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Abstract

Objective:

Clinical investigators in Japan have long suggested that exposure to methamphetamine might cause a persistent schizophrenia-like psychosis. This possibility is discounted in the Western literature. To investigate the relationship between drug use and later schizophrenia, the authors conducted a large-scale cohort study of drug users initially free of persistent psychosis.

Method:

A population-based cohort study was conducted using data from California inpatient hospital discharge records from 1990 through 2000. Patients with methamphetamine-related conditions (N=42,412) and those with other drug use disorders (cannabis, cocaine, alcohol, and opioids) were propensity score-matched to individuals with primary appendicitis who served as a population proxy comparison group; the methamphetamine cohort was also matched to the other drug cohorts. Cox modeling was used to estimate differences between matched groups in the rates of subsequent admission with schizophrenia diagnoses.

Results:

The methamphetamine cohort had a significantly higher risk of schizophrenia than the appendicitis group (hazard ratio=9.37) and the cocaine, opioid, and alcohol groups (hazard ratios ranging from 1.46 to 2.81), but not significantly different from that of the cannabis group. The risk of schizophrenia was higher in all drug cohorts than in the appendicitis group.

Conclusions:

Study limitations include difficulty in confirming schizophrenia diagnoses independent of drug intoxication and the possibility of undetected schizophrenia predating drug exposure. The study's findings suggest that individuals with methamphetamine-related disorders have a higher risk of schizophrenia than those with other drug use disorders, with the exception of cannabis use disorders. The elevated risk in methamphetamine users may be explained by shared etiological mechanisms involved in the development of schizophrenia.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 389 - 396
PubMed: 22193527

History

Received: 5 July 2010
Revision received: 3 August 2011
Accepted: 6 September 2011
Published online: 1 April 2012
Published in print: April 2012

Authors

Details

Russell C. Callaghan, Ph.D.
From the Centre for Addiction and Mental Health, Toronto; the Dalla Lana School of Public Health, the Departments of Psychiatry and Pharmacology, Faculty of Medicine, and the Institute of Medical Science, University of Toronto, Toronto; the Department of Family and Community Medicine, University of Arizona, Tucson; and the Department of Public Health Sciences, Karolinska Institutet, Stockholm.
James K. Cunningham, Ph.D.
From the Centre for Addiction and Mental Health, Toronto; the Dalla Lana School of Public Health, the Departments of Psychiatry and Pharmacology, Faculty of Medicine, and the Institute of Medical Science, University of Toronto, Toronto; the Department of Family and Community Medicine, University of Arizona, Tucson; and the Department of Public Health Sciences, Karolinska Institutet, Stockholm.
Peter Allebeck, M.D., Ph.D.
From the Centre for Addiction and Mental Health, Toronto; the Dalla Lana School of Public Health, the Departments of Psychiatry and Pharmacology, Faculty of Medicine, and the Institute of Medical Science, University of Toronto, Toronto; the Department of Family and Community Medicine, University of Arizona, Tucson; and the Department of Public Health Sciences, Karolinska Institutet, Stockholm.
Tamara Arenovich, M.Sc.
From the Centre for Addiction and Mental Health, Toronto; the Dalla Lana School of Public Health, the Departments of Psychiatry and Pharmacology, Faculty of Medicine, and the Institute of Medical Science, University of Toronto, Toronto; the Department of Family and Community Medicine, University of Arizona, Tucson; and the Department of Public Health Sciences, Karolinska Institutet, Stockholm.
Gautam Sajeev, M.Sc.
From the Centre for Addiction and Mental Health, Toronto; the Dalla Lana School of Public Health, the Departments of Psychiatry and Pharmacology, Faculty of Medicine, and the Institute of Medical Science, University of Toronto, Toronto; the Department of Family and Community Medicine, University of Arizona, Tucson; and the Department of Public Health Sciences, Karolinska Institutet, Stockholm.
Gary Remington, M.D., Ph.D.
From the Centre for Addiction and Mental Health, Toronto; the Dalla Lana School of Public Health, the Departments of Psychiatry and Pharmacology, Faculty of Medicine, and the Institute of Medical Science, University of Toronto, Toronto; the Department of Family and Community Medicine, University of Arizona, Tucson; and the Department of Public Health Sciences, Karolinska Institutet, Stockholm.
Isabelle Boileau, Ph.D.
From the Centre for Addiction and Mental Health, Toronto; the Dalla Lana School of Public Health, the Departments of Psychiatry and Pharmacology, Faculty of Medicine, and the Institute of Medical Science, University of Toronto, Toronto; the Department of Family and Community Medicine, University of Arizona, Tucson; and the Department of Public Health Sciences, Karolinska Institutet, Stockholm.
Stephen J. Kish, Ph.D.
From the Centre for Addiction and Mental Health, Toronto; the Dalla Lana School of Public Health, the Departments of Psychiatry and Pharmacology, Faculty of Medicine, and the Institute of Medical Science, University of Toronto, Toronto; the Department of Family and Community Medicine, University of Arizona, Tucson; and the Department of Public Health Sciences, Karolinska Institutet, Stockholm.

Notes

Address correspondence to Dr. Callaghan ([email protected]).

Funding Information

Dr. Remington has received research support from Medicure, Neurocrine Biosciences, and Novartis and has served as an adviser to Roche. Dr. Kish has received research funding from the National Institute on Drug Abuse (grants 071301 and DA 025096) and has received remuneration as an expert witness (to provide an opinion on amphetamine toxicity). The other authors report no financial relationships with commercial interests.Supported indirectly by an institutional grant (which contributes salary support to scientists) from the Ontario Ministry of Health and Long-Term Care to the Centre for Addiction and Mental Health. The ministry did not have any role in the study design, analyses, interpretation of results, manuscript preparation, or approval to submit the final version of the manuscript for publication. The views expressed in this article do not necessarily reflect those of the ministry.

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