Funcionamiento psicosocial de pacientes esquizofrénicos de acuerdo con su consumo de alcohol

• Autores: María Elena Medina-Mora Icaza, Leonila Rosa Díaz Martínez, Valerio Villamil Salcedo, Francisco Juárez García, Marcelo Valencia Collazos
• Localización: Salud mental, ISSN 0185-3325, Vol. 28, Nº. 4, 2005, págs. 40-48
• Idioma: español
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• Resumen
  • español

    Antecedentes: La esquizofrenia afecta a 1-1.5% de la población mundial; en México, se ha calculado que, en 2000, existían de 619,550 a 1¿239,101 (1-2%) sujetos con esquizofrenia. Las características principales de la esquizofrenia son los síntomas positivos y negativos que guardan estrecha relación con el deterioro del funcionamiento psicosocial. Por otro lado, el consumo de sustancias adictivas en la población psiquiátrica va de 25% a 80%, siendo el alcohol una de las sustancias de mayor abuso. El consumo de dicha sustancia está muy relacionado con un deficiente funcionamiento psicosocial; si al consumo de alcohol se asocia la esquizofrenia, la funcionalidad psicosocial estará más alterada. En los últimos años se ha comprobado que la reincorporación temprana de los sujetos esquizofrénicos a su medio social y familiar provoca menor deterioro del funcionamiento psicosocial. Este funcionamiento consiste en evaluar los roles que desempeña el paciente, así como las habilidades para desenvolverse en su medio familiar, social y laboral. En tal sentido, el funcionamiento psicosocial se define como la capacidad de cada sujeto para adaptarse, funcionar, desenvolverse e interactuar en el ámbito social y personal.

    Objetivo: Conocer la relación que existe entre el funcionamiento psicosocial de los pacientes esquizofrénicos de acuerdo con su consumo de alcohol y la severidad de la esquizofrenia.

    Metodología: Se seleccionó a 80 sujetos esquizofrénicos a quienes se les aplicaron, en una sola ocasión, la Escala de Funcionamiento Psicosocial (EFPS), la Cédula Diagnóstica Internacional Compuesta (CIDI), la Escala de Síntomas Positivos y Negativos (PANSS) y la Prueba de Identificación de Trastornos Derivados del Consumo de Alcohol (AUDIT). Para el análisis estadístico, se utilizaron la Chi cuadrada, la U de Mann-Whitney, la prueba t, la Kruskal-Wallis y el ANOVA de una vía.

    Resultados: El 71% de los sujetos fueron varones y 29% mujeres; 87% eran solteros, y 70% desempleados o subempleados. En 87% de los sujetos la esquizofrenia se inició entre los 12 y 30 años (promedio = 23 años; DE = 6.36), y 94% inició el consumo de alcohol en este mismo grupo de edad (promedio = 20 años; DE = 4.98). El 76% de los sujetos tenía menos de 10 años de evolución con esquizofrenia. Al comparar el consumo de alcohol según el AUDIT con el funcionamiento psicosocial, las áreas más alteradas fueron la social y la familiar, con resultados estadísticamente significativos. En cuanto al tiempo de evolución de la esquizofrenia y el funcionamiento psicosocial, el grupo con menos satisfacción en su funcionamiento fue el de 16-20 años. La severidad de la esquizofrenia no mostró una significancia estadística al compararla con el tipo de consumo de alcohol.

    Conclusión: Los resultados de esta investigación se relacionan con muchos estudios nacionales e internacionales respecto a la edad de inicio, el sexo, la escolaridad y el estado civil de los pacientes con esquizofrenia. Por otro lado, se ha visto que el inicio del consumo de alcohol es a una edad cada vez más temprana y que los hombres son los principales consumidores. Esta relación ha llevado a pensar a muchos investigadores que el inicio de la esquizofrenia está altamente asociado con el inicio del consumo de alcohol. En esta investigación no se pudo comprobar tal hipótesis por el número reducido de sujetos en la muestra; lo que sí es claro es que existe una alta comorbilidad entre esquizofrenia y consumo de alcohol, que se traduce en un mayor deterioro del funcionamiento psicosocial. Dentro de los instrumentos utilizados, el AUDIT es un excelente instrumento de tamizaje para detectar sujetos en riesgo de volverse alcohólicos. Por ello se sugiere su uso tanto en hospitales de primer nivel como de tercero. Finalmente, existe suficiente evidencia de que la esquizofrenia asociada con el alcohol produce un efecto acumulado para el deterioro del funcionamiento psicosocial, por lo que se sugiere a los clínicos investigar más el fenómeno de la comorbilidad esquizofrenia-alcohol y su relación con el funcionamiento psicosocial, para de esta manera plantear programas adecuados de prevención, tratamiento y rehabilitación de la población esquizofrénica.

  • English

    Background:

    Between 1% and 1.5% of the world population is affected by schizophrenia. In Mexico, it has been estimated that between 619,550 and 1,239,101 (1-2%) individuals suffered from schizophrenia in 2000. The condition is more common among male teenagers and young adults. The main features of schizophrenia are the positive and negative symptoms closely associated with a psychosocial functioning impairment. In addition, between 25% and 80% of the psychiatric population uses addictive substances, with alcohol, at 50%, being one of the most highly used. These substances use is closely associated with a poor psychosocial functioning; when alcohol use is accompanied by schizophrenia, psychosocial functioning is even more disrupted. In the last few years, it has been shown that an early reinsertion of schizophrenic individuals into their social and familial environment causes a lesser degree of impairment in their psychosocial functioning. This functioning is evaluated through the acquisition of new skills to move about in familial, social and work environments. The latter is called psychosocial treatment. In this sense, psychosocial functioning is described as each individual’s ability to adapt, function, move about and interact in a social and personal environment. This functioning evaluates the social, occupational, economic, sexual and familial areas.

    Objective:

    The objective of this study was to establish the association between schizophrenic patients’ psychosocial functioning according to their alcohol use and the severity of schizophrenia.

    Methodology:

    Eighty schizophrenic, psychiatrically stable, subjects were selected during a 14-month period of time. All of them were submitted only once to the Psychosocial Functioning Scale (PFS), the Composite International Diagnostic Interview (CIDI), the Positive and Negative Symptoms Scale (PANSS) and the Alcohol Use Disorders Identification Test (AUDIT). These scales were used in order to confirm the schizophrenia diagnostic and its severity, to measure the psychosocial functioning of this population, to identify early on problems related to alcohol use and to perform an alcohol use/dependency diagnostic on those individuals who met such diagnostic criteria. A Chi squared, Mann-Whitney’s U, the t test, Kruskal-Wallis and the one-way ANOVA were used for statistical analysis purposes.

    Results:

    Seventy-one percent of the subjects were males and 29% females; 87% were single and 70% were unemployed or had an informal job. Thirty-one years was the average age among males and 34 among females. Subjects started suffering schizophrenia when they were between 12 and 30 years (average: 23 years; SD: 6.36), and 94% of them started using alcohol while they were at this very same age range (average: 20 years; SD: 4. 98). Seventy-six percent of the subjects presented a schizophrenia evolution of less than ten years. Comparing alcohol use with psychosocial functioning according to the AUDIT, the social and familial were the more affected areas, both of which showed statistically significant differences. As to the period of evolution of schizophrenia and psychosocial functioning, the 16-20 year group was the one which showed less satisfaction. Schizophrenia severity did not show any statistical significance when compared to the type of alcohol use.

    Conclusion:

    Results from this research are similar to those from other Mexican and international studies which have found out that schizophrenia onset is more common during teenage, that more men than women are affected by the condition and that most subjects suffer it first when they are between 16 and 25 years. On the other hand, it has been found out that alcohol use is starting at increasingly early ages, with men being the main users. Such an association has lead many researchers to think that schizophrenia onset is highly associated with alcohol use, be it because the negative symptoms of schizophrenia promote the initial use of alcohol or because alcohol use triggers the early onset of schizophrenia.

    In this study it was not possible to prove such an hypothesis given the reduced number of subjects in the sample. This was not either the main objective of the study and given the fact that some other type of methodology is required to identify such an association. However, it is clear that there is a high non-diagnosed comorbidity between schizophrenia and alcohol use which, as a result, is not treated and translates, ultimately, into a bigger impairment of the psychosocial functioning. Among the scales employed, AUDIT is an excellent screening instrument to detect subjects at risk of becoming alcoholics and to identify incipient alcohol use patterns and the problems associated with it. Thus, it is suggested that it could be used both in first and third level hospitals. Finally, although no statistically significant results were found out in any of the variables, there is enough evidence where the association between schizophrenia and alcohol leads to an accumulated effect influencing the psychosocial functioning impairment. In the light of this, it is suggested that clinicians inquire about alcohol use in patients showing some mental pathology to research more in depth the schizophrenia-alcohol comorbidity phenomenon and its association with psychosocial functioning so as to design adequate prevention, treatment and rehabilitation programs for the schizophrenic population.