Individuals developing schizophrenia are hidden among adolescent substance misusers

Abstract

Treatment programmes for adolescents misusing substances include a disproportionate number developing schizophrenia. Early detection and treatment have the potential to improve long-term outcomes.

Severe conduct problems in adolescence and risk of schizophrenia in early adulthood

“…First, there was a significant group by gender interaction, suggesting that compared to the general population, the risk of schizophrenia was elevated more in RS girls than in RS boys. This resembles previous findings from a study on adolescents treated for substance misuse (Hodgins, Larm, & Westerman, ). One reason for this observation may be that only 35% of the RS population were girls, and RS girls may be even more selected subgroup than RS boys.…”

“…Second, we were not able to investigate cannabis or other substance abuse. In a previous study by Hodgins et al (), among adolescents treated for substance misuse, a large proportion of subjects were developing schizophrenia. Third, for younger cohorts, the follow‐up time was relatively short, which in turn results in false negatives.…”

Dilemmas in the treatment of early-onset first-episode psychosis

“…Low expectations of full recovery may affect clinicians' motivation to diagnose additional conditions and therefore miss the opportunity to implement evidence-based interventions which are likely to significantly improve the clinical progress of the young person. Finally, substance misuse, frequently preceding or coexisting with psychosis, 72,73 can influence not only the aetiological conceptualization of young people's symptomatology, but also lower the expectations of recovery and lead to suboptimal treatments of both conditions.…”

Clinical Factor 2016

“…The relationship between various problem behaviors in adolescence and schizophrenia is a complex one - individuals who develop schizophrenia have an increased frequency of conduct disorder in childhood/adolescence, large proportions of first-episode patients have a history of criminality and substance misuse, the incidence of psychotic disorder in young delinquents is higher than in the general population, and heavy use of cannabis during adolescence is associated with an increased risk of schizophrenia. Considering all these factors, Hodgins et al [5] studied adolescents in a large urban center in Sweden to determine whether adolescents seeking treatment for substance misuse were at a higher risk of developing schizophrenia compared to age- and sex-matched general population peers, whether this risk has changed since 1960, whether cannabis misuse in adolescence predicted the development of schizophrenia, and whether adolescent substance misuse predicted substance use disorders, physical disorders, criminal convictions, poverty and death in those who developed schizophrenia. They obtained 3 population samples from the only clinic for adolescent substance misuse in Stockholm: 1,992 individuals (1,660 males, 332 females) treated from 1968 to 1971; 1,576 individuals (1,010 males and 566 females) treated from 1980 to 1984 (matched samples were obtained for both samples), and 180 individuals (81 males, 99 females) followed at the clinic between 2000 and 2009.…”