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Prevalence of alcohol use disorders in schizophrenia – A systematic review and meta-analysis

Prevalence of alcohol use disorders in schizophrenia – A systematic review and meta-analysis. Jouko Miettunen University of Oulu, Finland. Disclosure. I have no financial relationships to disclose I will not discuss off label use and/or investigational use in my presentation.

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Prevalence of alcohol use disorders in schizophrenia – A systematic review and meta-analysis

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  1. Prevalence of alcohol use disorders in schizophrenia – A systematic review and meta-analysis Jouko Miettunen University of Oulu, Finland

  2. Disclosure • I have no financial relationships to disclose • I will not discuss off label use and/or investigational use in my presentation.

  3. Introduction • Previous systematic reviews have found a wide range of rates (12-55%) of alcohol use disorder in schizophrenia samples • Previous studies published between the years 1960-89 were reviewed by Mueser et al. and those from the years 1990-2001 by Cantor-Graae et al. Mueser et al. Schizophr Bull 1990;16:31-55 Cantor-Graae et al. Schizophr Res 2001;48:69-82

  4. Population lifetime prevalence of alcohol abuse or dependence Somers et al. Can J Psychiatry 2004;49:373-84

  5. Schizophrenia and alcohol Schizophrenia patients with alcohol use disorders have • more psychotic symptoms and more severe depressive symptoms (less negative symptoms?) • poorer treatment compliance • increased somatic morbidity • risk for violence, criminality and suicides • more negative psychosocial events e.g. divorce and unemployment • more admissions and longer hospitalization periods Potvin et al. Psychol Med 2006;36:431-440; Potvin et al. Aust N Z J Psychiatry 2007;41:792-799; Drake & Mueser. Alcohol Health Res World 1996;20:87-93; Dixon. Schizophr Res 1999;35(suppl.):93-100; Gregg et al. Clin Psychol Rev 2007;27:494-510.

  6. Aim • Our aim is to present recent studies of alcohol use disorders (AUDs) in schizophrenia, estimate overall prevalence, and characteristics affecting the prevalence of AUDs

  7. Methods • We conducted a search using three literature databases and a manual search on articles published in 1996-2008 • Metaregression was used to study how prevalence is affected by different study characteristics • Articles that reported diagnoses according to DSM or ICD diagnostic systems were included • We compared results with those of cannabis use disorders

  8. Alcohol use disorders in schizophrenia • Altogether 60 studies met our criteria • median of current AUD prevalence was 9.4% (IQR = 4.6-19.0, 18 studies) • median of lifetime AUD prevalence 20.6% (IQR = 12.0-34.5, 47 studies)

  9. Prevalence of alcohol use disorders in schizophrenia patients by type of alcohol use diagnosis

  10. Comparison of studies 1996-2008

  11. Comparison of studies 1996-2008 Current alcohol vs. cannabis use disorders (7) • 2 younger (mean age < 30 years) samples with more cannabis • 5 older (mean age > 30 years) samples with more alcohol Lifetime alcohol vs. cannabis use disorders (24) • 8 studies with more cannabis • 14 studies with more alcohol • 2 with no difference

  12. Diagnostic criteria ICD-10 vs. DSM-IV • Alcohol use that causes either physical or mental damage in the absence of dependence is categorized in ICD-10 as harmful • This category highlights the somatic problems related to alcohol use more than abuse in DSM-IV • This may lead to lower rate of abuse in younger populations in ICD-10 Kaczynski Pollock et al. J Stud Alcohol 2000;61:439–46. Hiller. Eur Arch Psychiatry Neurol Sci 1989;239:101–8.

  13. Conclusion • Approximately every fifth schizophrenia patient had lifetime AUD diagnosis • The decrease seen in prevalence estimates may be explained by stricter AUD criteria in diagnostic systems

  14. Conclusion • Alcohol and cannabis use disorder are both common schizophrenia • Alcohol use disorders were more common in older than in younger schizophrenia patient samples • When contrasted to the most recent review there might be a descending trend in AUD prevalence in schizophrenia patients

  15. Koskinen J, Löhönen J, Koponen H, Isohanni M, Miettunen J. Prevalence of alcohol use disorders in schizophrenic psychoses – A systematic review and meta-analysis. Acta Psychiatr Scand 2009; doi: 10.1111/j.1600-0447.2009.01385.x • Koskinen J, Löhönen J, Koponen H, Isohanni M, Miettunen J. Rate of cannabis use disorders in clinical samples of patients with schizophrenia: A meta-analysis. Schizophr Bull 2009; doi:10.1093/schbul/sbp031 www.joukomiettunen.net

  16. Research Group Department of Psychiatry, University of Oulu, Finland • Koskinen Johanna, MD • Isohanni Matti, MD, PhD • Löhönen Johanna, MA • Miettunen Jouko, PhD Department of Psychiatry, University of Kuopio, Finland • Koponen Hannu, MD, PhD This study has been supported by the Academy of Finland

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