PSYCHIATRIC DISORDER

Psychotic disorders are a group of syndromes characterized by positive symptoms, including hallucinations, delusions, and thought disorder; and negative symptoms, including mood symptoms, social withdrawal, and reduced motivation. Cognitive deficits also appear with psychotic disorders. Psychotic disorders rank 22nd in the World Health Organization's list of worldwide causes of disability.  This ranking is adjusted for the relatively low lifetime prevalence rate for psychosis; the perceived burden of the disease on those affected with psychotic disorders, as well as their relatives and caregivers, is much higher. Some symptoms are present, albeit in an attenuated form, prior to the onset of a diagnosable disorder. Features of psychotic disorders are detectable in the general population and are referred to as schizotypal traits, representing a normally distributed trait of risk for psychosis.

A recent large study of patients in their first episode of psychosis found a 74% lifetime prevalence of a substance use disorder, with 62% of the sample presenting at baseline with current substance use. Alcohol, nicotine, and cannabis are the predominant substances abused by patients with psychotic disorders. A US epidemiology study reported the risk for substance use as 4.6 fold higher in patients with schizophrenia compared with the general population. Even in Sweden, where there are tight restrictions on the sale of alcohol, patient consumption far exceeds rates reported in the general population.

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