Reasons for increased substance use in psychosis

Avatar Intervention in Virtual Reality for Cannabis Use Disorder in Individuals With Severe Mental Disorders: Results From a 1-Year, Single-Arm Clinical Trial

Background

The dual diagnosis of cannabis use disorder (CUD) and severe mental disorder (SMD) results in clinically complex individuals. Cannabis use is known to have negative consequences on psychiatric symptoms, medication compliance, and disease prognosis. Moreover, the effectiveness of currently available psychotherapeutic treatments is limited in this population. In this context, our research team developed avatar intervention, an approach using virtual reality as a therapeutic tool to treat CUD in individuals with SMD.

Objective

This pilot clinical trial aimed to evaluate, until the 1-year follow-up, the efficacy of avatar intervention for CUD among 32 participants with a dual diagnosis of SMD and CUD.

Methods

Over the course of the 8 intervention sessions, participants were given the opportunity to enter a dialogue in virtual reality with an avatar representing a person with a significant role in their consumption, who was animated in real time by a therapist. The primary outcomes were the quantity of cannabis consumed and the frequency of use. Secondary outcomes included severity of problematic cannabis use, motivation for change, protective strategies for cannabis use, consequences of cannabis use, psychiatric symptoms, and quality of life. Changes in reported outcomes during the assessment periods before the intervention; postintervention; and 3, 6, and 12 months after the end of the intervention were assessed using a linear mixed-effects model.

Results

Significant reductions were observed in the quantity of cannabis consumed, and these were maintained until the 12-month follow-up visit (d=0.804; P<.001; confirmed by urine quantification). Frequency of cannabis use showed a small significant reduction at the 3-month follow-up (d=0.384; P=.03). Moreover, improvements were observed in the severity of CUD, cannabis-related negative consequences, the motivation to change cannabis use, and the strategies used to mitigate harms related to cannabis use. Finally, moderate benefits were observed for quality of life and psychiatric symptoms.

Conclusions

Overall, this unique intervention shows promising results that seem to be maintained up to 12 months after the end of the intervention. With the aim of overcoming the methodological limitations of a pilot study, a single-blind randomized controlled trial is currently underway to compare the avatar intervention for CUD with a conventional addiction intervention.

Impact of a family history of mental disorders on the characteristics of patients with early psychosis

AIM

Children of parents with psychiatric illness have a higher risk of developing psychiatric disorders. This is particularly the case for psychoses and the evolution of these disorders could likely differ. The aim of this study was to study the impact of a first-degree and second-degree family history of psychiatric disorders (FHPD) on the characteristics of patients with early psychosis in a specialized programme.

METHOD

This research is a prospective study based on 408 patients aged 18-35 years enrolled in the Treatment and Early Intervention in Psychosis Program (TIPP) with a three-years follow-up. Various characteristics were compared between patients with first-degree-FHPD and those without, then between patients with 2nd degree-FHPD and those without. The influence of the number of parents with first or second degree FHPD on clinical characteristics was also studied.

RESULTS

Our results showed an influence of FHPD on the characteristics of patients presenting a first episode of psychosis. Over the 3 years of follow-up, patients with at least one second-degree relative showed more negative and depressive symptoms and poorer general functioning than patient who did not. The number of parents with first or second degree FHPD was also negatively associated with several clinical variables.

CONCLUSION

The results of this study confirm the existence of a distinct premorbid profile and a different evolution in patients with FHPD, which is not limited to first-degree relatives. This suggests the importance of specific needs that should be addressed during treatment.

Relapse rate and predictors among people with severe mental illnesses at Debre Markos Comprehensive specialized hospital, Northwest Ethiopia: a prospective follow up study

Severe mental illness is usually marked by periods of remission, when symptoms are absent or well controlled, and of exacerbation, when symptoms return or worsen. Relapse of these severe illnesses costs a lot for patients and their families and imposes a financial burden on hospital and community services. Costs for relapse cases were four times higher than that of non-relapse cases. There is a dearth of evidence in on relapse rate on these vulnerable population in Sub-Saharan Africa, therefore this study assessed relapse rate and predictors among people with severe mental illnesses at Debre Markos Comprehensive specialized hospital, Northwest Ethiopia. Prospective follow up study design was employed among 315 people with severe mental illnesses who were selected by systematic random sampling technique. Epi.data version 4.2 was used for data entry and exported to STATA 14 for analysis. The Kaplan-Meier curve was used to estimate the median duration of occurrence and the Log rank test was used to compare survival curves between different categories of explanatory variables. A survival analysis was used to estimate the cumulative rate of relapse, Cox proportional hazards models was used to examine independent factors associated with time to develop relapse. To estimate the association between predictors and relapse, hazard ratio with 95% confidence intervals was used. Variables score p value < 0.25 with in the Bivariable analysis was entered in to the multivariable analysis model. The statistical significance was accepted at p-value < 0.05. Around 119 (37.78%) had develop relapse, and the remaining 196 (62.22%) were censored. The overall incidence rate of relapse was 3.66 per 100 person-month (95% CI:3.06-4.38) with a total of 3250 patient-month observations. Variables such as: age (18-36 years) [(AHR) = 3.42:95% (CI) :1.67,6.97)], marital status (single and widowed) 1.87 [AHR: 1.87; 95% CI: (1.06 ,3.27)] and 2.14 [AHR: 2.14; 95% CI: (1.03 ,4.44)], duration of delay in getting treatment ( > = 1 year) [(AHR = 2.55:CI:1.20, 5.38)], types of diagnosis (Major Depressive Disorder) (AHR = 2.38, CI:1.37 ,4.14), medication adherence (low adherence) (AHR = 5.252.45, 11.21) were statistically significant (P value < 0.05). Nearly two-fifth of people diagnosis with severe mental illnesses had develop relapse and the median survival time to develop relapse was nine months. It is advised that early detection of severe mental illness and early initiation of treatments are very crucial to prevent relapse. Psycho education, counseling that alleviates poor treatment adherence are highly recommended.

Racial and ethnic differences in comorbid psychosis: a population-based study

Introduction

Differences in the prevalence of psychiatric conditions such as psychosis as well as patterns of comorbidity for psychosis have been reported between racial and ethnic groups. It is unclear whether those differences are consistent for comorbid psychosis.

Methods

Self-reported diagnostic data from American adults ages 18-99 participating in the Collaborative Psychiatric Epidemiology Surveys (CPES) (N ~ 11,844) were used to test the association between four racial and ethnic group categories (White, Asian, Hispanic, Black) and comorbid psychosis. Comorbid psychosis was measured as a 4-level categorical variable (No mental illness nor psychosis, Mental Illness, Psychosis only, comorbid psychosis (i.e., Psychosis + Mental Illness). Chi-square tests were used to determine significant differences in the prevalence of comorbid psychosis by race and ethnicity. A multinomial logistic regression was used to test the association between racial and ethnic classifications and comorbid psychosis after adjusting for common demographic characteristics (i.e., education, sex, income, and age).

Results

Relative to White participants, Hispanic and Asian participants were less likely to be affected with comorbid psychosis. (Adjusted Odds Ratio, AORAsian = 0.32, CI = 0.22 - 0.47, p <0.0001, AORHispanic = 0.66, CI = 0.48 - 0.92, p = 0.012). Relative to White participants there was not significant association for comorbid psychosis in Black participants (AORBlack = 0.91, CI = 0.70 - 1.20, p = 0.52) In contrast Hispanic and Black participants were more likely to report psychosis alone (AORHispanic = 1.94, CI = 1.27-2.98, p = 0.002, AORBlack = 1.86, 1.24-2.82, p = 0.003) compared to White participants.

Conclusion

There were different patterns of associations by race and ethnicity for psychosis and comorbid psychosis. The lower prevalence of comorbid psychosis in non-White groups may be due to underdiagnosis or underreporting of other mental disorders.

Psychotic-like experiences and problem drinking among adults in Japan

BACKGROUND

Psychotic-like experiences (PLEs) are common in the general population and have been linked to alcohol misuse and abuse. However, much of this research has been undertaken in Western countries. To address this deficit, the current study examined the association between PLEs and problem drinking in the Japanese general population.

METHODS

Data were used from 3717 adults (age 18-89) collected in an online survey in 2023. Information was obtained on PLEs with the PRIME Screen-Revised (PS-R), while problem drinking was assessed with the CAGE questionnaire (where a score of ≥ 2 was used to categorize cases). Logistic regression was used to examine the associations.

RESULTS

Problem drinking was prevalent in the study sample (12.5%). In an analysis that was adjusted for sociodemographic factors, self-rated health, smoking status and depressive symptoms, PLEs were associated with significantly higher odds for problem drinking in the total sample (OR: 1.70, 95%CI: 1.13-2.55). In a sex-stratified analysis PLEs were not linked to problem drinking in men (OR: 1.16, 95%CI 0.68-2.00), whereas women with PLEs had over 2.8 times higher odds for problem drinking (OR: 2.83, 95%CI: 1.54-5.21).

CONCLUSION

PLEs are associated with problem drinking in the Japanese general population and this association is especially pronounced in women. As problem drinking has been linked to a number of detrimental outcomes, future research should examine the potential effects of problem drinking in individuals with PLEs.

Use of antipsychotic medication, benzodiazepines, and psychiatric hospitalization in cannabis-related versus cannabis-unrelated schizophrenia - a nationwide, register-based cohort study

BACKGROUND

Evidence suggests that cannabis may be a causal factor for development of schizophrenia. We aimed to investigate whether use of antipsychotic medication, benzodiazepines, and psychiatric service use differs among patients with schizophrenia depending on whether psychosis was precipitated by a diagnosis of cannabis use disorder (CUD).

METHODS

We utilized the nationwide Danish registries to identify all individuals with an incident diagnosis of schizophrenia from 1995 to 2016. We also collected information on whether first CUD diagnosis preceded schizophrenia and thus defined a group of potentially cannabis-related schizophrenia. We compared the cannabis-related schizophrenia group both with all non-cannabis-related patients with schizophrenia and with non-cannabis-related patients with schizophrenia that were propensity-score matched to cases using a range of potentially confounding variables.

RESULTS

We included 35 714 people with incident schizophrenia, including 4116 (11.5%) that were cannabis-related. In the unmatched-comparison analyses, there were no clear differences over time in use of antipsychotics and benzodiazepines related to whether the diagnosis of schizophrenia was cannabis-related. After propensity-score matching, use of antipsychotics and benzodiazepines was significantly lower among cannabis-related cases of schizophrenia. In the unmatched comparison, the cannabis-related group had significantly more days admitted than the non-cannabis-related group. This was markedly attenuated after propensity-score matching.

CONCLUSIONS

Our findings indicate the importance of considering cannabis-related cases of schizophrenia as a potentially distinct disorder in terms of prognosis. It is unclear, however, if these differences are due to different biological types of schizophrenia being compared or if they rather indicate behavioral differences such as reduced adherence and treatment-seeking.

Sociodemographic and treatment-related determinants of recent substance use among adults with comorbid substance misuse and psychotic disorders discharged from substance use treatment

INTRODUCTION

Rates of alcohol and illicit substance use are higher among persons with psychotic disorders relative to the general population. The adverse health and psychological effects of substance use behaviors disproportionately impact persons with psychotic disorders. Prior research has shown that persons with psychotic disorders experience increased difficulty in reducing substance use behaviors, and interventions targeting substance use behavior change among this population have demonstrated limited effectiveness. One reason for this is that little is known about the factors that influence substance use and behavior change among this population. To address these disparities, the present study investigated sociodemographic and treatment-related factors of substance use recurrence among persons with psychotic disorders who received substance use treatment services.

METHODS

Data came from the 2015-2018 Treatment Episode Dataset-Discharges (TEDS-D). TEDS-D collects annual data on adolescent and adult discharges from state-certified substance use treatment centers in the United States. The study conducted all analyses with a subsample of 1956 adult discharges with a psychotic disorder who received services from an outpatient substance use treatment center for at least one month. χ2 tests of independence and multivariable logistic regression analyses were used to examine associations of sociodemographic and treatment-related characteristics with substance use recurrence while in treatment (α < 0.05 analyses). The study presents results from multivariable logistic regression models as adjusted odds ratios (AORs) with 95 % confidence intervals (CI).

RESULTS

Those who were age 50 or older, were referred to treatment by the criminal justice system, and attended substance use self-help groups had lower odds of substance use recurrence while in treatment. Sex, educational attainment, employment status, living situation, type of substance use, and treatment history were not significantly associated with substance use recurrence.

CONCLUSIONS

In designing treatment services, providers should consider whether focusing on sociodemographic, including cultural, factors can affect more positive substance use behavior change and other desired treatment outcomes among those with psychotic disorders and comorbid substance misuse. Further study is needed to identify these factors among specific subpopulations of those with psychotic disorders and substance misuse.

Perceived advantages and disadvantages of substance use in a dual diagnosis population with severe mental disorders and severe substance use disorder. Considering the self-medication hypothesis

AIM

Based on a large cohort of dual diagnosis patients, the aim of this study was to quantify the patient-perceived problems and advantages of their substance use and relate the quantity of problems to the substance type and psychiatric diagnosis.

MATERIAL

Data comes from a naturalistic cohort admitted to an in-patient facility in Denmark specialized in integrated dual diagnosis treatment. We included 1076 patients at their first admission to the facility from 2010 to 2017. Participants completed 607 DrugCheck and 130 DUDIT-E questionnaires.

METHOD

we analyzed the questionnaires and included admission diagnosis by use of t-test and ANOVA to depict the patterns in substance use in relation to psychiatric diagnosis.

RESULTS

The three most common substance related problems according to the DrugCheck questionnaire were: feeling depressed, financial problems, and losing interest in daily activities. From DUDIT-E, the highest-ranking negative substance related effects were financial ruin, deterioration of health, and problems at work. Effects on social life relationships were also evident with more than 40% of participants. The top three positive substance related effects reported were relaxation, improved sleep, and control over negative emotions. The number of problems listed varied significantly with the type of preferred substance. Patients using pain medication, sedatives, central stimulants, and alcohol reported most problems. Diagnosis did not differentiate the problems experienced. Results partially support the broad self-medication hypothesis for patients with severe mental illness, but also points out that patients are well aware of negative effects.

Hazardous drinking in young adults with co-occurring PTSD and psychosis symptoms: A network analysis

BACKGROUND

Existing literature suggests the co-occurrence of post-traumatic stress disorder (PTSD) and psychosis among young adults is related to hazardous drinking. However, the influencing mechanisms among these co-occurrences are inconclusive. Thus, this study aimed to investigate the symptomatic associations between PTSD, psychosis, and hazardous drinking.

METHODS

This study included 96,218 young Chinese adults, divided into three groups (PTSD, Psychosis, and co-occurring PTSD-Psychosis). PTSD, psychosis, and hazardous drinking were measured by the ten-item Trauma Screening Questionnaire, the seven-item Psychosis Screener Scale, and the four-item Alcohol Use Disorders Identification Test, respectively. Network analysis was utilized to explore and compare the symptomatic correlation between PTSD, psychosis, and hazardous drinking.

RESULTS

In this study, the most crucial symptom (both central and bridge) was "delusion of control" among the three networks. Hazardous drinking was another main bridge symptom. Compared to the Psychosis group and the co-occurring PTSD-Psychosis group, "Delusion of reference or persecution" to "Grandiose delusion" was the strongest edge in "the network structure of the PTSD group".

LIMITATIONS

The cross-sectional study cannot determine the causal relationship. Applying self-reporting questionnaires may cause inherent bias. Young adult participants limited the generalization of the results to other groups.

CONCLUSIONS

Among the three network structures, delusion of control was the most crucial symptom, and hazardous drinking was another bridge symptom; the edge of delusion of reference or persecution and grandiose delusion was strongest in the PTSD group's network. Efforts should be taken to develop diverse targeted interventions for these core symptoms to relieve PTSD, psychosis, and hazardous drinking in young adults.

The relationship between substance use and self-reported aspects of social functioning in patients with a psychotic disorder

BACKGROUND

In patients with a psychotic disorder, rates of substance use (tobacco, cannabis, and alcohol) are higher compared to the general population. However, little is known about associations between substance use and self-reported aspects of social functioning in patients with a psychotic disorder.

METHODS

In this cross-sectional study of 281 community-dwelling patients with a psychotic disorder, linear regression models were used to assess associations between substance use (tobacco, cannabis, or alcohol) and self-reported aspects of social functioning (perceived social support, stigmatization, social participation, or loneliness) adjusting for confounders (age, gender, and severity of psychopathology).

RESULTS

Compared to nonsmokers, both intermediate and heavy smokers reported lower scores on loneliness (E = -0.580, SE = 0.258, p = 0.025 and E = -0.547, SE = 0,272, p = 0.046, respectively). Daily cannabis users reported less social participation deficits than non-cannabis users (E = -0.348, SE = 0.145, p = 0.017). Problematic alcohol use was associated with more perceived social support compared to non-alcohol use (E = 3.152, SE = 1.102, p = 0.005). Polysubstance users reported less loneliness compared to no users (E = -0.569, SE = 0.287, p = 0.049).

CONCLUSIONS

Substance use in patients with psychosis is associated with more favorable scores on various self-reported aspects of social functioning.

Women with Schizophrenia Have Difficulty Maintaining Healthy Diets for Themselves and Their Children: A Narrative Review

Severe psychiatric disorders such as schizophrenia are inevitably linked to unemployment, meagre per capita income, and residence in disadvantaged, poorly resourced neighbourhoods. This means difficult access to healthy food and is particularly problematic for pregnant women and mothers with children to feed. The necessity of taking antipsychotic drugs is an additional barrier to healthy eating because these drugs are associated with serious cognitive, psychological, behavioural, and metabolic sequelae. Being ill with psychosis makes it extremely difficult to maintain a healthy diet; nutritional deficiencies result, as do medical complications. The results of present literature review confirm the gravity of the problem and suggest a number of potentially useful clinical interventions.

Depression and Suicidal Ideation in Patients with Mental Illness in South Korea: The Mediating Effect of Alcohol Drinking

This study aimed to investigate the mediating effect of alcohol drinking on the relationship between depression and suicidal ideation inpatients with mental illness. A survey was conducted among 163 individuals with various major mental disorders using a self-reported questionnaire. Data were collected from July to September 2020. Subsequently, the data were analyzed using a t-test, one-way analysis of variance, Pearson's correlation coefficients, hierarchical multiple linear regression, and a Sobel test. Significant relationships were found between alcohol depression and drinking (r = 0.26, p < 0.001), depression and suicidal ideation (r = 0.63, p < 0.001), and alcohol use and suicidal ideation (r = 0.36, p < 0.001). In addition, alcohol drinking was found to partially mediate the association between depression and suicidal ideation (Z = 3.63, p < 0.001). These results indicated that patients with mental illness who are concerned about drinking alcohol might be able to reduce suicidal thoughts by consulting with a healthcare professional or taking informed actions with the support of a counselor or support group.

Does drug use affect the efficacy of amisulpride, aripiprazole and olanzapine in patients with schizophrenia spectrum disorders? Results from a pragmatic, randomised study

OBJECTIVES

Drug use is prevalent in patients with schizophrenia spectrum disorders (SSD) but there is limited knowledge about the influence of drug use on the effectiveness of antipsychotic medication. This secondary explorative study compared the effectiveness of three antipsychotics in patients with SSD, with and without drug use.

METHODS

The BeSt InTro multi-centre, head to head, rater-blinded randomised study compared amisulpride, aripiprazole and olanzapine over a 1-year follow-up period. All patients (n = 144) were aged ≥18 years and met the ICD-10 criteria for SSD (F20-29). Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). The primary outcome was reduction of a PANSS positive subscale score.

RESULTS

At baseline, 38% of all patients reported drug use in the last 6 months before inclusion, with cannabis as the main drug (85%), followed by amphetamine-type stimulants (45%), sedatives (26%), hallucinogens (19%), cocaine (13%), opiates (4%), GHB (4%), solvents (4%), analgesics (4%) and anabolic steroids (2%). The predominant pattern was the use of several drugs. There were no significant overall differences in the PANSS positive subscale score reduction for the three studied antipsychotics among patients either with or without drug use. In the drug use group, older patients treated with amisulpride showed a greater PANSS positive subscale score reduction during the treatment period compared to younger patients.

CONCLUSION

The current study showed that drug use does not appear to affect the overall effectiveness of amisulpride, aripiprazole and olanzapine in patients with SSD. However, amisulpride may be a particularly suitable choice for older patients with drug use.

A Mobile Health App (ChillTime) Promoting Emotion Regulation in Dual Disorders: Acceptability and Feasibility Pilot Study

BACKGROUND

A growing number of studies highlight the importance of emotion regulation in the treatment and recovery of individuals with psychosis and concomitant disorders such as substance use disorder (SUD), for whom access to integrated dual-disorder treatments is particularly difficult. In this context, dedicated smartphone apps may be useful tools to provide immediate support to individuals in need. However, few studies to date have focused on the development and assessment of apps aimed at promoting emotional regulation for people with psychosis.

OBJECTIVE

The aim of this study was to evaluate the feasibility, acceptability, and potential clinical impact of a dedicated app (ChillTime) for individuals with psychotic disorders and concurrent SUD. The app design process followed recommendations for reducing cognitive effort on a mobile app. A total of 20 coping strategies regrouped in four categories (behavioral, emotional, cognitive, spiritual) were included in the app.

METHODS

This open pilot study followed a pre-post design. After the initial assessment, researchers asked participants to use the app as part of their treatment over a 30-day period. Feasibility was determined by the frequency of use of the app and measured using the number of completed strategies. Acceptability was determined by measuring ease of use, ease of learning, satisfaction, and perceived utility at the end of the 30-day study period based on responses to satisfaction questionnaires. Clinical scales measuring emotion regulation, substance use (ie, type of substance, amount taken, and frequency of use), and various psychiatric symptoms were administered at the beginning and end of the 30-day period.

RESULTS

A total of 13 participants were recruited from two first-episode psychosis clinics in Montreal, Quebec, Canada. All participants were symptomatically stable, were between 18 and 35 years of age (mostly men; 70% of the sample), and had a schizophrenia spectrum disorder with a comorbid substance use diagnosis. A total of 11 participants completed the study (attrition<20%). Approximately half of the participants used the tool at least 33% of the days (11-21 days). Cognitive and emotion-focused techniques were rated the highest in terms of usefulness and were the most frequently used. The majority of participants gave positive answers about the ease of use and the ease of learning the tool. A nonsignificant association of ChillTime use with negative symptoms and drug use was observed. No other statistically significant changes were observed.

CONCLUSIONS

The ChillTime app showed good feasibility (approximately half of the participants used the tool at least 33% of the days) and acceptability among people with schizophrenia spectrum disorder and SUD. Trends suggesting a potential impact on certain clinical outcomes will need to be replicated in larger-sample studies before any conclusion can be drawn.

Profiles and factors associated with schizophrenia in eastern Ethiopia: A matched case-control study

Background

Despite its strong hereditary and genetic connections, there are other factors reported to be linked to schizophrenia, but not well studied in eastern Ethiopia.

Objective

This study was aimed to investigating the potential profiles and factors associated with schizophrenia in eastern Ethiopia.

Materials and methods

A matched case-control study was conducted in two public hospitals from December 1, 2021, to January 30, 2022. Cases were patients with schizophrenia who visited the hospitals, and controls were healthy individuals without any mental illness who visited the same hospitals. A questionnaire was used to collect the data. Cases and controls were matched using age and sex. STATA-14 was used for analysis. A conditional logistic regression with an adjusted odds ratio (AOR) and a 95% confidence interval (CI) was applied to identify the determinants. P-values of <0.05 were used to build the final model as a measure of statistical significance.

Results

The mean age of the study participants group was 28.6 (±8.44) years, mean age for cases was 28.7(±8.5) ranging from 18 to 56 years and the mean age for the controls was 28.4 (±8.5), ranging from 18 to 60 years. About 181 (83.03%) of the participants were male. The odds of having schizophrenia was about 12.2 times higher among participants with family history of mental illness (AOR: 12.21; 95% CI: 4.83-30.00). The odds of having schizophrenia was 4.5 times higher among polysubstance users (AOR: 4.45; 95% CI: 1.28-5.45) and 2.8 times higher among khat consumers (AOR: 2.82; 95% CI: 1.23-6.45) compared to their counterparts.

Conclusion

Our findings show that genetic risk factors as well as some modifiable behaviors are associated to schizophrenia in eastern Ethiopia. At all levels, special attention should be given to those who are at risk.

Analysis of color vision and cognitive function in first-episode schizophrenia before and after antipsychotic treatment

BACKGROUND

A large body of recent research has demonstrated that patients with schizophrenia exhibit significant changes in visual function and ocular tissue structure in the early stages of onset. It is therefore possible to explore a novel scientific breakthrough in the etiology of schizophrenia by transforming the traditional study of brain structure and function with a view to examining the potential field of eye tissue and function. However, few studies have investigated the correlation between iris characteristics and schizophrenia, and evidence is lacking in this regard. Thus, further exploration is needed.

PURPOSE

This study was designed to analyze the characteristics of iris structure, color vision function and cognitive function, as well as the changes therein in patients with the first-episode drug-free schizophrenia before and after antipsychotic treatment. It aimed to preliminarily identify easily-measurable biomarkers for early clinical screening and diagnosis of schizophrenia.

METHODS

This study recruited 61 patients (22 males) with first-episode schizophrenia. Prior to the commencement of treatment with antipsychotic drugs, the Montreal Cognitive Assessment (MoCA) and Farnsworth-Munsell Dichotomous (D-15 Hue Test) were used as assessment tools to evaluate cognitive function and color vision function, respectively. Over a 6-week period, patients received a second-generation antipsychotic treatment (all converted to olanzapine equivalent dose) as prescribed by the doctor, and the Positive and Negative Syndrome Scale (PANSS) was applied to evaluate the clinical treatment effects before treatment (baseline), as well as at the 2nd, 4th, and 6th weeks after drug treatment. On the basis of iris characteristics, the patients were divided into groups. The observed differences in drug treatment effects between the groups were then compared and analyzed to further clarify the relationship between treatment efficacy and iris characteristics. Finally, changes in the cognitive function and color vision function of patients at baseline and at the 6th week after drug treatment were compared, and the effects of antipsychotic drug treatment on the above-mentioned functions were analyzed.

RESULTS

On the basis of structural iris characteristics, 61 patients were classified as follows: 28 patients without iris crypts and 33 with iris crypts; 35 without iris pigment dots and 26 with iris pigment dots; 42 without iris wrinkles and 19 with iris wrinkles. No significant difference was observed in the PANSS scores of all of the patients at baseline; however, significant differences were found in patients with iris crypts and iris pigment dots at each follow-up timepoint (i.e., at the 2nd, 4th, and 6th week). Moreover, it is noteworthy that, compared with other patients, the PANSS scores of patients without specific iris structure characteristics (iris crypts and pigment dots) decreased significantly (P<0.05), which indicated that the drug therapy was highly effective. Excluding the interference of drug factors, a significant correlation was found between the results of the D-15 (color vision function) and MoCA (cognitive function) in first-episode untreated patients (r = -0.401, P < 0.05). In addition, the MoCA scores (mean difference = 2.36, t = 10.05, P ˂ 0.01) were significantly higher after 6 weeks of antipsychotic drug treatment compared to conditions at baseline.

CONCLUSIONS

The findings of this study demonstrated that color vision function of patients with schizophrenia improved with the improvement of cognitive function. The structural characteristics of the iris with crypts and pigment dots could have a significant impact on the drug treatment effect of schizophrenia and could be considered as a potential biomarker for detecting and recognizing schizophrenia.

Are we Truly "Safer-At-Home"? A Test of Contextual Effects on Mental Health and Drug Overdose Incidents During the COVID-19 Pandemic

This study examined whether the social restrictions stemming from COVID-19 impacted the locations of mental health and drug overdose incidents, while controlling for immediate and community contextual indices. Addresses for mental health/overdose calls to law enforcement or emergency medical services between January 1, 2018 and August 13, 2020 were collected from one police department in the Midwestern United States. Businesses and previous victimization/offending were joined with parcels (level-1; N = 20,019), whereas local services and socioeconomic indicators were joined with block groups (level-2; N = 32), to allow for a multi-level (HLM7) examination of context on mental health/overdose incidents. Event Rate Ratios (ERR) revealed the greatest contextual effects took place following social distancing mandates. Findings highlight the importance of allocating to areas with the highest likelihood of reporting incidents and suggest that parcels with a history of sex offenses, drug offenses, and prior mental health calls may benefit the greatest from preventative resources.

Longitudinal effects of cannabis use on attentional processes in patients with first episode of psychosis

BACKGROUND

Attention deficits have been considered to be a central characteristic of schizophrenia-spectrum disorders. However, the specific interactions with, and longitudinal effects of, cannabis use at the different stages of the disorder remain unknown. Due to the high percentage of patients who are cannabis users at the onset of the disease, our objective was to explore this relationship and how it evolves in the first three years of the disease.

METHOD

A total of 461 patients with a first episode of psychosis (FEP) and 187 healthy controls were studied. The differences between cannabis users and non-users at baseline were explored based on both sociodemographic variables and performance in neuropsychological tests of attention. The interaction between cannabis, attentional, and clinical variables was followed up at 3 years.

RESULTS

Of the 648 participants included in this study, 229 (35.34%) were cannabis users. Of them, 187 (40.6%) were patients and 42 (22.5%) were healthy controls. At baseline, control groups [cannabis users (N = 42); non-users (N = 145)] outperformed the patient groups [cannabis users (N = 187); non-users (N = 274)] in all attention tasks. Longitudinal analyses showed significant improvements in the attentional domains at 3-year follow-up, mainly in the group of patients who had never used cannabis (N = 238), followed by ex-users (N = 105), and persistent users (N = 43). At 3-year follow-up, the group of ex-users was the one that achieved scores closer to those of healthy controls.

CONCLUSION

FEP patients, both cannabis users and non-users, showed attention deficits. However, the patients who had never used cannabis fared better than cannabis users.

Developing a theoretical framework for persistent cannabis use among young adults with first episode psychosis

AIM

Cannabis use is common among individuals with first episode psychosis (FEP) and persistent use is associated with worse outcomes. The purpose of this qualitative study is to identify factors pertaining to onset of cannabis use and persistent use among young adults with early psychosis receiving coordinated specialty care (CSC) in the United States and begin to develop a theoretical framework to drive further study and hypothesis testing and inform the approach to treatment of cannabis use disorder in this setting.

METHODS

Participants were ages 16-30 years with early psychosis attending a CSC program in New York State. Interviews were conducted in December 2018. Coding and analysis was conducted in Atlas.ti and themes were identified via a thematic analysis approach.

RESULTS

Thirteen individuals completed the interview. The mean age in years was 20.7 and the majority were male (n = 10). Almost half (46%) were Black, non-Hispanic and 39% were Hispanic. Seven participants indicated they were currently using cannabis and six participants indicated they had stopped for at least 6 months at the time of the interview. Several themes emerged including the influence of family and social norms, motivating factors for persistent use and for reduced use or abstinence, and ambivalence regarding the impact of cannabis use on mental health.

CONCLUSION

A theoretical framework emerged which may help identify future research in this area and inform the approach to treatment of cannabis use disorder in this setting.

Early social isolation stress increases addiction vulnerability to heroin and alters c-Fos expression in the mesocorticolimbic system

RATIONALE

Adverse psychosocial factors during early childhood or adolescence compromise neural structure and brain function, inducing susceptibility for many psychiatric disorders such as substance use disorder. Nevertheless, the mechanisms underlying early life stress-induced addiction vulnerability is still unclear, especially for opioids.

OBJECTIVES

To address this, we used a mouse heroin self-administration model to examine how chronic early social isolation (ESI) stress (5 weeks, beginning at weaning) affects the behavioral and neural responses to heroin during adulthood.

RESULTS

We found that ESI stress did not alter the acquisition for sucrose or heroin self-administration, nor change the motivation for sucrose on a progressive ratio schedule. However, ESI stress induced an upward shift of heroin dose-response curve in female mice and increased motivation and seeking for heroin in both sexes. Furthermore, we examined the neuronal activity (measured by c-Fos expression) within the key brain regions of the mesocorticolimbic system, including the prelimbic cortex (PrL), infralimbic cortex (IL), nucleus accumbens (NAc) core and shell, caudate putamen, and ventral tegmental area (VTA). We found that ESI stress dampened c-Fos expression in the PrL, IL, and VTA after 14-day forced abstinence, while augmented the neuronal responses to heroin-predictive context and cue in the IL and NAc core. Moreover, ESI stress disrupted the association between c-Fos expression and attempted infusions during heroin-seeking test in the PrL.

CONCLUSIONS

These data indicate that ESI stress leads to increased seeking and motivation for heroin, and this may be associated with distinct changes in neuronal activities in different subregions of the mesocorticolimbic system.

Genetic correlation, pleiotropy, and causal associations between substance use and psychiatric disorder

BACKGROUND

Substance use occurs at a high rate in persons with a psychiatric disorder. Genetically informative studies have the potential to elucidate the etiology of these phenomena. Recent developments in genome-wide association studies (GWAS) allow new avenues of investigation.

METHOD

Using results of GWAS meta-analyses, we performed a factor analysis of the genetic correlation structure, a genome-wide search of shared loci, and causally informative tests for six substance use phenotypes (four smoking, one alcohol, and one cannabis use) and five psychiatric disorders (ADHD, anorexia, depression, bipolar disorder, and schizophrenia).

RESULTS

Two correlated externalizing and internalizing/psychosis factor were found, although model fit was beneath conventional standards. Of 458 loci reported in previous univariate GWAS of substance use and psychiatric disorders, about 50% (230 loci) were pleiotropic with additional 111 pleiotropic loci not reported from past GWAS. Of the 341 pleiotropic loci, 152 were associated with both substance use and psychiatric disorders, implicating neurodevelopment, cell morphogenesis, biological adhesion pathways, and enrichment in 13 different brain tissues. Seventy-five and 114 pleiotropic loci were specific to either psychiatric disorders or substance use phenotypes, implicating neuronal signaling pathway and clathrin-binding functions/structures, respectively. No consistent evidence for phenotypic causation was found across different Mendelian randomization methods.

CONCLUSIONS

Genetic etiology of substance use and psychiatric disorders is highly pleiotropic and involves shared neurodevelopmental path, neurotransmission, and intracellular trafficking. In aggregate, the patterns are not consistent with vertical pleiotropy, more likely reflecting horizontal pleiotropy or more complex forms of phenotypic causation.

Mental disorder and opioid overdose: a systematic review

PURPOSE

This systematic review summarizes and presents the current state of research quantifying the relationship between mental disorder and overdose for people who use opioids.

METHODS

The protocol was published in Open Science Framework. We used the PECOS framework to frame the review question. Studies published between January 1, 2000, and January 4, 2021, from North America, Europe, the United Kingdom, Australia, and New Zealand were systematically identified and screened through searching electronic databases, citations, and by contacting experts. Risk of bias assessments were performed. Data were synthesized using the lumping technique.

RESULTS

Overall, 6512 records were screened and 38 were selected for inclusion. 37 of the 38 studies included in this review show a connection between at least one aspect of mental disorder and opioid overdose. The largest body of evidence exists for internalizing disorders generally and mood disorders specifically, followed by anxiety disorders, although there is also moderate evidence to support the relationship between thought disorders (e.g., schizophrenia, bipolar disorder) and opioid overdose. Moderate evidence also was found for the association between any disorder and overdose.

CONCLUSION

Nearly all reviewed studies found a connection between mental disorder and overdose, and the evidence suggests that having mental disorder is associated with experiencing fatal and non-fatal opioid overdose, but causal direction remains unclear.

Primary Nonadherence to Antipsychotic Treatment Among Persons with Schizophrenia

It has remained unclear what factors relate to primary nonadherence to antipsychotic treatment and whether specific agents and routes of administration differ in how patients adhere to them. We collected electronic prescriptions and their dispensings from the Finnish electronic prescription database for 29 956 patients with schizophrenia prescribed antipsychotics via electronic prescription during 2015-2016. We defined primary nonadherence as being prescribed an antipsychotic, which was not dispensed from the pharmacy within one year from prescription. Using logistic regression, we analyzed whether several sociodemographic and clinical factors related to nonadherence. We found that 31.7% (N = 9506) of the patients demonstrated primary nonadherence to any of their prescribed antipsychotics. We found that young age (OR = 1.77, 95%CI = 1.59-1.96), concomitant benzodiazepines (OR = 1.47, 95%CI = 1.40-1.55) and mood stabilizers (OR = 1.29, 95%CI = 1.21-1.36), substance abuse (OR = 1.26 95%CI = 1.19-1.35), previous suicide attempt (OR = 1.21, 95%CI = 1.11-1.31), diabetes (OR = 1.15, 95%CI = 1.06-1.25), asthma/COPD (OR = 1.14, 95%CI = 1.04-1.25), and cardiovascular disease (OR = 1.12, 95%CI = 1.05-1.19), were related to primary nonadherence to antipsychotic treatment. Patients using clozapine showed the lowest nonadherence (4.77%, 95%CI = 4.66-4.89), and patients using long-acting injectables were more adherent to treatment (7.27%, 95%CI = 6.85-7.71) when compared to respective oral agents (10.26%, 95%CI = 10.02-10.49). These results suggest that selection between different pharmacological agents and routes of administration while taking into account patients' concomitant medications (benzodiazepines in particular) and comorbidities play a key role in primary nonadherence to antipsychotic treatment.

Exploring protective associations between the use of classic psychedelics and cocaine use disorder: a population-based survey study

Cocaine Use Disorder (CUD) is a significant public health problem associated with elevated morbidity and mortality within the United States. Current behavioral treatments have limited efficacy and there are currently no FDA approved pharmacological treatments for CUD. Classic psychedelics might be associated with lowered odds of substance misuse and may effectively treat various forms of addiction. Thus, the goal of this study is to assess protective associations that lifetime use of classic psychedelics may share with CUD within a nationally representative sample of the U.S. We used data from The National Survey on Drug Use and Health (NSDUH) (2015–2019) and conducted survey-weighted multivariable logistic regression to test whether each of four classic psychedelics (peyote, mescaline, psilocybin, LSD) conferred lowered odds of CUD and its related 11 sub-criteria. Participants were 214,505 adults in the NSDUH (2015–2019) aged 18 and older. Peyote conferred lowered odds of CUD, reducing the odds of CUD by over 50% (aOR: 0.47). All other substances (including other classic psychedelics) either shared no association to CUD or conferred increased odds of CUD. Furthermore, sensitivity analyses revealed peyote to confer sharply lowered odds of the majority (seven of 11) of CUD criteria as well (aOR range: 0.26–0.47). Peyote use is associated with lowered odds of CUD. Future inquiries into third variable factors (i.e., demographic/personality profiles of individuals who use peyote, motivational/contextual factors surrounding peyote use) that may underlie our observed associations may reveal protective factors that can inform treatment development for CUD. Additionally, future longitudinal studies can shed further light on whether there is a temporal link between peyote use and lowered odds of CUD.

A pilot study of a yoga intervention for the treatment of anxiety in young people with early psychosis

BACKGROUND

Anxiety is common in young people with early psychosis and treatment options for this co-morbidity remain limited. Yoga is a promising adjunct intervention that has been shown to reduce anxiety for adults with schizophrenia, therefore this pilot study evaluated the acceptability and potential effectiveness of yoga for anxiety in early psychosis.

METHODS

A prospective single arm pilot study of a yoga intervention was conducted within an Early Intervention for psychosis service. Rates of attendance, as well as symptoms of anxiety pre and post yoga session were measured.

RESULTS

A total of 14 young people participated in the study and over 70% attended half or more of the yoga sessions offered. Significant transient reduction in state anxiety after a single session of yoga was observed (p < 0.01).

CONCLUSIONS

Yoga was found to be an acceptable and potentially effective adjunctive treatment for anxiety in early psychosis and the results warrant further clinical trials.

GABRB2, a key player in neuropsychiatric disorders and beyond

The GABA receptors represent the main inhibitory system in the central nervous system that ensure synaptogenesis, neurogenesis, and the regulation of neuronal plasticity and learning. GABAA receptors are pentameric in structure and belong to the Cys-loop superfamily. The GABRB2 gene, located on chromosome 5q34, encodes the β2 subunit that combines with the α and γ subunits to form the major subtype of GABAA receptors, which account for 43% of all GABAA receptors in the mammalian brain. Each subunit probably consists of an extracellular N-terminal domain, four membrane-spanning segments, a large intracellular loop between TM3 and TM4, and an extracellular C-terminal domain. Alternative splicing of the RNA transcript of the GABRB2 gene gives rise at least to four long and short isoforms with dissimilar electrophysiological properties. Furthermore, GABRB2 is imprinted and subjected to epigenetic regulation and positive selection. It has been associated with schizophrenia first in Han Chinese, and subsequently validated in other populations. Gabrb2 knockout mice also exhibited schizophrenia-like behavior and neuroinflammation that were ameliorated by the antipsychotic drug risperidone. GABRB2 was also associated with other neuropsychiatric disorders including bipolar disorder, epilepsy, autism spectrum disorder, Alzheimer's disease, frontotemporal dementia, substance dependence, depression, internet gaming disorder, and premenstrual dysphoric disorder. Recently, it has been postulated that GABRB2 might be a potential marker for different cancer types. As GABRB2 has a pivotal role in the central nervous system and is increasingly recognized to contribute to human diseases, further understanding of its structure and function may expedite the generation of new therapeutic approaches.

Vaping and psychotic experiences among college students in the United States

AIM

While cigarette and marijuana use has been linked to psychotic experiences, few empirical studies have examined the relation between vaping and psychotic experiences.

METHODS

We analyzed data from the Healthy Minds Survey (September 2020 - December 2020; N = 29,232 students from 36 universities), and used multiple logistic regression models to examine the associations between vaping over the past 30 days and psychotic experiences over the past 12 months, adjusting for age, gender, and race/ethnicity. We then additionally adjusted for cigarette and marijuana use, as well as depression and anxiety.

RESULTS

Roughly 14 % of students in the sample reported psychotic experiences over the past year, and around 14-15 % of students reported vaping over the past month. In multiple logistic regression models, vaping was significantly associated with psychotic experiences (aOR 1.88; 95 % CI: 1.63-2.18). This association attenuated but remained statistically significant even after adjusting for any cigarette use and marijuana use, and after adjusting for depression and anxiety.

CONCLUSIONS

Among college students, vaping was significantly associated with psychotic experiences, even after accounting for simple measures of cigarette and marijuana use, and mental health problems, calling for more prospective studies to examine the association.

Depression and suicidal ideation in schizophrenia spectrum disorder: a cross-sectional study from a lower middle-income country

OBJECTIVES

Depression has long been considered a significant feature of schizophrenia and is associated with more frequent psychotic episodes, increased service utilisation, substance misuse, poor quality of life and completed suicide. However, there is a distinct lack of literature on this comorbidity from low- and middle-income countries or non-western cultural backgrounds.

METHODS

This is a cross-sectional analysis of baseline data from a large randomised controlled trial, examining the prevalence of depression and suicidal ideation in patients with schizophrenia spectrum disorder. A total of 298 participants were recruited from inpatient and outpatient psychiatric units in Karachi, Pakistan. Participants completed the Calgary Depression Scale for Schizophrenia (CDSS), Positive and Negative Syndrome Scale (PANSS), Euro Qol (EQ-5D) and Social Functioning Scale (SFS).

RESULTS

Data indicate that 36% of participants in the study were depressed and 18% endorsed suicidal ideation. Depression was associated with higher positive symptom scores and reduced quality of life, but no significant difference in negative symptoms and social functioning.

CONCLUSIONS

Depression and suicidal ideation are prevalent in Pakistani patients diagnosed with schizophrenia spectrum disorder. Evaluation of depressive symptoms in this group may help identify individuals at higher risk of completed suicide, allowing for targeted interventions to improve outcomes.Key pointsTo our knowledge, this is the first study describing the prevalence of depression and suicidal ideation in individuals with schizophrenia from Pakistan.Our data indicate that 36% of individuals with schizophrenia in our sample were depressed and 18% endorsed suicidal ideation.Depression in schizophrenia was associated with poorer quality of life and higher positive symptom burden.This study adds to the scarce literature from low- and middle-income countries where the burden of mental illness is great and where the majority of suicide deaths occur.Addressing social inequality, food insecurity, high rates of unemployment and low levels of literacy in these settings may have a profound effect on population mental health and suicide risk.

Mental Illness and its Link to Illegal Street Market Activity: Prevalence, Risk Factors, and How They Compare to Violence

Given the focus on research assessing violence among people with mental illness, other forms of deviance such as illegal street market offending have been relatively ignored. As such, the prevalence and risk factors for illegal street market offending among those with mental disorders is unknown. Utilizing the MacArthur Risk Assessment Study, the prevalence of illegal street market offending among this population is assessed along with the risk factors for engaging in this type of behavior. These factors are investigated for their generality in predicting violent offending to see if there are unique risk factors associated with illegal street market offending. Results indicate that factors related to money, factors related to substance usage, and general factors related to offending are significantly associated with illegal street market offending. Theoretical implications and future research are discussed.

Prevalence and clinical correlates of substance use disorders in South African Xhosa patients with schizophrenia

PURPOSE

To determine the prevalence of substance use disorders (SUDs) in patients with schizophrenia in a sample from South Africa and compare the clinical and demographic correlates in those with and without co-occurring SUDs.

METHODS

Patients with schizophrenia were interviewed using the Xhosa version SCID-I for DSM-IV. We used logistic regression to determine the predictors of SUDs.

RESULTS

In the total sample of 1420 participants, SUDs occurred in 47.8%, with the most prevalent SUD being cannabis use disorders (39.6%), followed by alcohol (20.5%), methaqualone (6.2%), methamphetamine (4.8%) and other SUDs (cocaine, ecstasy, opioids, 0.6%). Polydrug use occurred in 40%, abuse occurred in 13.5%, and 39.6% had at least one substance dependence diagnosis. Significant predictors of any SUD were younger age (41-55 vs. 21-30: OR = 0.7, 95% CI = 0.5-0.9), male sex (OR = 8.6, 95% CI = 5.1-14.6), inpatient status (OR = 1.7, 95% CI = 1.3-2.1), post-traumatic stress symptoms (OR = 4.6, 95% CI = 1.6-13.3), legal (OR = 3.4, 95% CI = 2.0-5.5) and economic problems (OR = 1.4, 95% CI = 1.0-2.0). Methamphetamine use disorders occurred significantly less often in the Eastern compared to the Western Cape provinces. Inpatient status and higher levels of prior admissions were significantly associated with cannabis and methamphetamine use disorders. Post-traumatic stress symptoms were significantly associated with alcohol use disorders. Anxiety disorders were associated with other SUDs.

CONCLUSION

SUDs occurred in almost half of the sample. It is important for clinicians to identify the presence of SUDs as their presence is associated with characteristics, such as male sex, younger age, inpatient status, more prior hospitalisations, legal and economic problems, PTSD symptoms and anxiety.

Use of illicit substances and violent behaviour in psychotic disorders: two nationwide case-control studies and meta-analyses

BACKGROUND

Substance use disorder explains much of the excess risk of violent behaviour in psychotic disorders. However, it is unclear to what extent the pharmacological properties and subthreshold use of illicit substances are associated with violence.

METHODS

Individuals with psychotic disorders were recruited for two nationwide projects: GROUP (N = 871) in the Netherlands and NEDEN (N = 921) in the United Kingdom. Substance use and violent behaviour were assessed with standardized instruments and multiple sources of information. First, we used logistic regression models to estimate the associations of daily and nondaily use with violence for cannabis, stimulants, depressants and hallucinogens in the GROUP and NEDEN samples separately. Adjustments were made for age, sex and educational level. We then combined the results in random-effects meta-analyses.

RESULTS

Daily use, compared with nondaily or no use, and nondaily use, compared with no use, increased the pooled odds of violence in people with psychotic disorders for all substance categories. The increases were significant for daily use of cannabis [pooled odds ratio (pOR) 1.6, 95% confidence interval (CI) 1.2-2.0), stimulants (pOR 2.8, 95% CI 1.7-4.5) and depressants (pOR 2.2, 95% CI 1.1-4.5), and nondaily use of stimulants (pOR 1.6, 95% CI 1.2-2.0) and hallucinogens (pOR 1.5, 95% CI 1.1-2.1). Daily use of hallucinogens, which could only be analysed in the NEDEN sample, significantly increased the risk of violence (adjusted odds ratio 3.3, 95% CI 1.2-9.3).

CONCLUSIONS

Strategies to prevent violent behaviour in psychotic disorders should target any substance use.

Current marijuana use among women of reproductive age

BACKGROUND

The objective of this study was to estimate the prevalence of current (past 30 days) marijuana use and its associations with demographic, other substance use, chronic disease, physical health and mental health measures among women of reproductive age (18-44 years) in 12 US states.

METHODS

This analysis used 2016 Behavioral Risk Factor Surveillance System (BRFSS) data from 16,556 women of reproductive age in 12 US states. Women self-reported current marijuana use and covariates. Weighted χ² statistics and adjusted prevalence ratios (aPR) were calculated accounting for the complex survey design.

RESULTS

Among women of reproductive age, 9.9 % reported current marijuana use. Current cigarette use (aPR: 2.0, 95 % CI: 1.6, 2.6), current e-cigarette use (aPR: 1.9, 95 % CI: 1.4, 2.6), binge drinking (aPR: 2.6, 95 % CI: 1.9, 3.6), ever having received a depression diagnosis (aPR: 1.6, 95 % CI: 1.2, 2.1), and ≥14 days of poor mental health in the past 30 days (aPR: 1.8, 95 % CI: 1.3, 2.4) were all associated with higher adjusted prevalence of current marijuana use. Reporting ≥14 days of poor physical health within the last 30 was associated with a 40 % lower adjusted prevalence of current marijuana use (aPR: 0.6, 95 % CI: 0.4, 0.8).

CONCLUSION

Current marijuana use among women of reproductive age was associated with other substance use, poor mental health, and depression. As state laws concerning marijuana use continue to change, it is important to monitor usage patterns and to assess associated health risks in this population.

Psychosocial interventions for people with both severe mental illness and substance misuse

BACKGROUND

Even low levels of substance misuse by people with a severe mental illness can have detrimental effects.

OBJECTIVES

To assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care.

SEARCH METHODS

The Information Specialist of the Cochrane Schizophrenia Group (CSG) searched the CSG Trials Register (2 May 2018), which is based on regular searches of major medical and scientific databases.

SELECTION CRITERIA

We included all randomised controlled trials (RCTs) comparing psychosocial interventions for substance misuse with standard care in people with serious mental illness.

DATA COLLECTION AND ANALYSIS

Review authors independently selected studies, extracted data and appraised study quality. For binary outcomes, we calculated standard estimates of risk ratio (RR) and their 95% confidence intervals (CIs) on an intention-to-treat basis. For continuous outcomes, we calculated the mean difference (MD) between groups. Where meta-analyses were possible, we pooled data using a random-effects model. Using the GRADE approach, we identified seven patient-centred outcomes and assessed the quality of evidence for these within each comparison.

MAIN RESULTS

Our review now includes 41 trials with a total of 4024 participants. We have identified nine comparisons within the included trials and present a summary of our main findings for seven of these below. We were unable to summarise many findings due to skewed data or because trials did not measure the outcome of interest. In general, evidence was rated as low- or very-low quality due to high or unclear risks of bias because of poor trial methods, or inadequately reported methods, and imprecision due to small sample sizes, low event rates and wide confidence intervals. 1. Integrated models of care versus standard care (36 months) No clear differences were found between treatment groups for loss to treatment (RR 1.09, 95% CI 0.82 to 1.45; participants = 603; studies = 3; low-quality evidence), death (RR 1.18, 95% CI 0.39 to 3.57; participants = 421; studies = 2; low-quality evidence), alcohol use (RR 1.15, 95% CI 0.84 to 1.56; participants = 143; studies = 1; low-quality evidence), substance use (drug) (RR 0.89, 95% CI 0.63 to 1.25; participants = 85; studies = 1; low-quality evidence), global assessment of functioning (GAF) scores (MD 0.40, 95% CI -2.47 to 3.27; participants = 170; studies = 1; low-quality evidence), or general life satisfaction (QOLI) scores (MD 0.10, 95% CI -0.18 to 0.38; participants = 373; studies = 2; moderate-quality evidence). 2. Non-integrated models of care versus standard care There was no clear difference between treatment groups for numbers lost to treatment at 12 months (RR 1.21, 95% CI 0.73 to 1.99; participants = 134; studies = 3; very low-quality evidence). 3. Cognitive behavioural therapy (CBT) versus standard care There was no clear difference between treatment groups for numbers lost to treatment at three months (RR 1.12, 95% CI 0.44 to 2.86; participants = 152; studies = 2; low-quality evidence), cannabis use at six months (RR 1.30, 95% CI 0.79 to 2.15; participants = 47; studies = 1; very low-quality evidence) or mental state insight (IS) scores by three months (MD 0.52, 95% CI -0.78 to 1.82; participants = 105; studies = 1; low-quality evidence). 4. Contingency management versus standard care We found no clear differences between treatment groups for numbers lost to treatment at three months (RR 1.55, 95% CI 1.13 to 2.11; participants = 255; studies = 2; moderate-quality evidence), number of stimulant positive urine tests at six months (RR 0.83, 95% CI 0.65 to 1.06; participants = 176; studies = 1) or hospitalisations (RR 0.21, 95% CI 0.05 to 0.93; participants = 176; studies = 1); both low-quality evidence. 5. Motivational interviewing (MI) versus standard care We found no clear differences between treatment groups for numbers lost to treatment at six months (RR 1.71, 95% CI 0.63 to 4.64; participants = 62; studies = 1). A clear difference, favouring MI, was observed for abstaining from alcohol (RR 0.36, 95% CI 0.17 to 0.75; participants = 28; studies = 1) but not other substances (MD -0.07, 95% CI -0.56 to 0.42; participants = 89; studies = 1), and no differences were observed in mental state general severity (SCL-90-R) scores (MD -0.19, 95% CI -0.59 to 0.21; participants = 30; studies = 1). All very low-quality evidence. 6. Skills training versus standard care At 12 months, there were no clear differences between treatment groups for numbers lost to treatment (RR 1.42, 95% CI 0.20 to 10.10; participants = 122; studies = 3) or death (RR 0.15, 95% CI 0.02 to 1.42; participants = 121; studies = 1). Very low-quality, and low-quality evidence, respectively. 7. CBT + MI versus standard care At 12 months, there was no clear difference between treatment groups for numbers lost to treatment (RR 0.99, 95% CI 0.62 to 1.59; participants = 327; studies = 1; low-quality evidence), number of deaths (RR 0.60, 95% CI 0.20 to 1.76; participants = 603; studies = 4; low-quality evidence), relapse (RR 0.50, 95% CI 0.24 to 1.04; participants = 36; studies = 1; very low-quality evidence), or GAF scores (MD 1.24, 95% CI -1.86 to 4.34; participants = 445; studies = 4; very low-quality evidence). There was also no clear difference in reduction of drug use by six months (MD 0.19, 95% CI -0.22 to 0.60; participants = 119; studies = 1; low-quality evidence).

AUTHORS' CONCLUSIONS

We included 41 RCTs but were unable to use much data for analyses. There is currently no high-quality evidence to support any one psychosocial treatment over standard care for important outcomes such as remaining in treatment, reduction in substance use or improving mental or global state in people with serious mental illnesses and substance misuse. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high-quality trials are required which address these concerns and improve the evidence in this important area.

Schizophrenia is associated with increased risk of subsequent substance abuse diagnosis: A nation-wide population-based register study

AIMS

We aimed to investigate whether or not a diagnosis of schizophrenia increases the risk of a substance abuse diagnosis.

DESIGN

Prospective cohort study using a longitudinal study design.

SETTING AND PARTICIPANTS

Individuals born in Denmark from 1955 to 1999 and registered in the Danish registers between 1 January 1968 and 1 July 2013.

MEASUREMENTS

We investigated the associations between schizophrenia and ICD diagnoses of substance abuse, both established through various Danish registers. The Cox regression model was used and adjusted for calendar year, gender, urbanicity, co-abuse, other psychiatric diagnoses, parents' substance abuse and psychiatric history, parents' immigration and parents' socio-economic position. Individuals diagnosed with substance abuse less than a year after diagnosis of schizophrenia were classified as not diagnosed with schizophrenia.

FINDINGS

The cohort consisted of 3 133 968 individuals. During follow-up (103 212 328 person-years at risk), a total of 14 007 individuals developed schizophrenia, with 2885 subsequently diagnosed with substance abuse. A diagnosis of schizophrenia was positively associated with the risk of developing substance abuse [hazard ratio (HR) = 3.69, 95% confidence interval (CI) = 3.56-3.83]. Additionally, adjusting for a co-abuse markedly affected the associations, making schizophrenia primarily associated with an increased risk of abuse of cannabis, alcohol, stimulants and other substances (adjusted HR = 2.48, 95% CI = 2.34-2.64 for cannabis; HR = 1.94, 95% CI = 1.87-2.02 for alcohol; HR = 1.77, 95% CI = 1.61-1.95 for stimulants; HR = 1.36, 95% CI = 1.20-1.54 for other substances). The association was still significant 10-15 years subsequent a diagnosis of schizophrenia (HR = 2.50, 95% CI = 2.26-2.76).

CONCLUSIONS

In Denmark a diagnosis of schizophrenia is significantly associated with increased risk of subsequent diagnosis of substance abuse.

Negative symptoms in first-episode psychosis: Clinical correlates and 1-year follow-up outcomes in London Early Intervention Services

AIM

Negative symptoms (NS) have been associated with poor outcome and remain difficult to treat in patients with psychosis. This study examined the association of NS with clinical features at first presentation to mental health services for psychosis and with outcomes at 1-year follow-up.

METHODS

Clinical data were utilized from five London Early Intervention Services (EIS) included in the MiData audit database. The sample comprised 484 first-episode psychosis patients with complete Positive and Negative Syndrome Scale data at baseline and 1-year follow-up. Multiple imputation (N = 50) was conducted to account for missing follow-up data.

RESULTS

Baseline NS were associated with male gender (B = -1.63, P < .05), younger age at onset (B = -.15, P <. 05), a higher level of impairment on the Global Assessment of Functioning (disability) Scale at baseline (B = -.19, P <. 010), an absence of reported substance misuse prior to baseline assessment (B = -3.05, P <. 001) and unemployment at baseline (B = -.93, P <. 01). At 1-year follow-up, NS at presentation were associated with worse Global Assessment of Functioning Scale for symptom (B = -.28, P < .01) and disability (B = -.27, P <. 05) and with hospital admission (OR = 1.06, P < .01).

CONCLUSIONS

Negative symptoms at presentation to EIS were associated with worse functioning at entry and poorer outcomes 1 year later. Future research is required to better understand the aetiology and trajectories of NS in early psychosis and propose novel targeted interventions.

Cannabis and Tramadol are Prevalent among the First Episode Drug-Induced Psychosis in the Egyptian Population: Single Center Experience

(1) Background: Cannabis and tramadol are featuring prominently in Egypt; however, their prevalence in first episode psychosis is still uncertain. We aimed at determining the prevalence of cannabis and tramadol among the first-psychotic episode in Egyptian inpatients and to compare the demographic and psychopathological profiles of substance abusers versus patients with the comorbid diagnosis. (2) Methods: Patients presented with psychotic episode and admitted to Mansoura Psychiatric Department were recruited. Diagnosis of psychiatric illness and drug/substance use was carried out using the Diagnostic and Statistical Manual- Fourth Edition (DSM-IV) criteria. Standard urine tests and thin layer chromatography were performed to detect cannabis and tramadol. (3) Results: Of the 100 subjects in the study, the majority (55.6%) of patients were cannabis-only positive. Overall, cannabis-alone showed the highest frequency of substance used among the currently diagnosed psychotic disorders. According to urine tests, cannabis demonstrates the higher frequency of intake in both studied groups. 66.7% of the studied population had 1–5 years self-reported histories of substance abuse predating the first psychotic episode. (4) Conclusions: The percentage of cannabis and tramadol among the first episode psychotic patients has been unexpectedly high and the standard urine testing should be considered in emergency and mental health facilities.

Mobile Intervention for Individuals With Psychosis, Dual Disorders, and Their Common Comorbidities: A Literature Review

Over 50% of people diagnosed with a severe mental illness, such as schizophrenia or bipolar disorder, will meet criteria for a substance use disorder in their lifetime. This dual disorder often starts during youth and leads to significant societal costs, including lower employability rates, more hospitalizations, and higher risk of homelessness and of suicide attempts when compared to those with a serious mental illness without substance misuse. Moreover, many individuals presenting with comorbid disorders also present with other psychological difficulties as well, such as personality disorders or anxiety and depression, also known as complex comorbid disorders. Transdiagnostic treatments that focus on core difficulties found in people with complex dual disorders, such as emotional regulation, are direly needed. Emotional regulation skills can help reduce distress related to psychotic symptoms and maintain abstinence in substance use disorders. New technologies in the field of communications have developed considerably over the past decade and have the potential to improve access to such treatments, a major problem in many health care settings. As such, this paper aims at: presenting core difficulties present in many individuals with dual disorders, reviewing the scientific literature pertaining to the use of mobile applications in mental health and addictions, and presenting the development and potential of a new application for emotional regulation for people with dual disorders.

The influence of substance use on the effectiveness of antipsychotic medication: a prospective, pragmatic study

Background: Psychosis is associated with a high prevalence of substance use, leading to worsened prognosis. Less is known about how comorbid substance abuse may influence the effectiveness of antipsychotic medications. The aim of this study was to compare the effectiveness of second generation antipsychotics in patients with psychosis with and without substance use. Methods: All patients (n = 226) were aged >18 years old had symptom level scores of ≥4 on selected psychosis items on the Positive and Negative Syndrome Scale and met ICD-10 diagnostic criteria for psychosis. Information on substance use was collected based on the Clinician Drug Use Scale. Patients were grouped at baseline according to the presence of substance use, medication history and diagnosis group. Clinical symptoms at baseline and changes at follow-up were assessed with the PANSS. Results: At baseline about 30% of the patients used substances, most frequently cannabis followed by methamphetamine. About half (47%) of the patients had no prior exposure to antipsychotic medication at inclusion. Patients who had consumed substances showed no substantial differences in the PANSS score reduction as a result of antipsychotic medication compared to patients without substance. There were, however, some group differences in relation to pattern of change that were influenced by medication history. Substance use was found to be related to stronger reduction of positive symptoms from week 4 to week 27. Conclusion: Substance use alone did not influence antipsychotic effectiveness in this sample of patients with psychosis.

Co-occurring mental illnesses and substance use disorders: Evidence from Cyprus

Co-occurrence of substance misuse and mental health conditions is an important problem in the treatment of substance use disorders and mental illnesses. The focus of this paper is to investigate co-occurring disorders with feedback directly to patients on outpatient individual treatment adherence. The study is conducted using data from a randomly selected sample from an outpatient treatment centre of a private psychiatric clinic in Cyprus. Participants are individuals with substance (ab) use disorder and dependence, who had asked for admission and who had been advised to start individual treatment, after a standardized admission assessment with the European Addiction Severity Index (EuropASI). Despite the limitations of this study, the overall results do provide evidence of an association between mental illness and substance abuse. However, it is concluded that more research is needed in order to disentangle the dynamics of this dual relationship.

Substance Abuse and Excessive Mortality Among Forensic Psychiatric Patients: A Finnish Nationwide Cohort Study

Background: Forensic psychiatric patients are known to have reduced life expectancy. The aim of this study was to explore to what extent substance abuse disorders account for this increased mortality. Methods: Data up to December 31, 2016 for mortality (causes of death register) and substance abuse (forensic psychiatric examinations) were collected for all of the 950 patients committed to involuntary forensic psychiatric hospital care in Finland during 1980-2009 and discharged no later than December 31, 2016. Patients were then classified as suffering or not suffering from substance abuse disorders and their causes of death were examined. The standardized mortality ratio was then calculated for these groups on the basis of sex-, age-, and calendar-period-specific mortality rates for the general Finnish population. Results: During the follow-up time (mean 13.4 years), 354 (320 men, 34 women) patients died, resulting in a standardized mortality ratio of 3.5. The standardized mortality ratio for the patients with a history of substance abuse disorders was 4.1 compared to 2.8 for those with no such history. Among men, but not women, the age-adjusted proportion of death was significantly higher for those with a history of substance abuse disorders. In addition, in patients with a history of substance abuse disorders, the male age-adjusted competing risk of mortality was higher for unnatural causes, but not natural causes. Furthermore, a prominent proportion (16%) of all deaths and a majority of the accidental deaths (64%) occurred under the influence of some substance. Conclusions: Substance abuse is a major factor causing excessive mortality among forensic psychiatric patients. The management of substance abuse problems should be one cornerstone of the treatment of patients with both severe mental disorders and substance abuse disorders during their time in hospital and this should be extended to outpatient care.

Effectiveness of Integrated Dual Diagnosis Treatment (IDDT) in severe mental illness outpatients with a co-occurring substance use disorder

Integrating substance use disorder treatment with psychiatric treatment is considered more favourable then treating these disorders parallel or sequential, but the evidence base is inconclusive. We examined the effectiveness of Integrated Dual Diagnosis Treatment (IDDT) on substance use in severe mental illness outpatients with substance use disorders. IDDT is a collaborative, multidisciplinary team approach in which motivational interviewing is a key element. In addition, we also examined the effects of IDDT implementation on skills and knowledge of mental health care professionals. A randomized controlled stepped-wedge cluster trial was performed in 6 functional assertive cummunity treatment teams. We included 37 clinicians who were given a three-day IDDT training. Our primary outcome was days of substance use at follow up, 12 months after IDDT implementation. This was assessed in 154 included patients and was measured with the Measurement in the Addiction for Triage and Evaluation. After implementation of IDDT we found a reduction in the number of days patients used alcohol or drugs, but no improvements on other secondary outcomes such as psychopathology, functioning, therapeutic alliance or motivation to change. Also, IDDT training did not seem to improve clinicians' knowledge, attitudes and motivational interviewing skills. Effects on our secondary outcomes may have been limited by the absence of a training effect in our clinicians. Our study clearly underlines the complexity of disseminating IDDT and in particular motivational interviewing.

Study to determine the prevalance of substance use and factors associated with it, in first-episode of psychosis

BACKGROUND

Psychoactive substance use occurs commonly in patients with psychotic disorders.

AIM

This study aimed to determine the prevalence of substance use in first-episode psychotic patients and to evaluate the association between substance use and various sociodemographic variables.

MATERIALS AND METHODS

This was a cross-sectional study, and symptomatic first-episode, treatment-naive psychosis patients were included (n = 79). A semi-structured pro forma was used for the evaluation of sociodemographic and clinical characteristics. The patients were then interviewed for use of any psychoactive substance in their lifetime. In each case, the history was corroborated by a family member or a caregiver. Wherever required, a second interview was conducted.

RESULTS

The mean age at the onset of psychotic disorder for substance users was 36.09 years and for nonusers was 35.50 years. Almost three-fourth of the patients reported the use of at least one substance in their lifetime. Alcohol use was reported by 40.50% of patients, tobacco by 55%, and cannabis by 8.86%. It was significant in patients who were diagnosed with schizophrenia, acute and transient psychotic disorder, persistent delusional disorder, and unspecified nonorganic psychotic disorder.

CONCLUSION

The results show a high prevalence of psychoactive substance abuse compared to the prevalence in the general population. This has tremendous significance in the management of such illness, which is known to impact the prognosis adversely.

Perspectives of cannabis use in the life experience of men with schizophrenia

Substance use amongst people with schizophrenia is well-established: up to 50% report using illicit substances. The occurrence of both conditions can also induce people to disengage from mental health services. The research question sought to understand, from the perspective of both service users and clinicians, cannabis use within the experience of people with schizophrenia. The transcripts of the seven participants and the two focus groups were analysed using interpretative phenomenological analysis. Service Users and Clinicians were recruited from Assertive outreach community-based teams. seven male service users who described their ethnic identity as 'black', diagnosed with schizophrenia and a history of treatment disengagement and 12 clinicians who worked with this client group. The two component study involved semi-structured interviews with the Service Users and two focus groups with the Clinicians. Service Users perceived cannabis use as a means by which they could 'reestablish their identity' that had been damaged and the social consequences of diagnosis. Clinicians similarly perceived drugs, cannabis in particular, as a significant part of the service users' life. This study provides greater depth to understanding cannabis use within the experience of people with a diagnosis of schizophrenia.

A comparative study of socio-demographic and substance use correlates in early-onset psychosis

BACKGROUND

Comorbid substance use, particularly cannabis among adolescents with mental illness, is a major public health concern in developing countries with limited mental health resources. Better understanding of the association between cannabis use and other polysubstance use and early mental illness will provide for more targeted early interventions.

AIM

This aim of this study was to examine the socio-demographic profile and cannabis use characteristics among adolescents with first-episode early-onset psychosis (EOP) and compare with age-matched and gender-matched adolescents with first-episode non-psychotic mental illness (controls).

METHOD

Forty-five adolescents with first-episode EOP and 45 controls were assessed using a clinical interview, Positive and Negative Syndrome Scale and World Health Organization Alcohol, Smoking and Substance Involvement Screening test (ASSIST) for substance-related problems.

RESULTS

There were significant socio-demographic differences among the adolescents with EOP (73% Black, 64% from low family income, 44% from rural areas) compared with controls (24% Black, 53% from low family income, 2% from rural areas). Although there was no difference in lifetime cannabis use, EOP adolescents differed in motivation for cannabis use, had increased current cannabis use (38%, P = 0.01) and more frequent use (52%, P = 0.04) compared with controls (16% current and 18% frequent use). EOP adolescents reported more hazardous use with higher ASSIST mean cannabis-specific involvement scores (EOP 10,2; controls 2,3; P = 0.004).

CONCLUSION

The differences in socio-demographic variables may reflect the marked disparity in access to mental health care for rural Black youth. Psychotic youth may be more vulnerable to comorbid cannabis-related problems than other mentally ill adolescents. The study highlights the need for early introduction of substance use interventions among adolescents with mental illness.

Risk factors of compliance with self-harm command hallucinations in individuals with affective and non-affective psychosis

Clinicians are often left with the difficult task of assessing and managing the risk of violent behaviors in individuals having command hallucinations, which may result in substantial rates of false positive or false negative. Moreover, findings on the association between command hallucinations and suicidal behaviors are limited. In an attempt to better understand compliance to this hallucinatory phenomenon, our objective was to identify the risk factors of compliance with self-harm command hallucinations. Secondary analyses from the MacArthur Study were performed on 82 participants with psychosis reporting such commands. Univariate logistic regression was used to examine the classification value of each characteristic associated with compliance with such commands. Seriousness and frequency of childhood physical abuse, a current comorbid substance use disorder, emotional distress, general symptomatology, history of compliance, and belief about compliance in the future were found to be significant risk factors of compliance with self-harm commands in the week preceding psychiatric inpatient. Multivariate analyses revealed that severity of childhood physical abuse, belief about compliance in the future, and a current comorbid substance use disorder were independent risk factors. The final model showed excellent classification accuracy as suggest by the receiver operating characteristic curve (AUC=0.84, 95% CI: 0.75-0.92, p<0.001). Our results suggest considerable clinical implications in regard to the assessment of risk of compliance to self-harm command hallucinations in individuals with psychosis.

Psychotic-spectrum symptoms, cumulative adversity exposure and substance use among high-risk girls

AIM

Psychotic-spectrum symptoms are linked to trauma, substance/alcohol use (SAU), criminality/violence and poor functional outcomes, supporting the need for early detection in vulnerable populations. To better understand high-risk girls' mental health, we assessed: (1) psychotic-spectrum symptoms; (2) cumulative trauma, adversity and loss exposures (C-TALE) and adversity-indicators (symptoms, maladaptive coping, stressor-reactivity); and SAU risk-factors; and (3) relationships among psychotic-spectrum symptoms, adversity-indicators and SAU risk-factors.

METHODS

We administered the Structured Clinical Interviews for Psychotic Spectrum, and Trauma and Loss Spectrum to 158 adolescent delinquent girls.

RESULTS

Girls' psychotic-spectrum profiles were similar to previously reported adult psychotic patients and characterized by typical symptoms (hallucinations/delusions, reported largely SAU-independent), interpersonal sensitivity, schizoid traits and paranoia (over-interpretation, anger over-reactivity, hypervigilance). Auditory/visual hallucinations (55.7%), delusions (92.4%), ideas of reference (96.8%) and adversity (90.0% ≥10/24 C-TALE-types) were common. Mean loss (4) and trauma (8) onset-age occurred before SAU-onset (12). Significant positive correlations were found among psychotic-spectrum symptoms, stressor-reactivity, C-TALE, adversity-indicators; and number of SAU-types; and a negative correlation occurred between psychotic-spectrum symptoms and earlier alcohol use onset. After controlling for number of SAU-types, stressor-reactivity and adversity-related numbing individually had the largest associations with total psychotic-spectrum symptoms (b = 2.6-4.3). Girls averaged more than 4 maladaptive coping strategies (e.g., 24.8% attempted suicide) in response to adversity, amplifying potential health-disparities. No racial/ethnic differences emerged on psychotic-spectrum symptoms.

CONCLUSIONS

This symptom constellation during adolescence likely interferes with social and academic functioning. Whether representing a prodromal phase, trauma-response or cross-diagnostic psychopathology, accurate early detection and appropriate treatment of psychotic-spectrum symptoms are warranted to improve functional outcomes in vulnerable populations.