD. 34.3% cannabis use disorder. 30.6% alcohol. 27.4% methamphetamine. 10.4% methaqualone. 4.8% other substances.

How the study worked

Cross-sectional study of 248 patients at a secondary-level psychiatric hospital in Cape Town, South Africa, using the Structured Clinical Interview for DSM-IV. Logistic regression identified predictors of substance use disorders.

What this study cannot tell us

Cross-sectional design cannot determine whether substance use preceded or followed psychosis onset. Single hospital setting in Cape Town may not represent all of South Africa. DSM-IV criteria were used rather than the more current DSM-5.

How to read the evidence

Well-designed cross-sectional study using validated diagnostic interviews, but single-site and cannot establish causation.

When this study was published

2020 study from Cape Town, South Africa. One of few studies examining this topic in a low-and-middle-income country.

The bigger picture

The high rates of co-occurring substance use and psychotic disorders across different economic settings underscore the need for integrated psychiatric and addiction treatment worldwide, not just in wealthy nations.

Questions still open

Are treatment outcomes different for psychotic disorder patients with versus without co-occurring SUDs in this setting? Would integrated treatment programs be feasible in resource-limited psychiatric hospitals?

Common questions

What was the most common substance use disorder among psychotic disorder patients?

Cannabis use disorder was the most common at 34.3%, followed by alcohol use disorders at 30.6% and methamphetamine use disorders at 27.4%.

Were there demographic patterns in substance use?

Male sex was associated with most substance use disorders. Younger age and Coloured ethnicity were linked to methamphetamine use, and lower education was linked to cannabis use disorders.

Read the original research

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

The South African journal of psychiatry : SAJP : the journal of the Society of Psychiatrists of South Africa, 26, 1473

View on PubMed ↗Publisher’s paper ↗

Citation

Temmingh, Henk S; Mall, Sumaya; Howells, Fleur M; Sibeko, Goodman; Stein, Dan J. (2020). The prevalence and clinical correlates of substance use disorders in patients with psychotic disorders from an Upper-Middle-Income Country.. The South African journal of psychiatry : SAJP : the journal of the Society of Psychiatrists of South Africa, 26, 1473. https://doi.org/10.4102/sajpsychiatry.v26i0.1473