Screening for substance use disorders in first-episode psychosis: Implications for readmission

Abstract

Introduction Screening of substance use may prove useful to prevent readmission after the first episode of psychosis. The aim of the present study was to evaluate the influence of drug use on readmission risk in a first-episode psychosis sample, and to determine whether the cannabis/cocaine subscale of the Dartmouth Assessment of Lifestyle Inventory (DALI) is a better predictive instrument than urinary analysis. Methods After admission, first-episode psychotic patients were interviewed for substance use and assessed with the DALI scale. They also underwent blood and urine sampling. Time to readmission was studied as a dependent outcome. The Kaplan–Meier estimator was applied to estimate the survival curves for bivariate analysis. The Cox proportional hazards model for multivariate analysis was assessed in order to control for potential confounders. ROC curve and validity parameters were used to assess validity to detect readmission. Results Fifty-eight patients were included. The DALI cannabis/cocaine subscale and urinalysis were associated with increased readmission risk in survival curves, mainly the first five years of follow-up. After controlling for potential confounding variables for readmission, only the DALI cannabis/cocaine subscale remained as a signifi-cant risk factor. In terms of validity, the DALI cannabis/cocaine subscale was more sensitive than urinalysis. Alcohol assessments were not related to readmission. Conclusions The findings demonstrated that a quick screening self-report scale for cannabis/cocaine use disorders is superior to urinary analysis for predicting readmission. Future research should consider longitudinal assessments of brief validated screening tests in order to evaluate their benefits in preventing early readmission in first-episode psychosis.

Internações e reinternações psiquiátricas em um hospital geral de Porto Alegre: características sociodemográficas, clínicas e do uso da Rede de Atenção Psicossocial

“…In regard to gender, a slightly higher number of women (53.1%) may be observed in the sample. Although no significant difference was found in the group of frequent readmissions, the percentage of men (54.3%) was higher, while only 34.6% were men in the group of non-frequent users, which corroborates some studies in the literature which indicate gender as a significant variable, in which men had higher numbers and chances of readmissions 18,19,20,34 . The mean education in the sample was of 9.29 years, which indicates that most (46.9%) participants attended high school.…”

“…In relation to marital status, most participants in this study did not have a companion (77.1%), which is in agreement to other researches showing a predominance of participants without partners in their samples [7][8][9]21,24 . Although no statistical significance was found, the frequent readmissions group had higher number of people without a partner (85.7%) when compared to the group which did not meet this criterion (77%), corroborating the literature reviewed 12,[18][19][20][21] . Among the clinical data evaluated, the duration of hospitalizations in this sample ranged between 5 and 130 days, with an average of 36 days.…”

“…The mean education in the sample was of 9.29 years, which indicates that most (46.9%) participants attended high school. In relation to this profile, it may be highlighted it is in the same direction of other studies indicating most participants had secondary levels of study or low education 7,8,[18][19][20] . This was not a variable to present differences when compared to the frequent readmission group, which corroborates the literature 33,34 .…”

“…younger users 16,17 ; 2. single or living by themselves 5,12,[18][19][20][21] ; and 3. those who have less contact with their families 19,22,23 .…”

Cannabis use in first‐treatment bipolar I disorder: relations to clinical characteristics

“…4,8,10,[29][30][31][32][33] It supports the hypothesis that cannabis may increase the risk for bipolar disorder, in particular manic and psychotic episodes, interacting with individual genetic vulnerability and other environmental stressors. [33][34][35][36][37][38] However, since this is a cross-sectional study, we do not know in the case of individual patients if the cannabis use started before, at the same time or after the onset of the first manic and/or psychotic episode. Since this is a first-treatment sample, with a short time period from the first mood episode to time of first treatment, we can, to a large extent, rule out the hypothesis that the more severe course seen in early-onset BD increases the risk for later cannabis use.…”