Drug-related predictors of readmission for schizophrenia among patients admitted to treatment for drug use disorders

Abstract

Background: Patients with schizophrenia and comorbid drug use disorders (DUD) have a severe course of illness. Despite strong evidence that drug use can exacerbate psychotic symptoms, we have limited knowledge of how specific drugs may increase risk of schizophrenia readmission in this group. This study aimed to assess drug-related predictors of readmission for schizophrenia among a national cohort of patients with a history of schizophrenia admitted to DUD treatment.

Methods: A record-linkage study was used to assess drug-related factors associated with readmission to mental health treatment for schizophrenia, using a consecutive cohort of 634 patients admitted to DUD treatment between 2000 and 2006 in Danish treatment services and tracked until February 2013 or death, controlling for baseline psychiatric treatment variables.

Results: The majority of patients were males (79.8%) and the mean age was 34.7years. Of all patients, 78.7% were readmitted for schizophrenia during follow-up, and 6.8% died without having been readmitted. We found a robust association between use of amphetamine at baseline and elevated risk of readmission, a less robust association between use of cannabis and elevated risk of readmission, and no association with cocaine, opioids, alcohol, benzodiazepines, and MDMA. Furthermore, one or more psychiatric inpatients visit in the year prior to DUD admission was robustly associated with elevated risk of schizophrenia readmission.

Conclusions: Use of amphetamine and cannabis are risk markers for schizophrenia readmission among patients with a history of schizophrenia and DUD. Psychiatric history is a predictor of schizophrenia readmission in this patient group.

Keywords: Amphetamine; Cannabis; Dual diagnosis; Psychosis; Schizophrenia; Substance use disorder.