Substance misuse in first-episode psychosis: 15-month prospective follow-up study

Abstract

BackgroundWell-designed prospective studies of substance misuse in first-episode psychosis can improve our understanding of the risks associated with comorbid substance misuse and psychosis.AimsTo examine the potential effects of substance misuse on in-patient admission and remission and relapse of positive symptoms in first-episode psychosis.MethodThe study was a prospective 15-month follow-up investigation of 103 patients with first-episode psychosis recruited from three mental health services.ResultsSubstance misuse was independently associated with increased risk of in-patient admission, relapse of positive symptoms and shorter time to relapse of positive symptoms after controlling for potential confounding factors. Substance misuse was not associated with remission or time to remission of positive symptoms. Heavy substance misuse was associated with increased risk of in-patient admission, relapse and shorter time to relapse.ConclusionsSubstance misuse is an independent risk factor for a problematic recovery from first-episode psychosis.

Substance Use Disorder Among People With First-Episode Psychosis: A Systematic Review of Course and Treatment

“…Approximately one-half of first-episode clients have a history of cannabis abuse or dependence and one-third have a current cannabis use disorder (7–12). The proportions are similar for alcohol use disorders (7–9,13,14). Smaller but significant proportions have use disorders related to cocaine, amphetamines, barbiturates, and other drugs (7,8,11,15,16).…”

“…Overall, approximately half of all clients with first episodes of psychosis present for treatment with a current substance use disorder. Once in treatment, continued use of alcohol and other drugs is associated with increased symptoms (6,9,16–19), adjustment difficulties (17), treatment nonadherence (16,19,20), relapses (9,21), and hospitalizations (7,9,19,22). Thus substance use disorders constitute a major risk factor for these clients.…”

Early Psychosis: Where we've been, where we still have to go

“…Birchwood identified the first five years as being a critical period (Birchwood & Fiorillo, 2000), and yet many early intervention programs provide only 18 months or at best 3 years. While many outcome studies look at one year outcomes (Addington et al, 2003a, b), the high rate of relapse in young people with psychosis (Gleeson et al, 2005) has led some to suggest that a longer continuity of care within first episode programmes is warranted, and that there may even be ethical issues about referral to mainstream agencies during this critical period (Linszen et al, 2001) as is seen with data about suicide rates (Power et al, 2003) and levels of substance use (Wade et al, 2006). Clearly the length of treatment required in optimal early psychosis services warrants further investigation.…”

Experiencias psicóticas atenuadas y consumo de sustancias en universitarios

“…El uso y abuso de sustancias ha sido asociado con un peor curso clínico, un inicio más temprano, una mayor duración de la psicosis sin tratar, exacerbación de la sintomatología, así como un mayor número de recaídas y hospitalizaciones y una peor adherencia al tratamiento, entre otros aspectos (Broussard et al, 2013;González-Pinto et al, 2011;Henquet et al, 2010;Lambert et al, 2005;Stefanis et al, 2014;Wade et al, 2006;Wisdom, Manuel, y Drake, 2011;Zammit et al, 2008). Además, el consumo previo de determinadas sustancias, como por ejemplo el cannabis, parece incrementar el riesgo posterior de desarrollar psicosis, así como las tasas de síntomas psicóticos subclínicos y experiencias psicóticas atenuadas, tanto en población general (Henquet, Murray, Linszen, y Van Os, 2005;Kuepper et al, 2011;McGrath et al, 2010;Moore et al, 2007), como en familiares de pacientes con psicosis (McGuire et al, 1995).…”