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ObjectivesTo evaluate the influence of cannabis in the long-term follow-up in patients with a first psychotic episode, comparing those who have never used cannabis with (a) those who used cannabis before the first psychotic episode but stopped it during the follow-up, and (b) those who used cannabis both before and after the first psychotic episode.MethodPatients were followed from the first psychotic admission. They were assessed at 1, 3 and 5 years obtaining information about functional outcome, positive and negative symptoms. At 8th year functional outcome was evaluated. Patients were classified in 3 groups: 40 that never used cannabis (NU), 27 that used cannabis and stopped during follow-up (CUS), and 25 that had continued use during follow-up (CU).ResultsAt baseline, there were differences neither in functional outcome nor in negative symptoms. The CUS group improved the functional outcome during the follow-up (p< 0.001), while CU and NU groups did not show any significant results (p= 0.466 and p= 0.370 respectively). CUS group had also a significant decreasing trend in negative symptoms (p= 0.012), whereas for the other two groups no significant results were observed (p= 0.069 and p= 0.226 respectively). All groups improved in positive symptoms during follow-up.ConclusionsAlthough cannabis use has deleterious effect, to stop it after the first psychotic episode produces a clearly improvement in the long-term follow-up.

IntroductionEarly onset forms of bipolar disorder may be difficult to distinguish from schizophrenia. Although operational criteria have become more precise, and there are more diagnostic systems to catalogue a psychotic adolescent, the clinicians continue having difficulties.ObjectiveTo know the stability of the diagnosis of definitively bipolar patients with psychotic symptoms during the episodes, and factors that can influence other psychotic diagnoses in the first episode of the illness.Method140 bipolar patients of Araba, (Basque country) were included during 2 years. Patients were divided into two groups: unstable diagnoses (UD)(bipolar patients with an initial diagnosis of other psychosis) and stable diagnoses (SD) of bipolar disorder. Clinical and sociodemographic data were obtained.ResultsThe mean age at onset was significantly lower in the UD group (p = 0.004). It was rare to have an unstable diagnosis when the first psychotic episode occurred after age 38 (p = 0.008). There were more singles in the UD group (p = 0.010).The presence of mood incongruent psychotic symptoms was more frequent in the UD group (p < 0.001).Mood incongruent psychotic symptoms variable was the only independent factor significantly associated with an unstable diagnosis in the multivariate analysis (p = 0.036).DiscussionOne third of the patients have been previously diagnosed with other psychotic illness.This study suggests that the most important factor is the clinical picture, especially the presence of mood-incongruent psychotic symptoms. A correct diagnosis is important because patients who are prescribed mood stabilizers have lower rates of rehospitalisation than those who are not treated with mood stabilizers.