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Am J Psychiatry 1993; 150:758-762
Copyright © 1993 by American Psychiatric Association
Unrecognized cocaine use among schizophrenic patients
A Shaner, ME Khalsa, L Roberts, J Wilkins, D Anglin and SC Hsieh
West Los Angeles VA Medical Center, CA 90073.
OBJECTIVE: Unrecognized stimulant use could lead to the misdiagnosis of
schizophrenia or the misunderstanding of its course and prognosis. This
study was conducted to determine the prevalence of unrecognized stimulant
use among patients with a clinical diagnosis of schizophrenia. METHOD: The
subjects were 108 schizophrenic patients admitted consecutively to a
Veterans Affairs psychiatric hospital. Admitting psychiatrists supplemented
routine clinical evaluations with a semistructured interview regarding
recent and lifetime use of alcohol, cocaine, amphetamine, marijuana, and
opiates. A urine specimen was assayed for the four illicit drugs. RESULTS:
Of the 103 patients who provided a urine specimen, 37 (36%) used cocaine
during the 6 months before admission, including 31 who used the drug in the
week before admission. Because of the poor reliability of negative self-
reports of recent cocaine use, clinicians failed to recognize cocaine use
in one-third of the patients with a urine toxicology positive for cocaine
metabolites. Two other groups of patients were identified; schizophrenic
patients without substance abuse (including alcohol) and schizophrenic
patients with substance abuse other than stimulants. Both substance-abusing
groups were younger than the nonabusing group, but the three groups had
similarly high rates of recent psychotic symptoms, homelessness, and
unemployment. CONCLUSIONS: Among schizophrenic patients who require
hospitalization, clinicians should not rely solely on self-reported
stimulant use. Recognition of stimulant use could be improved through
routine urine toxicologies for all psychotic patients. The authors suggest
that recognition of stimulant use among schizophrenic patients may identify
a population with a better prognosis for schizophrenia and different
treatment needs.
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