Hospital length of stay in individuals with schizophrenia with and without cocaine-positive urine drug screens at hospital admission.

Despite the high prevalence of cocaine use disorder (CUD) in individuals with schizophrenia, current understanding of the effect of cocaine on psychiatric hospital length of stay (LOS) in individuals with schizophrenia is limited. We therefore retrospectively examined the medical records of 5106 hospital admissions due to exacerbation of schizophrenia. Linear regression and t-test were used to compare LOS between individuals with schizophrenia with cocaine-positive urine drug test results and those with negative test results. Individuals with schizophrenia who were also positive for cocaine had shorter LOS from both unadjusted (geometric mean LOS, 8.07 ± 1.92 vs. 11.83 ± 1.83 days; p < 0.001) and adjusted (ß = 0.69; confidence interval, 0.63-0.76; p < 0.001) analyses. Our results suggest that individuals with schizophrenia who also have comorbid CUD may require shorter inpatient treatment during periods of exacerbation of symptoms. Replication of this finding has relevance in treatment planning and resource allocation for the subpopulation of individuals with schizophrenia who also have stimulant use disorders.

Cocaine use in individuals with schizophrenia: impact on doses of discharge antipsychotic medications.

OBJECTIVES: Despite the high prevalence of cocaine use disorder in schizophrenia, the impact of cocaine on antipsychotic requirement has not been studied in this population. The aim of this study was to evaluate the effect of cocaine on doses of antipsychotic medication prescribed during periods of acute exacerbation of psychotic symptoms in individuals with schizophrenia. METHODS: We reviewed the medical records of individuals with schizophrenia discharged from hospitals between 2008 and 2012. Student t tests and linear regression were used to compare doses of discharge antipsychotic medications (in chlorpromazine equivalents) between individuals with schizophrenia with cocaine positive urine drug test results (n = 180; age 42.71 ± 10.03 years) and individuals with schizophrenia with negative urine drug test results (n = 3194; age 38.49 ± 12.86 years). RESULTS: Unadjusted analysis revealed that individuals with schizophrenia who tested positive for cocaine were discharged on lower doses of antipsychotic medication compared with those who tested negative (449.88 ± 2.12 vs 515.47 ± 2.16; P = 0.021). However, after adjusting for age, sex, race, and length of stay, the 2 groups did not differ on doses of discharge antipsychotic medication (geometric mean difference 7.41; CI: 7.62-12.30; P = 0.703). CONCLUSIONS: Our preliminary result suggests that cocaine use does not impact significantly on the doses of antipsychotic medication prescribed during periods of acute exacerbation of psychosis in schizophrenia and individuals with schizophrenia with comorbid cocaine use disorder may require similar doses of antipsychotic medication as those without cocaine use disorder.