WASHINGTON – Chronic medical conditions are very common among patients with co-occurring schizophrenia and alcohol use disorder. In one study of 80 patients, 83% of the patients had at least one chronic illness.
The most common chronic illnesses in the study were hypertension (46.3%), gastroesophageal reflex disease (26.3%), asthma (23.8%), hyperlipidemia (22.5%), and osteoarthritis/degenerative joint disease (21.3%), according to a poster presented at a joint meeting sponsored by the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism.
“Comparing our sample to that of the CATIE (Clinical Antipsychotic Trials in Intervention Effectiveness) trial, medical illness burden appears to be markedly higher in patients with both schizophrenia and alcohol dependence than in patients with schizophrenia only,” wrote Dr. Zsuzsa S. Mezaros, who is with the psychiatry department of the State University of New York, Syracuse, and her colleagues.
The study involved 80 outpatients with schizophrenia or schizoaffective disorder and co-occurring alcohol dependence or abuse who were enrolled in a trial of directly monitored naltrexone treatment. Patients were prescribed antipsychotic medications by their clinical treatment providers. However, they were not prescribed acamprosate (Campral), naltrexone (Revia), or disulfiram (Antabuse).
Patients ranged in age from 18 to 69 years; mean age was 42. Almost three-quarters (72.5%) were male. Forty-five percent were white, 39% were African American, 2% were American Indian, and 14% were mixed or other. Slightly more than half (55%) had a diagnosis of schizophrenia; 45% had schizoaffective disorder.
Almost all (95%) were diagnosed with alcohol dependence; 5% were diagnosed with alcohol abuse. Roughly three-quarters (77.5%) reported having a primary care provider at the study start.
In the past 6 months, 26% reported a psychiatric hospitalization, 4% reported a medical hospitalization, and 3% reported a substance-related hospitalization. Also in the past 6 months, 29% reported an emergency department visit for medical reasons, and 16% reported an ED visit for psychiatric reasons.
Illness burden was predicted by demographic factors (e.g., age) and alcohol use severity (e.g., γ-glutamyl-transferase) and was less influenced by psychiatric severity. “The positive correlation between alcohol use severity and medical illness is mainly related to γ-glutamyl-transferase (GGT) levels, an objective measure of transaminase elevation possibly due to alcohol-related liver injury,” the researchers wrote.
Patient-reported levels of alcohol/drug use were not significantly related to medical severity. “This raises the possibility that biological markers of alcohol use may be a more reliable or sensitive correlate of medical status than self-report in patients with schizophrenia.”
The study was supported by a grant from the National Institutes of Health and the National Institute on Alcohol Abuse and Alcoholism.