الفهرس 
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Abstract
Co-morbid substance use disorders in patients who are suffering from schizophrenia has emerged as one of the greatest obstacles to the effective treatment of patients with schizophrenia. These patients tend to use substance as non-effective coping strategies to overcome their psychotic symptoms along with their daily challenges which are often troublesome socially, economically, and psychologically. This study provides a starting point to understand the relationship between psychotic symptom clusters and substance use among patients with schizophrenia.
The aim of the study:
The present study aimed to determine the relationship between psychotic symptom clusters and substance use among patients with schizophrenia.
The subjects for the study comprised 200 schizophrenic inpatients. (139) male patients and (61) female patients.
Research design:
Descriptive correlationl research design
Setting:
The study was conducted at El-Maamoura Hospital for psychiatric medicine in Alexandria.
Subjects:
Data of the study were obtained by using three tools:-
Tool I: Socio-demographic and clinical data structured interview schedule:
This tool was developed by the researcher; it includes two parts to elicit data about socio-demographic characteristics and clinical characteristics for the patients with schizophrenia.
Tool II: Positive and negative syndrome scale (PANSS):
This tool was originally developed by kay and Opler in (1987) to assess positive symptoms, negatives symptoms and general psychopathology associated with schizophrenia and its severity.
Tool III: Substance use among patients with schizophrenia:
This tool was developed by the researcher after review of literature to collect data about substance use experience in patients with schizophrenia. It contained data about history of substance use, sharing substance use with others, reasons of substance use and the effect of substance on patients with schizophrenia.
Method:
- Male and female wards were ranked by simple randomization by picking their names up from a pool.
- The psychiatric wards (four male wards were chosen randomly and four female wards).
- For each selected ward the hospital records were checked to identify those patients who meet the inclusion criteria. This process was repeated in the second ward, and then in the third ward that had been selected to participate in the study until the predetermined sample size was achieved.
- The same process repeated for female wards until reach to only61 female patient from all hospital female wards (2 free wards,2 private wards) they follow the inclusion criteria which is duration of illness not more than 10 years to exclude chroniocity and any other co morbidity.
- Subjects were ascertained that any obtained data will be confidential and their privacy will be maintained.
- The interview was carried individually with insuring privacy and confidentiality of each patient.
The following are the main results yielded by the study:
A- Socio demographic characteristics:-
- About two thirds of the studied subjects (69.5%) were males.
- Patients’ age ranged between 20 to less than 30 years, considered the high age group of this study.
- More than half of the studied subjects (53.5%) were single.
- Nearly two thirds of the studied subjects (61.5%) lived in urban areas.
- Nearly half of the studied subjects (51.5%) were not working.
B- Clinical characteristics
- Nearly half of the studied subject (46%) of the studied subject had more than 5 years duration of illness.
- About half of the studied subject (51%) had 20-30 years old at onset of disease.
- As regard to symptoms on admission, (73%) of them had hallucination, 65.5% of them had delusions, (45.5%) of them were excited and 11.5% of them had suicidal ideation.
C- Substance use among patients with schizophrenia:
- Three quarter of the studied subject (75.5%) were using one or more substance.
- The majority of the studied subjects (87.4%) reported daily use of substance.
- About Three quarter (77.5%) of the studied subjects reported that they used multiple substances with a mean of 3.13 ± 2.26 substances at the same time.
- More than half (52.3%) of the studied subjects reported that it is not possible for them to spend one day without substance use.
- About (36.4%) reported that their family member were using substance with them.
- More than half (67.5%) of the studied subjects reported that their psychotic symptoms pushed them to use substance.
- More than half (59.6%) reported that substance use increased their symptoms.
D- The difference between substance users & Non users among the studied subjects regarding positive syndrome scale.
- The studied subjects who were substance users had a high mean (3.25±1.48) than non substance users (2.73±1.43). A statistically significant difference (t=2.149, p=0.033). Regarding the severity of Suspiciousness/ persecution the studied subjects who were substance users had a high mean (3.10±2.03) than non substance users (2.31±1.333), with statistically significant difference (t=3.159, p=0.002). No statistically difference (t=1.656, p=0.099) was found between total mean percent score of users mean (25.21±14.29) and non users mean (21.33±14.16).
E- The difference between substance users & Non users among the studied subjects regarding negatives syndrome scale.
- The studied subjects who were not substance users had a high mean (2.27±1.29) than substance users (1.83±1.18).
- The table also shows that regarding the severity of Lack of spontaneity and flow of conversation, the studied subjects who were not substance users had a high mean (2.06±1.33) than substance users (1.64±1.11). A statistically significant difference (t=2.024, p=0.044) was found between total mean percent score of users mean (12.54±14.39) and non users mean (17.35±14.69).
The following are the main recommendations yielded by the study:-
A- Recommendation geared toward clinical practice:
1- Hospital health system need to be modified to incorporate management of substance use among patients with schizophrenia.
2- Reactivating clinical practice in dual diagnosis ward at ElMaamoura hospital is necessary.
3- Conducting psycho-educational programs for patients with schizophrenia who have a dual diagnosis is needed.
4- Teaching the patients with schizophrenia who have a dual diagnosis about alternative coping strategies with stressful events other than substance use is important for the prognosis of the patients.
5- Providing inpatients with a special place for smoking out side the ward so that non-smokers do not learn to smoke by modeling or peer pressure.
B- Recommendation geared toward Community:
1- Psycho educational program about substance use, its consequences on the patients with schizophrenia, their families and the community should be part of the community mental health services.
2- Activation of the narcotic anonymous program for families of patients with schizophrenia if they are substance users should be encouraged in public and private health sectors.
C- Recommendation geared toward education:
1- The dual diagnosis of substance use with mental disorder must be incorporated in the psychiatric nursing curriculum in order to shed the light on its effect and consequences on individual, families and community.