Influence of alcoholism on the prognosis of schizophrenic patients

Objective: This study was undertaken to investigate possible differences in clinical, social and hospital prognosis in schizophrenics with or without codiagnosed alcoholism. Method: A representative sample was selected by a two-stage random sample of sets from the total of 10,569 schizophrenic patients registered in the Croatian Psychotic Case Register in the period 1962-71. The resulting 449 schizophrenic patients were psychiatrically examined in 1973-75 wherever they were found--at home, in a hospital or in a social-health institution. Of these original patients, 312 with or without a dual diagnosis of schizophrenia nd alcoholism who were found at home were followed up until the final examination in 1990-91. Results: Rate changes in 37 patients with the dual diagnosis were significant in the following characteristics: they were more often men, married, with a paranoid-hallucinatory disease form, were aggressive during examination, and were without psychiatric aftercare or regular psychopharmacotherapy (p < .01); they came from rural areas, had a mixed clinical picture with a deteriorating disease course and were less communicative and socially functional, and were without work self-initiative and personal income (p < .05). Conclusions: Schizophrenic patients found at home with codiagnosed alcoholism have poorer clinical, hospital, social and life prognosis and need longer hospitalization. They represent aspecial subgroup of schizophrenics requiring special therapeutic approach and early identification, inasmuch as their course of the disease has a tendency toward rapid deterioration. Prevention of alcoholism and its adequate treatment have far reaching implications for the prognosis of schizophrenic llness. (J. Stud. Alcohol 56: 622-627, 1995) EUROSES, personality disorders and other nonpsychotic disorders are psychiatric disorders most commonly connected with alcoholism (Kozarit-Kova•i6 and Lang, 1992; Mendelson et al., 1986; Robins et al., 1984) Many clinical (Barbee et al., 1989; Lindquist and Allebeck, 1990; Noordsy et al., 1991; Searles et al., 1990; Smith and Pristach, 1990; Toland and Moss, 1989) and epidemiological (Krasik et al., 1988; Mendelson et al., 1986; Pulver et al., 1989; Regier et al., 1990; Ross et al., 1988; Soni and Brownlee, 1991; Soyka, 1992) studies report on a rather high comorbidity of alcohol abuse among schizophrenics. The prevalence rates of alcohol abuse among schizophrenics reported in the above-mentioned studies range from 3% to 63%. However, comparison of results across the studies is difficult for many reasons, including the differences in the diagnosis of alcoholism, differences in the samples of schizophrenic patients and in the variables evaluated. Schizophrenia has been studied in Croatia since 1961, when the Croatian Psychotic Case Register (CPCR) was established by Kul•ar and his co-workers (1983, 1986), and the collection of data on schizophrenic hospital patients has been continuous and uniform ever since. CPCR data show that the incidence admission rates for schizophrenia remained virtually constant in the period from 1965 to 1984 (Folnegovi6 et al., 1990). The variation was 0.21-0.22 per 1,000 general Received: July 27, 1994. Revision: March 1, 1995. *Zdenko Folnegovi6 is with the Institute of Public Health, Zagreb, Croatia. Ana Maru•i6 is with the Department of Anatomy, Zagreb University School of Medicine, Zagreb, Croatia. 622 population and 0.26-0.29 per 1,000 population older than 15 years of age (this population in Croatia was 1,601,469 in 1981). Male incidence admission rate was slightly higher than that of females (Folnegovi• et al., 1990). The existence of the CPCR large database permitted the present investigation i to the possible differences in the clinical, social and hospital prognosis in schizophrenics with and those without diagnosed alcoholism.