Shustov D.I., Kiselev D.N., Novikov S.A., Zuykova N.L.
Secondary alcohol dependence in patients with schizophrenia and organic brain damages
Abstract.
The article presents findings of the clinical trial aimed at the investigation of clinical characteristics of secondary alcohol dependence in patients suffering from mental disorders, as well as an impact of these characteristics on patients’ anti-alcohol help seeking and outcomes of various types of anti-alcohol treatment. The clinical examination of 108 patients (93 males and 15 females) with mental disorders combined with alcohol dependence was performed. True alcohol dependence was diagnosed in 67 people (60 males and 7 females), symptomatic alcohol dependence was diagnosed in 33 subjects (28 males and 5 females). True alcohol dependence preceded the development of schizophrenia significantly more often, and by the time of an endogenous disorder onset this dependence had reached the 2nd degree severity. It has been demonstrated that the onset of schizophrenia in 43,3% of cases with true alcohol dependence was connected with an incident of heavy drinking and was provoked by it. The evidence has been received that true alcohol dependence combined with schizophrenia has a clearly marked hereditary component and progresses quickly. Most patients with such a condition abuse alcohol on an occasional basis and develop the alcohol withdrawal syndrome with expressed somatic and mental components earlier, with psychoses occurring during the withdrawal. True alcohol dependence in the majority of cases contributes to a greater severity of schizophrenia, more frequent self-destructive behaviours, manifestations of antisocial behaviours – criminal acts resulting in conviction and regular mandatory visits to the in-patient dispensaries. At the same time true alcohol dependence is the main factor contributing to an increased anti-alcohol help seeking. The findings show that symptomatic alcoholism in the structure of a concomitant disease increases the manifestation severity of the productive symptoms of endogenous and exogenous mental disorders, leads to problems in adaptation (pathological adaptation) and socialization, which negatively influences treatment motivation.
Key words: alcohol dependence, schizophrenia, organic brain damage.
References
1. Gofman AG, Malkov KD, Shlemina IV. Shizofreniia, sochetaiushchaiasia s alkogolizmom (klinicheskaia kartina i lechenie) [The schizophrenia which is combined with an alcoholism (clinical picture and treatment)]. Psikhiatriia i psikhofarmakoterapiia. 2008;10(3):23-7.
2. Chirko VV, Drozdov ES. O klinicheskoi tipologii zavisimosti ot psikhoaktivnykh veshchestv u bol'nykh endogennymi psikhozami [About a clinical typology of dependence on psychoactive agents at patients with endogenic psychoses]. Voprosy narkologii. 2001;(5):40-3.
3. Gofman AG, Malkov KD, Iashkina IV, Kozhinova TA. Shizofreniia i zabolevaniia shizofrenicheskogo spektra, sochetaiushchiesia s khronicheskoi alkogol'noi intoksikatsiei ili alkogolizmom [Schizophrenia and diseases of a schizophrenic range which are combined with a chronic drunkenness or an alcoholism]. Narkologiia. 2003;(5):35-9.
30. Dixon L. Dual diagnosis of substance abuse in schizophrenia: prevalence and impact on outcomes. Schizophr Res. 1999 Mar;(35):93-100.
5. Gofma AG, Loshakov ES. K voprosu o sochetanii alkogolizma i shizofrenii [To a question of a combination of an alcoholism and schizophrenia]. V: Aktual'nye problemy psikhiatrii. Moscow, RF; 1981. р. 70-74.
6. Kiselev DN, Shustov DI, Gazha AK, Ignatiev SV, Gurevich GL. Sravnitel'naia kharakteristika patsientov s sochetannoi psikhiatricheskoi i narkologicheskoi patologiei v kontekste razlichnykh grupp dispansernogo nabliudeniia [The comparative characteristic of patients with the combined psychiatric and narcological pathology in the context of various groups of a dispensary observation]. Zhurnal nevrologii i psikhiatrii imeni SS. Korsakova. 2011;11(2):61-5.
7. Loshakov ES, Shlemina IV. Affektivnye narusheniia u bol'nykh shizotipicheskim rasstroistvom (maloprogredientnoi shizofreniei), sochetaiushchimsia s alkogolizmom [Affective disturbances at patients with the shizotipichesky disorder (low-progreduated schizophrenia) which is combined with an alcoholism]. V: Vzaimodeistvie nauki i praktiki v sovremennoi psikhiatrii: materialy ros. konf., Moskva, 9-11 okt. 2007 g. Moscow, RF; 2007. р. 288.
8. Pogosov AV, red. Posttravmaticheskie stressovye rasstroistva i komorbidnye sostoianiia u voennosluzhashchikh (klinika, faktory riska, terapiia) [Posttraumatic stressful disorders and komorbidny states at the military personnel (clinic, risk factors, therapy)]. Kursk, RF: KGMU; 2006. 268 р.
9. Chirko VV, Drozdov ES. Endogennye psikhozy i zavisimost' ot psikhoaktivnykh veshchestv [Endogenic psychoses and dependence on psychoactive agents]. V: Ivanets NN, red. Rukovodstvo po narkologii. V 2 t. T. 1. Moscow, RF: Medpraktika; 2002. р. 385-408.
12. Nunes EV, Levin FR. Treatment of Depression in Patients With Alcohol or Other Drug Dependence. JAMA. 2004 Apr;291(15):1887-96.
11. Entin GM, Gofman AG, Muzychenko AP, Krylov EN. Alkogol'naia i narkoticheskaia zavisimost' [Alcohol and drug addiction]: prakt. ruk. dlia vrachei. Moscow, RF: Medpraktika-M; 2002. 328 р.
12. Miles H, Johnson S, Amponsah-Afuwape S, Finch E, Leese M, Thornicroft G. Characteristics of subgroups of individuals with psychotic Illness and a comorbid substance use disorder. Psychiatr Serv. 2003 Apr;54(4):554-61.
13. Kiselev DN, Shustov DI, Ignatiev SV. Narkologicheskaia otiagoshchennost' kak psikhologicheskii faktor, vliiaiushchii na kachestvo spetsializirovannoi pomoshchi patsientam s psikhicheskimi rasstroistvami [Narcological burdeness as the psychological factor influencing quality of the specialized help to patients with alienations]. V: Lichnost' v sovremennykh issledovaniiakh: materialy VIII mezhdunar. nauch.-prakt. konf. Ryazan, RF: Kopi Print; 2008. Vyp. 1. р. 33-34.
14. Chirko VV. Alkogol'naia i narkoticheskaia zavisimost' u bol'nykh endogennymi psikhozam [Alcohol and drug addiction at patients endogenic to psychoses]. Moscow, RF: Medpraktika-M; 2002. 167 р.
15. Miroshnichenko LD, Pelipas VE, Ivanets NN, red. Narkologicheskii entsiklopedicheskii slovar' [Narcological encyclopedic dictionary]. Ch. 1. Alkogolizm. Moscow, RF: Anakharsis; 2001. 192 р.
16. Malkov KD. Kliniko-dinamicheskie osobennosti rasstroistv shizofrenicheskogo spektra i sochetaiushchegosia s nimi alkogolizma [Clinicodynamic features of disorders of a schizophrenic range and the alcoholism which is combined with them]: dis. … kand. med. nauk: 14.00.18. Moscow, RF; 2001. 255 р.
17. Malkov KD. Osobennosti dinamiki nepreryvno tekushchei paranoidnoi shizofrenii, sochetannoi s alkogolizmom [Features of dynamics of continuously current paranoica schizophrenia, combined with an alcoholism]. Voprosy narkologii. 2000;(3):44-50.
18. Malkov KD. Osobennosti dinamiki shizofrenii s epizodicheskim techeniem [Features of the dynamics of schizophrenia with episodic course]. Voprosy narkologii. 2000;(4):33-42.
