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Petersen SM, Toftdahl NG, Nordentoft M, Hjorthøj C. Schizophrenia is associated with increased risk of subsequent substance abuse diagnosis: A nation-wide population-based register study. Addiction 2019; 114:2217-2226. [PMID: 31301685 DOI: 10.1111/add.14746] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/30/2019] [Accepted: 07/05/2019] [Indexed: 01/18/2023]
Abstract
AIMS We aimed to investigate whether or not a diagnosis of schizophrenia increases the risk of a substance abuse diagnosis. DESIGN Prospective cohort study using a longitudinal study design. SETTING AND PARTICIPANTS Individuals born in Denmark from 1955 to 1999 and registered in the Danish registers between 1 January 1968 and 1 July 2013. MEASUREMENTS We investigated the associations between schizophrenia and ICD diagnoses of substance abuse, both established through various Danish registers. The Cox regression model was used and adjusted for calendar year, gender, urbanicity, co-abuse, other psychiatric diagnoses, parents' substance abuse and psychiatric history, parents' immigration and parents' socio-economic position. Individuals diagnosed with substance abuse less than a year after diagnosis of schizophrenia were classified as not diagnosed with schizophrenia. FINDINGS The cohort consisted of 3 133 968 individuals. During follow-up (103 212 328 person-years at risk), a total of 14 007 individuals developed schizophrenia, with 2885 subsequently diagnosed with substance abuse. A diagnosis of schizophrenia was positively associated with the risk of developing substance abuse [hazard ratio (HR) = 3.69, 95% confidence interval (CI) = 3.56-3.83]. Additionally, adjusting for a co-abuse markedly affected the associations, making schizophrenia primarily associated with an increased risk of abuse of cannabis, alcohol, stimulants and other substances (adjusted HR = 2.48, 95% CI = 2.34-2.64 for cannabis; HR = 1.94, 95% CI = 1.87-2.02 for alcohol; HR = 1.77, 95% CI = 1.61-1.95 for stimulants; HR = 1.36, 95% CI = 1.20-1.54 for other substances). The association was still significant 10-15 years subsequent a diagnosis of schizophrenia (HR = 2.50, 95% CI = 2.26-2.76). CONCLUSIONS In Denmark a diagnosis of schizophrenia is significantly associated with increased risk of subsequent diagnosis of substance abuse.
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Affiliation(s)
- Stine Mai Petersen
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Nanna Gilliam Toftdahl
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
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Kim M, Suh DH, Lee KH, Eom KY, Toftdahl NG, Mirza MR, Kim JW. Major clinical research advances in gynecologic cancer in 2018. J Gynecol Oncol 2019; 30:e18. [PMID: 30806045 PMCID: PMC6393635 DOI: 10.3802/jgo.2019.30.e18] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 02/08/2023] Open
Abstract
Nineteen topics were selected as major clinical research advances in gynecologic oncology in 2018. For cervical cancer, the importance of human papillomavirus (HPV) testing alone as primary cervical cancer screening method and negative survival impact of minimally invasive surgery in early-stage cervical cancer were addressed. For ovarian cancer, cost-effectiveness of genetic testing to prevent cancer, use of analgesics and oral pill to reduce cancer risk, efficacy of secondary cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, update in the use of poly (ADP-ribose) polymerase inhibitor, and efficacy of anti-angiogenic targeted treatments, including bevacizumab and tyrosine kinase inhibitors, were reviewed. For corpus cancer, sentinel lymph node mapping technique, adjuvant therapy in high-risk endometrial cancer (PORTEC-3), and targeted therapy in recurrent disease were covered. For the field of radiation oncology, survival outcomes of chemoradiation compared with chemotherapy alone in metastatic cervical cancer and new findings regarding the use of neoadjuvant chemotherapy in locally advanced cervical cancer were introduced. Lastly, for breast cancer, the use of talazoparib in patients with germline BRCA1/2 mutation, ovarian suppression for premenopausal patients, adjuvant chemotherapy guided by 21-gene assay, and combination therapy of atezolizumab and nab-paclitaxel for triple-negative cancer as well as promising overall survival results of palbociclib and fulvestrant in advanced breast cancer were briefly mentioned.
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Affiliation(s)
- Miseon Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Keun Yong Eom
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Nanna Gilliam Toftdahl
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
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Nielsen SM, Toftdahl NG, Nordentoft M, Hjorthøj C. Association between alcohol, cannabis, and other illicit substance abuse and risk of developing schizophrenia: a nationwide population based register study. Psychol Med 2017; 47:1668-1677. [PMID: 28166863 DOI: 10.1017/s0033291717000162] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several studies have examined whether use of substances can cause schizophrenia. However, due to methodological limitations in the existing literature (e.g. selection bias and lack of adjustment of co-abuse) uncertainties still remain. We aimed to investigate whether substance abuse increases the risk of developing schizophrenia, addressing some of these limitations. METHOD The longitudinal, nationwide Danish registers were linked to establish a cohort of 3 133 968 individuals (105 178 673 person-years at risk), identifying 204 505 individuals diagnosed with substance abuse and 21 305 diagnosed with schizophrenia. Information regarding substance abuse was extracted from several registers and did not include psychotic symptoms caused by substance abuse in the definition. This resulted in a large, generalizable sample of exposed individuals. The data was analysed using Cox regression analyses, and adjusted for calendar year, gender, urbanicity, co-abuse, other psychiatric diagnosis, parental substance abuse, psychiatric history, immigration and socioeconomic status. RESULTS A diagnosis of substance abuse increased the overall risk of developing schizophrenia [hazard ratio (HR) 6.04, 95% confidence interval (CI) 5.84-6.26]. Cannabis (HR 5.20, 95% CI 4.86-5.57) and alcohol (HR 3.38, 95% CI 3.24-3.53) presented the strongest associations. Abuse of hallucinogens (HR 1.86, 95% CI 1.43-2.41), sedatives (HR 1.68, 95% CI 1.49-1.90), and other substances (HR 2.85, 95% CI 2.58-3.15) also increased the risk significantly. The risk was found to be significant even 10-15 years subsequent to a diagnosis of substance abuse. CONCLUSION Our results illustrate robust associations between almost any type of substance abuse and an increased risk of developing schizophrenia later in life.
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Affiliation(s)
- S M Nielsen
- Copenhagen University Hospital, Mental Health Center Copenhagen,Hellerup,Denmark
| | - N G Toftdahl
- Copenhagen University Hospital, Mental Health Center Copenhagen,Hellerup,Denmark
| | - M Nordentoft
- Copenhagen University Hospital, Mental Health Center Copenhagen,Hellerup,Denmark
| | - C Hjorthøj
- Copenhagen University Hospital, Mental Health Center Copenhagen,Hellerup,Denmark
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Abstract
OBJECTIVE It remains unclear whether there is an association between severity of cannabis use and psychotic symptom severity over time. Shedding light on this under-researched matter could have clinical implications for this patient group. METHODS This was a secondary analysis of a randomized, parallel-group, superiority, assessor-blinded trial. We followed 60 patients with dually diagnosed psychosis and cannabis use disorders from the Danish CapOpus trial, which included assessments at baseline, post-treatment (6 months) and 10 months. Cannabis use was registered by self-report assisted by timeline follow-back. Psychotic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS) positive, negative, and general symptoms scores. Analyses were adjusted for potential confounders. RESULTS Patients were classified into four categories: minor use (0-30 joints at baseline and 0-9 joints at follow-up; n = 19), moderate use (0-30 joints at baseline and 10-196 joints at follow-up; n = 11), high (reducing) use (31-240 joints at baseline and 0-9 joints at follow-up; n = 9), and severe use (31-240 joints at baseline and 10-196 joints at follow-up; n = 21). Those with severe and persistent cannabis use (severe use group) had significantly higher scores, as compared to those with minor use, on the positive symptom (17.0, 95% CI [4.7-19.2] vs. 12.7, 95% CI [10.4-15.0], respectively, adjusted p < .009) and general symptom (37.4, 95% CI [34.0-40.8] vs. 29.8, 95% CI [26.3-33.3], respectively, adjusted p < .003) scales at follow-up. The severe use group had significantly higher scores, as compared to the moderate use group, on the negative symptom scale at follow-up (17.4, 95% CI [15.1-19.7] vs. 12.5, 95% CI [9.3-15.6], respectively, adjusted p < .02). On the other hand, patients in the high (reducing) use group demonstrated the greatest improvement in psychotic symptoms on all three measures. CONCLUSIONS These findings are preliminary and more research must be done to elucidate the relationship between cannabis use and psychosis. Treatment of psychosis and comorbid cannabis use disorder could in the future incorporate treatment strategies emphasising encouragement to reduce cannabis use. CapOpus is registered at clinicaltrials.gov (NCT00484302).
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Affiliation(s)
| | - Merete Nordentoft
- a University of Copenhagen, Mental Health Center Copenhagen , Hellerup , Denmark
| | - Carsten Hjorthøj
- a University of Copenhagen, Mental Health Center Copenhagen , Hellerup , Denmark
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Abayomi O, Amato D, Bailey C, Bitanihirwe B, Bowen L, Burshtein S, Cullen A, Fusté M, Herrmann AP, Khodaie B, Kilian S, Lang QA, Manning EE, Massuda R, Nurjono M, Sadiq S, Sanchez-Gutierrez T, Sheinbaum T, Shivakumar V, Simon N, Spiteri-Staines A, Sirijit S, Toftdahl NG, Wadehra S, Wang Y, Wigton R, Wright S, Yagoda S, Zaytseva Y, O'Shea A, DeLisi LE. The 4th Schizophrenia International Research Society Conference, 5-9 April 2014, Florence, Italy: a summary of topics and trends. Schizophr Res 2014; 159:e1-22. [PMID: 25306204 PMCID: PMC4394607 DOI: 10.1016/j.schres.2014.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/07/2014] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
Abstract
The 4th Schizophrenia International Research Society Conference was held in Florence, Italy, April 5-9, 2014 and this year had as its emphasis, "Fostering Collaboration in Schizophrenia Research". Student travel awardees served as rapporteurs for each oral session, summarized the important contributions of each session and then each report was integrated into a final summary of data discussed at the entire conference by topic. It is hoped that by combining data from different presentations, patterns of interest will emerge and thus lead to new progress for the future. In addition, the following report provides an overview of the conference for those who were present, but could not participate in all sessions, and those who did not have the opportunity to attend, but who would be interested in an update on current investigations ongoing in the field of schizophrenia research.
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Affiliation(s)
- Olukayode Abayomi
- Ladoke Akintola University of Technology Teaching Hospital, PMB 4007, Ogbomoso, Oyo, Nigeria
| | - Davide Amato
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nuremberg, Ulmenweg 19, 91054 Erlangen, Germany
| | - Candace Bailey
- University of Texas Medical Branch, School of Medicine, 215 Mechanic Street, Apt. M206, Galveston77550, TX, United States
| | - Byron Bitanihirwe
- Laboratory of System and Cell Biology of Neurodegeneration, University of Zurich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
| | - Lynneice Bowen
- Morehouse School of Medicine, 720 Westview Dr. SW, Atlanta, GA 30310, United States
| | | | - Alexis Cullen
- Health Services and Population Research Department, David Goldberg Centre, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Montserrat Fusté
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, 16 De Crespigny Park, SE5 8AF London, UK
| | - Ana P Herrmann
- Pharmacology Department, Basic Health Sciences Institute, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, 90050-170 Porto Alegre, RS, Brazil
| | | | - Sanja Kilian
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Qortni A Lang
- Howard University College of Medicine, 520 W Street, Washington, DC 20059, United States
| | - Elizabeth E Manning
- The Florey Institute of Neuroscience and Mental Health, Kenneth Myer Building, 30 Royal Parade, Parkville 3052, VIC, Australia
| | - Raffael Massuda
- Laboratory of Molecular Psychiatry, INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350 Santa Cecília, Porto Alegre, RS 90035-903, Brazil
| | - Milawaty Nurjono
- Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597, Singapore
| | - Sarosh Sadiq
- Government College University, 170-S, 19/B, College Road, New Samanabad, Lahore, Pakistan
| | - Teresa Sanchez-Gutierrez
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43 28009, Madrid, Spain
| | - Tamara Sheinbaum
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Edifici B, 08193 Bellaterra, Barcelona, Spain
| | | | - Nicholas Simon
- Department of Neuroscience, A210 Langley Hall, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Anneliese Spiteri-Staines
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville 3052, Victoria, Australia
| | - Suttajit Sirijit
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Nanna Gilliam Toftdahl
- Mental Health Centre Copenhagen, Bispebjerg Bakke 23, Entrance 13A, 3rd floor, DK-2400, Copenhagen NV, Denmark
| | - Sunali Wadehra
- Wayne State University School of Medicine, 469 West Hancock, Detroit 48201, MI, United States
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing 100101, China
| | - Rebekah Wigton
- Cognition and Schizophrenia Imaging Laboratory, Institute of Psychiatry, King's College, 16 De Crespigny Park Rd, Denmark Hill, London SE5 8AF, UK
| | - Susan Wright
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Neuroimaging Research Program, P.O. Box 21247, Baltimore, MD 21228, United States
| | - Sergey Yagoda
- Department of Psychiatry, Psychotherapy and Medical Psychology of Stavropol State Medical University, 28b Aivazovsky str, Stavropol 355007, Russia
| | - Yuliya Zaytseva
- Moscow Research Institute of Psychiatry, Russian Federation/Prague Psychiatric Centre affiliated with 3rd Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Anne O'Shea
- Harvard Medical School, Brockton, MA 02301, United States. anne_o'
| | - Lynn E DeLisi
- Department of Psychiatry, Harvard Medical School, 940 Belmont Street, Brockton, MA 02301, United States; VA Boston Healthcare System, 940 Belmont Street, Brockton, MA 02301, United States.
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