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Archived Comments for: Substance abuse in first-episode schizophrenic patients: a retrospective study

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  1. The relevance of older literature

    Joshua Kantrowitz, Yale University

    23 September 2006

    This is an interesting retrospective study of a large cohort of patients that notes an earlier onset of psychosis among substance abusers, when compared to non-drug-abusing patients. It references several earlier, similar studies, but we wish to bring an earlier, non-referenced article to the author’s attention.

    In 1972 [1], a similar, albeit smaller, study was published. This study compared 12 patients admitted after acute ingestion of a psychotomimetic drug compared to 26 patients with acute psychotic reactions unrelated to drug abuse. Substance abusers appeared to be as seriously ill as non-substance abusers, with no difference found between average length of hospitalization, nor between dosage of antipsychotic. On follow-up [2], despite favorable prognostic indicators at baseline, fifty percent of the substance group had a poor outcome, with two suicides. Most were admitted after acute LSD ingestion, but had used cannabis extensively in the past. Much like the present paper, an earlier onset of psychosis was found in substance abusers, as well as a higher level of excitement on the BPRS, which is correlated to hostility on factorial analysis [3].

    The absence of reference to this 1972 article is not a rare occurrence, and we do not mean to single out the authors for criticism. There are approximately 4800 journals referenced on Medline, and thousands of other relevant psychiatric journals are found when databases such as EMBASE and PSYCHINFO are included. This explosion in the number of journals has made it difficult to keep up with the literature, and has made it especially easy to miss older studies.

    It would be a mistake if our field continued to dismiss earlier literature. Of course much older literature is obsolete, but the near total disregard for it can lead to unnecessary duplication. It is regrettable that in an age of electronic databases, that it remains so easy to miss relevant articles.


    Joshua T Kantrowitz MD

    Malcolm B Bowers MD

    Yale University

    Department of Psychiatry

    1. Bowers MB Jr: Acute psychosis induced by psychotomimetic drug abuse. I. Clinical findings. Arch Gen Psychiatry 1972, 27:437-40.

    2. Bowers MB Jr: Psychoses precipitated by psychotomimetic drugs. A follow-up study. Arch Gen Psychiatry. 1977, 34:832-5.

    3. Harvey PD, Davidson M, White L, Keefe RS, Hirschowitz J, Mohs RC, Davis KL. Empirical evaluation of the factorial structure of clinical symptoms in schizophrenia: effects of typical neuroleptics on the brief psychiatric rating scale. Biol Psychiatry. 1996, 40:755-60.

    Competing interests