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Hui CLM, Chen EYH, Swapna V, Tagata H, Mizuno M, Liu C, Takeuchi H, Kim SW, Chung YC. Guidelines for Discontinuation of Antipsychotics in Patients Who Recover From First-Episode Schizophrenia Spectrum Disorders: Derived From the Aggregated Opinions of Asian Network of Early Psychosis Experts and Literature Review. Int J Neuropsychopharmacol 2022; 25:737-758. [PMID: 35451023 PMCID: PMC9515132 DOI: 10.1093/ijnp/pyac002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/01/2021] [Accepted: 04/20/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Antipsychotic discontinuation has been a long-standing clinical and medicolegal issue. The Asian Network of Early Psychosis developed guidelines for antipsychotic discontinuation in patients who recover from first-episode non-affective psychosis. We reviewed the existing studies and guidelines on antipsychotic discontinuation to develop guidelines for antipsychotic discontinuation in such patients. METHODS We reviewed the relevant studies, reviews, guidelines, and ongoing trials related to antipsychotic discontinuation in patients with first-episode psychosis or schizophrenia. The quality of randomized controlled trials was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS Most studies had low to very low quality, and 2 had moderate quality. All studies, except 1, advised against antipsychotic discontinuation because of higher relapse rates in the antipsychotic discontinuation group (19%-82% at 1-year follow-up) than the treatment maintenance group compared with the maintenance group. Based on expert opinion and Grading of Recommendations Assessment, Development, and Evaluation evidence of trials, guidelines have been recommended for future discontinuation studies on patients with first-episode schizophrenia spectrum disorders. CONCLUSIONS Currently, there are no recommendations for antipsychotic discontinuation in patients with first-episode schizophrenia spectrum disorders. However, there is a pressing need to conduct more rigorous research in remitted patients using more stringent criteria of full recovery, which can form the basis of guidelines on when and how antipsychotics should be tapered and discontinued. Studies that evaluate the patient characteristics and biomarkers that predict successful antipsychotic discontinuation are also needed.
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Affiliation(s)
| | - Christy L M Hui
- Department of Psychiatry Unive, University of Hong Kong , Hong Kong, SAR , China
| | - Eric Y H Chen
- Department of Psychiatry Unive, University of Hong Kong , Hong Kong, SAR , China
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong , Hong Kong, SAR , China
| | - Verma Swapna
- Institute of Mental Health , Singapore
- Duke-NUS Medical School , Singapore
| | - Hiromi Tagata
- Department of Neuropsychiatry, Toho University School of Medicine , Tokyo , Japan
| | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University School of Medicine , Tokyo , Japan
- Tokyo Metropolitan Matsuzawa Hospital , Tokyo , Japan
| | - Chen‑Chung Liu
- Department of Psychiatry, National Taiwan University Hospital , Taipei , Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University , Taipei , Taiwan
| | - Hiroyoshi Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine , Tokyo , Japan
- Schizophrenia Program, Centre for Addiction and Mental Health , Toronto, ON , Canada
| | - Sung-Wan Kim
- Mindlink, Gwangju Bukgu Mental Health Center , Gwangju , Korea
- Department of Psychiatry, Chonnam National University Medical School , Gwangju , Korea
| | - Young-Chul Chung
- Department of Psychiatry, Jeonbuk National University Medical School , Jeonju , Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital , Jeonju , Korea
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Opioid Use Disorder Comorbidity in Individuals With Schizophrenia-Spectrum Disorders: A Systematic Review and Meta-Analysis. CANADIAN JOURNAL OF ADDICTION 2021. [DOI: 10.1097/cxa.0000000000000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3
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Prat G, Marquez-Arrico JE, Río-Martínez L, Navarro JF, Adan A. Premorbid functioning in schizophrenia spectrum disorders with comorbid substance use: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110310. [PMID: 33775743 DOI: 10.1016/j.pnpbp.2021.110310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/03/2021] [Accepted: 03/23/2021] [Indexed: 11/26/2022]
Abstract
Premorbid functioning has been related with several clinical features and prognosis of schizophrenia spectrum disorders. Comorbidity with substance use is highly prevalent and usually hinders clinical improvement in this kind of psychiatric disorders. This systematic review analyzes the differences in the premorbid functioning of subjects with a schizophrenia spectrum disorder with substance use (SSD+, dual psychosis) or without it (SSD-). A systematic review (PRISMA guidelines), including search in electronic databases (MEDLINE, Web of Science, and Cochrane Library), was performed. 118 published works were considered of which only 20 met our inclusion criteria. Although there is a great variability in methodologies, diagnoses included, and substances used, studies using the Premorbid Functioning Scale to assess the academic and/or social domains found that SSD+ subjects had a poorer academic but better social premorbid functioning than those with SSD-. Current evidence is not conclusive, so additional studies are required to integrate intervening factors in order to clarify the clinical implications of premorbid functioning to improve the course and therapeutic response of patients.
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Affiliation(s)
- Gemma Prat
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Passeig de la Vall d'Hebron, 171, 08035 Barcelona, Spain
| | - Julia E Marquez-Arrico
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Passeig de la Vall d'Hebron, 171, 08035 Barcelona, Spain
| | - Laura Río-Martínez
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Passeig de la Vall d'Hebron, 171, 08035 Barcelona, Spain; Institute of Neurosciences, University of Barcelona, Passeig de la Vall d'Hebron, 171, 08035 Barcelona, Spain
| | - José Francisco Navarro
- Department of Psychobiology, School of Psychology, University of Málaga, Campus Teatinos s/n, 29071 Málaga, Spain
| | - Ana Adan
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Passeig de la Vall d'Hebron, 171, 08035 Barcelona, Spain; Institute of Neurosciences, University of Barcelona, Passeig de la Vall d'Hebron, 171, 08035 Barcelona, Spain.
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Irving J, Colling C, Shetty H, Pritchard M, Stewart R, Fusar-Poli P, McGuire P, Patel R. Gender differences in clinical presentation and illicit substance use during first episode psychosis: a natural language processing, electronic case register study. BMJ Open 2021; 11:e042949. [PMID: 33879482 PMCID: PMC8061860 DOI: 10.1136/bmjopen-2020-042949] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To determine whether gender differences in symptom presentation at first episode psychosis (FEP) remain even when controlling for substance use, age and ethnicity, using natural language processing applied to electronic health records (EHRs). DESIGN, SETTING AND PARTICIPANTS Data were extracted from EHRs of 3350 people (62% male patients) who had presented to the South London and Maudsley NHS Trust with a FEP between 1 April 2007 and 31 March 2017. Logistic regression was used to examine gender differences in the presentation of positive, negative, depressive, mania and disorganisation symptoms. EXPOSURES FOR OBSERVATIONAL STUDIES Gender (male vs female). MAIN OUTCOMES AND MEASURES Presence of positive, negative, depressive, mania and disorganisation symptoms at initial clinical presentation. RESULTS Eight symptoms were significantly more prevalent in men (poverty of thought, negative symptoms, social withdrawal, poverty of speech, aggression, grandiosity, paranoia and agitation). Conversely, tearfulness, low energy, reduced appetite, low mood, pressured speech, mood instability, flight of ideas, guilt, mutism, insomnia, poor concentration, tangentiality and elation were more prevalent in women than men. Negative symptoms were more common among men (OR 1.85, 95% CI 1.33 to 2.62) and depressive and manic symptoms more common among women (OR 0.30, 95% CI 0.26 to 0.35). After adjustment for illicit substance use, the strength of associations between gender and negative, manic and depression symptoms increased, whereas gender differences in aggression, agitation, paranoia and grandiosity became insignificant. CONCLUSIONS There are clear gender differences in the clinical presentation of FEP. Our findings suggest that gender can have a substantial influence on the nature of clinical presentation in people with psychosis, and that this is only partly explained by exposure to illicit substance use.
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Affiliation(s)
- Jessica Irving
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Craig Colling
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Hitesh Shetty
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Megan Pritchard
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Robert Stewart
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Paolo Fusar-Poli
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, London, UK
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Rashmi Patel
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, London, UK
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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5
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Gicas KM, Cheng A, Panenka WJ, Kim DD, Yau JC, Procyshyn RM, Stubbs JL, Jones AA, Bains S, Thornton AE, Lang DJ, Vertinsky AT, Rauscher A, Honer WG, Barr AM. Differential effects of cannabis exposure during early versus later adolescence on the expression of psychosis in homeless and precariously housed adults. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110084. [PMID: 32890696 DOI: 10.1016/j.pnpbp.2020.110084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/16/2020] [Accepted: 08/26/2020] [Indexed: 12/20/2022]
Abstract
Longitudinal studies of cannabis exposure during early adolescence in the general population frequently report an increased risk of subsequently developing psychotic symptoms or a psychotic illness. However, there is a dearth of knowledge about the effects of early cannabis exposure on psychosis in homeless and precariously housed adults, who represent a population afflicted with high rates of psychosis. The aim of the present study was to examine how early cannabis exposure (by age 15) compared to later first use (after age 15) affected the expression of adult psychosis in this population. Secondary measures of psychopathology, drug use, cognition and brain structure were also collected. 437 subjects were recruited from single room occupancy hotels in the urban setting of the Downtown Eastside of Vancouver, Canada. Psychiatric diagnoses were determined, and psychotic symptom severity was measured with the 5-factor PANSS. Participants completed a battery of neurocognitive tests, and brain structure was assessed using structural and diffusion tensor imaging MRI scans. Results indicated that early cannabis exposure was associated with an increased risk (OR = 1.09, p < .05) of developing substance induced psychosis, whereas later first use increased risk (OR = 2.19, p < .01) of developing schizophrenia or schizoaffective disorder. There was no group difference in neurocognitive function, although differences were observed in the lateral orbitofrontal cortex and white matter tract diffusivity. These findings indicate that early cannabis exposure in this population may increase the risk of developing drug associated psychoses, which could potentially be mediated in part through altered neurodevelopmental brain changes.
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Affiliation(s)
| | - Alex Cheng
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - David D Kim
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jade C Yau
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Simran Bains
- Department of Medicine, Imperial College London, United Kingdom
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Alexandra T Vertinsky
- Department of Radiology, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Alex Rauscher
- Department of Radiology, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
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The Impact of Treatment Orders for Residential Treatment of Comorbid Severe Substance Use Disorders for Youth Suffering from Early Psychosis: a Case Series. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00317-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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7
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Ferraro L, La Cascia C, Quattrone D, Sideli L, Matranga D, Capuccio V, Tripoli G, Gayer-Anderson C, Morgan C, Sami MB, Sham P, de Haan L, Velthorst E, Jongsma HE, Kirkbride JB, Rutten BPF, Richards AL, Roldan L, Arango C, Bernardo M, Bobes J, Sanjuan J, Santos JL, Arrojo M, Tarricone I, Tortelli A, Szöke A, Del-Ben CM, Selten JP, Lynskey M, Jones PB, Van Os J, La Barbera D, Murray RM, Di Forti M. Premorbid Adjustment and IQ in Patients With First-Episode Psychosis: A Multisite Case-Control Study of Their Relationship With Cannabis Use. Schizophr Bull 2020; 46:517-529. [PMID: 31361020 PMCID: PMC7147569 DOI: 10.1093/schbul/sbz077] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Psychotic patients with a lifetime history of cannabis use generally show better cognitive functioning than other psychotic patients. Some authors suggest that cannabis-using patients may have been less cognitively impaired and less socially withdrawn in their premorbid life. Using a dataset comprising 948 patients with first-episode psychosis (FEP) and 1313 population controls across 6 countries, we examined the extent to which IQ and both early academic (Academic Factor [AF]) and social adjustment (Social Factor [SF]) are related to the lifetime frequency of cannabis use in both patients and controls. We expected a higher IQ and a better premorbid social adjustment in psychotic patients who had ever used cannabis compared to patients without any history of use. We did not expect such differences in controls. In both patients and controls, IQ was 3 points higher among occasional-users than in never-users (mean difference [Mdiff] = 2.9, 95% CI = [1.2, 4.7]). Both cases and control daily-users had lower AF compared to occasional (Mdiff = -0.3, 95% CI = [-0.5; -0.2]) and never-users (Mdiff = -0.4, 95% CI = [-0.6; -0.2]). Finally, patient occasional (Mdiff = 0.3, 95% CI = [0.1; 0.5]) and daily-users (Mdiff = 0.4, 95% CI = [0.2; 0.6]) had better SF than their never-using counterparts. This difference was not present in controls (Fgroup*frequency(2, 2205) = 4.995, P = .007). Our findings suggest that the better premorbid social functioning of FEP with a history of cannabis use may have contributed to their likelihood to begin using cannabis, exposing them to its reported risk-increasing effects for Psychotic Disorders.
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Affiliation(s)
- Laura Ferraro
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy,2Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK,To whom correspondence should be addressed; Via Gaetano La Loggia, 1, 90129 Palermo, Italy; tel: 091-6555175, fax: 091-6555164, e-mail:
| | - Caterina La Cascia
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK,South London and Maudsley NHS Mental Health Foundation Trust, London, UK
| | - Lucia Sideli
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy,2Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Domenica Matranga
- Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy
| | - Veronica Capuccio
- Department of Economic, Management and Statistical Sciences (DSEAS) University of Palermo, Palermo, Italy
| | - Giada Tripoli
- 2Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, King’s College London, London, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, King’s College London, London, UK
| | - Musa B Sami
- South London and Maudsley NHS Mental Health Foundation Trust, London, UK
| | - Pak Sham
- Centre for Genomic Sciences, Li KaShing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Eva Velthorst
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands,Departments of Psychiatry and Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hannah E Jongsma
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Cambridge, UK,Psylife Group, Division of Psychiatry, University College London, London, UK
| | - James B Kirkbride
- Psylife Group, Division of Psychiatry, University College London, London, UK
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Alexander L Richards
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Laura Roldan
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Miquel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Department of Medicine, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Julio Bobes
- Department of Medicine, Psychiatry Area, School of Medicine, Universidad de Oviedo, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - Julio Sanjuan
- Department of Psychiatry, School of Medicine, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - Jose Luis Santos
- Department of Psychiatry, Servicio de Psiquiatría Hospital “Virgen de la Luz,” Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ilaria Tarricone
- Department of Medical and Surgical Sciences, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Andrea Tortelli
- Etablissement Public de Santé Maison Blanche, Paris, France,INSERM, Créteil, France
| | | | - Cristina Marta Del-Ben
- Division of Psychiatry, Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Jean-Paul Selten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands,Rivierduinen Institute for Mental Health Care, Leiden, The Netherlands
| | - Michael Lynskey
- Department of Addiction, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Cambridge, UK,CAMEO Early Intervention Service, Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Jim Van Os
- 2Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK,Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Daniele La Barbera
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | | | - Robin M Murray
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy,2Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK,South London and Maudsley NHS Mental Health Foundation Trust, London, UK
| | - Marta Di Forti
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK,South London and Maudsley NHS Mental Health Foundation Trust, London, UK
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8
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Thungana Y, Zingela Z, van Wyk S. First-episode psychosis and substance use in Nelson Mandela Bay: Findings from an acute mental health unit. S Afr J Psychiatr 2019; 25:1372. [PMID: 31745443 PMCID: PMC6851873 DOI: 10.4102/sajpsychiatry.v25i0.1372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 08/21/2019] [Indexed: 11/17/2022] Open
Abstract
Background Use of psychoactive substances is a common finding in studies on first-episode psychosis (FEP), and this has prognostic implications. We know very little about psychoactive substance use (SU) among patients with FEP in the Eastern Cape province (EC) of South Africa (SA). Aim The study seeks to determine SU prevalence and associated features among inpatients with non-affective FEP in an acute mental health unit (MHU) in Nelson Mandela Bay, EC. Setting Researchers conducted a retrospective clinical file review of a 12-month admission cohort of patients with FEP, without a concurrent mood episode, to the Dora Nginza Hospital MHU. Information collected included SU history, psychiatric diagnoses, and demographics. Data were then subjected to statistical analysis. Methods Researchers conducted a retrospective clinical file review of a 12-month admission cohort of patients with FEP, without a concurrent mood episode, to the Dora Nginza Hospital MHU. Information collected included SU history, psychiatric diagnoses and demographics. Data were then subjected to statistical analysis. Results A total of 117 patients (86 [73.5%] males; 31 [26.5%] females) aged 18–60 years (mean 29 years) met the inclusion criteria. After controlling for missing information, 95 of 117 (81.2%) patients had a history of active or previous SU, 82 of 90 (91.1%) were single and 61 of 92 (66.3%) were unemployed. A significant association was found between SU and unemployment (p < 0.001), as well as male sex (p < 0.001). The most common substances used were cannabis (59.8%), followed by alcohol (57.3%) and stimulants (46.4%). Conclusion In keeping with national and international literature, the results of this study showed a high prevalence of substance use in South African patients with first-episode psychosis. The high prevalence of lifetime substance use in this cohort compared to previous studies in South Africa requires further investigation and highlights the urgent need for dual diagnosis services in the Eastern Cape province.
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Affiliation(s)
- Yanga Thungana
- Department of Psychiatry and Behavioural Sciences, Walter Sisulu University, Mthatha, South Africa.,Acute Mental Health Care Unit, Dora Nginza Hospital, Bethelsdorp, South Africa
| | - Zukiswa Zingela
- Department of Psychiatry and Behavioural Sciences, Walter Sisulu University, Mthatha, South Africa.,Nelson Mandela Academic Hospital, Mthatha, South Africa
| | - Stephan van Wyk
- Department of Psychiatry and Behavioural Sciences, Walter Sisulu University, Mthatha, South Africa.,Nelson Mandela Academic Hospital, Mthatha, South Africa
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9
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Dervaux A, Plancke L, Amariei A, Trouiller P, Tahon M, Martinetti MP, Naassila M, Cottencin O, Danel T. Methadone and buprenorphine treatments in patients with schizophrenia. Schizophr Res 2019; 209:286-288. [PMID: 31101511 DOI: 10.1016/j.schres.2019.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 02/27/2019] [Accepted: 05/05/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Alain Dervaux
- Service de Psychiatrie et Addictologie de liaison, CHU Sud, 80054 Amiens Cedex, France; Fédération régionale de recherche en psychiatrie et santé mentale (F2RSM) des Hauts-de-France, Lille, France; Université de Picardie Jules Verne, Groupe de Recherche sur l'Alcool & les Pharmacodépendances (GRAP) INSERM U1247, France.
| | - Laurent Plancke
- Fédération régionale de recherche en psychiatrie et santé mentale (F2RSM) des Hauts-de-France, Lille, France; Centre lillois d'études sociologiques et économiques, Villeneuve d'Ascq, France
| | - Alina Amariei
- Fédération régionale de recherche en psychiatrie et santé mentale (F2RSM) des Hauts-de-France, Lille, France
| | - Philippe Trouiller
- Centre lillois d'études sociologiques et économiques, Villeneuve d'Ascq, France
| | - Michel Tahon
- Direction régionale du service du contrôle médical de l'assurance-maladie des Hauts-de-France, France
| | | | - Mickaël Naassila
- Université de Picardie Jules Verne, Groupe de Recherche sur l'Alcool & les Pharmacodépendances (GRAP) INSERM U1247, France
| | - Olivier Cottencin
- Univ. Lille, CNRS UMR 9193 SCALab (Sciences Cognitives et Sciences Affectives) & CHU Lille, Department of Psychiatry and Addiction Medicine, F-59000 Lille, France; Service d'Addictologie, Hôpital Fontan 2, 59000 Lille, France
| | - Thierry Danel
- Fédération régionale de recherche en psychiatrie et santé mentale (F2RSM) des Hauts-de-France, Lille, France; Service d'Addictologie, Hôpital Fontan 2, 59000 Lille, France
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10
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Weibell MA, Johannessen JO, Auestad B, Bramness J, Brønnick K, Haahr U, Joa I, Larsen TK, Melle I, Opjordsmoen S, Rund BR, Røssberg JI, Simonsen E, Vaglum P, Stain H, Friis S, Hegelstad WTV. Early Substance Use Cessation Improves Cognition-10 Years Outcome in First-Episode Psychosis Patients. Front Psychiatry 2019; 10:495. [PMID: 31354551 PMCID: PMC6640174 DOI: 10.3389/fpsyt.2019.00495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 06/24/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Cognitive impairment may be a risk factor for, as well as a consequence of, psychosis. Non-remitting symptoms, premorbid functioning, level of education, and socioeconomic background are known correlates. A possible confounder of these associations is substance use, which is common among patients with psychosis and linked to worse clinical outcomes. Studies however show mixed results for the effect of substance use on cognitive outcomes. In this study, the long-term associations of substance use with cognition in a representative sample of first-episode psychosis patients were examined. Methods: The sample consisted of 195 patients. They were assessed for symptom levels, function, and neurocognition at 1, 2, 5, and 10 years after first treatment. Test scores were grouped into factor analysis-based indices: motor speed, verbal learning, visuomotor processing, verbal fluency, and executive functioning. A standardized composite score of all tests was also used. Patients were divided into four groups based on substance-use patterns during the first 2 years of treatment: persistent users, episodic users, stop-users, and nonusers. Data were analyzed using linear mixed effects modeling. Results: Gender, premorbid academic functioning, and previous education were the strongest predictors of cognitive trajectories. However, on motor speed and verbal learning indices, patients who stopped using substances within the first 2 years of follow-up improved over time, whereas the other groups did not. For verbal fluency, the longitudinal course was parallel for all four groups, while patients who stopped using substances demonstrated superior performances compared with nonusers. Persistent users demonstrated impaired visuomotor processing speed compared with nonusers. Within the stop- and episodic use groups, patients with narrow schizophrenia diagnoses performed worse compared with patients with other diagnoses on verbal learning and on the overall composite neurocognitive index. Discussion: This study is one of very few long-term studies on cognitive impairments in first-episode psychosis focusing explicitly on substance use. Early cessation of substance use was associated with less cognitive impairment and some improvement over time on some cognitive measures, indicating a milder illness course and superior cognitive reserves to draw from in recovering from psychosis.
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Affiliation(s)
- Melissa A Weibell
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Bjørn Auestad
- Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway.,Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Jørgen Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorder, Innland Hospital Trust, Hamar, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kolbjørn Brønnick
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Ulrik Haahr
- Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Inge Joa
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Tor Ketil Larsen
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Institute of Psychiatry, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Stein Opjordsmoen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway.,Vestre Viken Hospital Trust, Drammen, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Helen Stain
- School of Social and Health Sciences, Leeds Trinity University, Leeds, United Kingdom
| | - Svein Friis
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Wenche Ten Velden Hegelstad
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
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11
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Abebe DS, Elstad JI, Lien L. Utilization of somatic specialist services among psychiatric immigrant patients: the Norwegian patient registry study. BMC Health Serv Res 2018; 18:852. [PMID: 30424757 PMCID: PMC6234592 DOI: 10.1186/s12913-018-3672-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/31/2018] [Indexed: 01/09/2023] Open
Abstract
Background Amongst psychiatric patients, the leading causes of reduced quality of life and premature death are chronic viral infections and cardiovascular diseases. In spite of this, there are extremely high levels of disparity in somatic healthcare amongst such populations. Little research has explored patterns of healthcare utilisation and, therefore, this study aims to examine the use of somatic specialist healthcare for infectious diseases and diseases of circulatory system among psychiatric patients from different immigrant groups and ethnic Norwegians. Methods Register data from the Norwegian Patient Registry and Statistics Norway were used. The sample (ages 0–90+) consisted of 276,890 native-born Norwegians and 52,473 immigrants from five world regions – Western countries, East Europe, Africa, Asia, and Latin America, all of whom had contacts with specialist mental healthcare during the period 2008–2011. Statistical analyses were applied using logistic regression models. Results Rates of outpatient consultation for circulatory system diseases were significantly lower amongst patients from Africa, Asia and Latin America compared with ethnic Norwegian psychiatric patients. Only patients from Eastern Europeans had a higher rate. With regard to hospital admission, all psychiatric patients had a lower rate than ethnic Norwegians with the exception of those from Africa where the finding was non-significant. In terms of infectious diseases, patients from African countries had significantly higher outpatient and admission rates than ethnic Norwegians. Outpatient consultation rates were lower amongst those from Western and Latin America and hospital admission rates were lower amongst those from Eastern Europe and Asia. Conclusions The findings suggest that the majority of immigrant psychiatric patients have lower hospitalization rates for circulatory system diseases than Norwegian psychiatric patients. This may suggest that poor access for immigrants is a contributing factor, though the findings were less pronounced for infectious diseases.
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Affiliation(s)
- Dawit Shawel Abebe
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway. .,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.
| | | | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Department of Public Health, Innlandet University College, Brumunddal, Norway
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12
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Boroughs MS, Ehlinger PP, Batchelder AW, Safren SA, O’Cleirigh C. Posttraumatic Stress Symptoms and Emerging Adult Sexual Minority Men: Implications for Assessment and Treatment of Childhood Sexual Abuse. J Trauma Stress 2018; 31:665-675. [PMID: 30338584 PMCID: PMC6557140 DOI: 10.1002/jts.22335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 05/24/2018] [Accepted: 06/06/2018] [Indexed: 11/09/2022]
Abstract
Emerging adulthood (EA) is a developmental period marked by unique challenges that affect health including burgeoning occupational, relational, and financial stability; and increased risk taking in terms of sexual behavior(s) and substance use. Data were collected from 296 HIV-uninfected sexual minority men with childhood sexual abuse (CSA) histories. We analyzed baseline assessment data from a multisite randomized controlled trial that tested the efficaciousness of an experimental psychosocial treatment and examined vulnerabilities known to be linked with CSA. Our analyses compared EA sexual minority men, aged 18-29, with older sexual minority men (OSMM) on posttraumatic stress disorder (PTSD) and other mental health and substance use outcomes. We found higher odds of PTSD, odds ratio (OR) = 0.57, 95% CI [0.33, 0.96]; panic disorder or panic disorder with agoraphobia, OR = 0.36, 95% CI [0.16, 0.85]; and cocaine use, OR = 0.50, 95% CI [0.25, 0.97], among OSMM and higher odds of alcohol intoxication, OR = 5.60, 95% CI [3.20, 9.82]; cannabis use, OR = 3.09, 95% CI [1.83, 5.21]; and non-HIV sexually transmitted infections, OR = 3.03, 95% CI [1.29, 7.13], among the EA men. These results present a complex picture of health risks among sexual minority men in general and EA sexual minority men in particular. HIV seroconversion linked health risk behaviors, among sexual minority men, may be better addressed via increased attention to treating trauma and comorbid mental health and substance use problems using evidence-based psychosocial assessments and integrated treatment platforms that are tailored to this population.
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Affiliation(s)
- Michael S. Boroughs
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada,The Fenway Institute at Fenway Health, Boston, Massachusetts, USA
| | - Peter P. Ehlinger
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, Oregon, USA
| | - Abigail W. Batchelder
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA,Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven A. Safren
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA,Department of Psychology, University of Miami, Miami, Florida, USA
| | - Conall O’Cleirigh
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA,Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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13
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Hunt GE, Large MM, Cleary M, Lai HMX, Saunders JB. Prevalence of comorbid substance use in schizophrenia spectrum disorders in community and clinical settings, 1990-2017: Systematic review and meta-analysis. Drug Alcohol Depend 2018; 191:234-258. [PMID: 30153606 DOI: 10.1016/j.drugalcdep.2018.07.011] [Citation(s) in RCA: 245] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/02/2018] [Accepted: 07/09/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Comorbidity is highly prevalent between substance use disorders (SUDs) and schizophrenia. This systematic review and meta-analysis estimated prevalence rates of SUDs in epidemiological and treatment-seeking patients diagnosed with schizophrenia or first episode psychosis. METHODS A literature search of Medline, EMBASE, PsycINFO and CINAHL databases was conducted from 1990 to 2017 inclusive. Prevalence of co-morbid SUDs and schizophrenia were extracted and odds ratios (ORs) were calculated using random effects meta-analysis. Combining like studies was dictated how authors reported substance use. RESULTS There were 123 included articles with a total sample size of 165,811 subjects that yielded six epidemiological studies, 11 national or state case-registry studies, 20 large cohort studies and 86 clinical studies using in- or out-patient samples. The prevalence of any SUD was 41.7%, followed by illicit drugs (27.5%), cannabis (26.2%), alcohol (24.3%) and stimulant use (7.3%). Meta-analysis showed the pooled variance of any SUD in males was 48% which was significantly higher than that for females with schizophrenia (22.1%, OR 3.43, 95% CI 3.01, 3.92). Patients with SUD had an earlier age of onset of schizophrenia. Meta-regression showed prevalence increased over time for illicit drugs but not for other substances, including alcohol. CONCLUSIONS The meta-analysis revealed that SUDs in schizophrenia is highly prevalent and rates have not changed over time. This indicates SUD are difficult to treat in this patient population and there is an urgent need for more informative studies to help develop better prevention, detection and treatment of SUDs in persons with schizophrenia and co-morbid disorders.
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Affiliation(s)
- Glenn E Hunt
- Discipline of Psychiatry and Addiction Medicine, Concord Clinical School, University of Sydney, Hospital Rd, Concord, NSW, 2139, Australia.
| | - Matthew M Large
- School of Psychiatry, University of New South Wales, Kensington, NSW, 2052, Australia.
| | - Michelle Cleary
- School of Health Sciences, University of Tasmania, Lilyfield, NSW, 2040, Australia.
| | - Harry Man Xiong Lai
- Discipline of Psychiatry, University of Sydney, Hospital Rd, Concord, NSW, 2139, Australia.
| | - John B Saunders
- Discipline of Psychiatry and Addiction Medicine, Concord Clinical School, University of Sydney, Hospital Rd, Concord, NSW, 2139, Australia.
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14
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Brunette MF, Mueser KT, Babbin S, Meyer-Kalos P, Rosenheck R, Correll CU, Cather C, Robinson DG, Schooler NR, Penn DL, Addington J, Estroff SE, Gottlieb J, Glynn SM, Marcy P, Robinson J, Kane JM. Demographic and clinical correlates of substance use disorders in first episode psychosis. Schizophr Res 2018; 194:4-12. [PMID: 28697856 DOI: 10.1016/j.schres.2017.06.039] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND We assessed the prevalence and correlates of lifetime substance use disorders in people with first episode psychosis using the baseline data from the Recovery After an Initial Schizophrenia Episode (RAISE) Early Treatment Program study. METHODS Research staff assessed 404 first episode patients at 34 community mental health centers across the United States with the Structured Clinical Interview for DSM-IV for diagnoses of psychotic and substance use disorders. Logistic regression was used to evaluate the relationships between participant characteristics and lifetime substance use disorders, followed with generalized linear mixed-effects regression models to identify unique predictors of lifetime substance use disorders. RESULTS Approximately one-third of participants reported recent alcohol use (36.6%) and cannabis use (30.7%), and one half (51.7%) met criteria for any lifetime alcohol or drug use disorder. Lifetime substance use disorders were associated with male gender, White race, higher excited (hyperactivity, mood lability, impulsivity, hostility, and uncooperativeness), psychotic and depressive symptoms, less impaired cognition, and greater perceived stigma. Gender, race, and excited symptoms were the most consistent unique predictors of lifetime substance use disorders found in multivariate analyses. CONCLUSIONS Half of first episode psychosis patients have co-occurring substance use disorders, which are associated with both more severe symptoms and greater perceptions of stigma. Programs aiming to serve these patients must have the skills and clinical strategies to help people with these unique characteristics.
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Affiliation(s)
- Mary F Brunette
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Bureau of Mental Health Services, Department of Health and Human Services, Concord, NH, USA.
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston, MA, USA
| | | | - Piper Meyer-Kalos
- Minnesota Center for Chemical and Mental Health, University of Minnesota, School of Social Work, St. Paul, MN, USA
| | | | - Christoph U Correll
- Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewis Glen Oaks, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA
| | | | - Delbert G Robinson
- Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewis Glen Oaks, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA
| | - Nina R Schooler
- Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewis Glen Oaks, NY, USA; SUNY Downstate Medical Center, Department of Psychiatry, Brooklyn, NY, USA
| | - David L Penn
- University of North Carolina-Chapel Hill, Department of Psychology, Chapel Hill, NC, USA; Australian Catholic University, School of Psychology, Melbourne, VIC, Australia
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Sue E Estroff
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Gottlieb
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston, MA, USA
| | - Shirley M Glynn
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | | | | | - John M Kane
- Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewis Glen Oaks, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA
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15
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Bogaty SER, Lee RSC, Hickie IB, Hermens DF. Meta-analysis of neurocognition in young psychosis patients with current cannabis use. J Psychiatr Res 2018; 99:22-32. [PMID: 29407284 DOI: 10.1016/j.jpsychires.2018.01.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Adult psychosis patients (i.e. over the age of 25 years) who are also lifetime cannabis users (CANN±) appear to exhibit superior cognition compared to never-using patients (CANN-). The objective of this meta-analysis was to evaluate the cognitive differences between CANN- and patients who currently use cannabis (CANN+) (i.e. during the CANN± patients' cannabis-using stage). Specifically, focusing on young patients under the age of 25 years, the typical stage of both psychosis- and cannabis-onset. METHOD Of the 308 studies identified through database searches and secondary referencing, 14 compared neurocognition of CANN+ and CANN- in young people with psychotic disorders (mean age between 15 and 45 years). Effect sizes were extracted using neurocognitive test performance between CANN+ and CANN- and random effects modelling was conducted on pooled ES and moderator analyses. RESULTS CANN+ performed worse on several cognitive domains (i.e. premorbid IQ, current IQ, verbal learning, verbal working memory, motor inhibition) compared to CANN-. The association between age and performance in CANN+ cognition was varied, with older age predictive of worse performance in processing speed, sustained attention, verbal memory, and better performance in verbal learning and very fluency. Of note, CANN+ outperformed CANN- in tests of conceptual set-shifting. CONCLUSION These results are consistent with previous findings indicating that CANN+ demonstrate poorer neurocognition than CANN-; and that this is exacerbated with increasing age. Our findings demonstrate significant cognitive differences between patients with CANN+ versus CANN- even at early-onset psychosis, which could suggest a different underlying mechanism towards psychosis for cannabis users.
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Affiliation(s)
| | - Rico S C Lee
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Brain and Mental Health Laboratory, Monash University, Melbourne, VIC, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Daniel F Hermens
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
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16
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Heavy cannabis use prior psychosis in schizophrenia: clinical, cognitive and neurological evidences for a new endophenotype? Eur Arch Psychiatry Clin Neurosci 2017; 267:629-638. [PMID: 28190094 DOI: 10.1007/s00406-017-0767-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 01/14/2017] [Indexed: 12/22/2022]
Abstract
Cannabis use is associated with an increased risk of schizophrenia, and is considered to impact late neurodevelopment. Neurological soft signs (NSS) associated with schizophrenia are considered as markers of early neurodevelopmental impairment. Our study examines the association between heavy cannabis use before the onset of psychosis and clinical, neuropsychological and neurological symptoms, including NSS. In a cross-sectional study, we consecutively included 61 patients with schizophrenia (34 reporting heavy cannabis use before the onset of psychosis and 27 not reporting such use), in the setting of a University Hospital and a Medical Center. Symptoms assessment and substance use disorder were evaluated with the Diagnostic Interview for Genetic Studies. NSS were assessed with the Neurological Evaluation Scale. Psychopathology was assessed with the Positive and Negative Symptom Scale. All patients underwent a battery of neurocognitive tests evaluating attention, memory and executive functions domains. Patients with heavy cannabis use before the onset of psychosis showed significantly less NSS (p < 0.05), less negative symptoms (p < 10-3) and a better cognitive functioning in different domains [median reaction time (p = 0.03), episodic memory (p = 0.04), visuoconstructive praxs (p = 0.03) than their non-heavy user counterparts]. Confounding effects of alcohol and tobacco were taken into account. Age and gender were not statistically different between the two groups (p = 0.70 and p = 0.16, respectively). Our study supports the clinical, neuropsychological and neurological specificity associated with the heavy use of cannabis before the onset of schizophrenia. Patients with heavy cannabis use before the onset of schizophrenia may exhibit later neurodevelopmental impairment than those who do not report such use. Schizophrenia associated with heavy cannabis use could represent a specific phenotype.
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17
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Ouellet-Plamondon C, Abdel-Baki A, Salvat É, Potvin S. Specific impact of stimulant, alcohol and cannabis use disorders on first-episode psychosis: 2-year functional and symptomatic outcomes. Psychol Med 2017; 47:2461-2471. [PMID: 28424105 DOI: 10.1017/s0033291717000976] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Many studies have concluded that cannabis use disorder (CUD) negatively influences outcomes in first-episode psychosis (FEP). However, few have taken into account the impact of concurrent misuse of other substances. METHODS This 2-year, prospective, longitudinal study of FEP patients, aged between 18 and 30 years, admitted to early intervention programs in Montreal, Quebec, Canada, examined the specific influence of different substance use disorders (SUD) (alcohol, cannabis, cocaine, amphetamines) on service utilization, symptomatic and functional outcomes in FEP. RESULTS Drugs and alcohol were associated with lower functioning, but drugs had a greater negative impact on most measures at 2-year follow-up. Half of CUD patients and more than 65% of cocaine or amphetamine abusers presented polysubstance use disorder (poly-SUD). The only group that deteriorated from years 1 to 2 (symptoms and functioning) were patients with persistent CUD alone. Outcome was worse in CUD than in the no-SUD group at 2 years. Cocaine, amphetamines and poly-SUD were associated with worse symptomatic and functional outcomes from the 1st year of treatment, persisting over time with higher service utilization (hospitalization). CONCLUSION The negative impact attributed to CUD in previous studies could be partly attributed to methodological flaws, like including polysubstance abusers among cannabis misusers. However, our investigation confirmed the negative effect of CUD on outcome. Attention should be paid to persistent cannabis misusers, since their condition seems to worsen over time, and to cocaine and amphetamine misusers, in view of their poorer outcome early during follow-up and high service utilization.
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Affiliation(s)
- C Ouellet-Plamondon
- Centre de recherche,Centre hospitalier de l'Université de Montréal (CRCHUM),Montreal, Quebec,Canada
| | - A Abdel-Baki
- Centre de recherche,Centre hospitalier de l'Université de Montréal (CRCHUM),Montreal, Quebec,Canada
| | - É Salvat
- Centre de recherche,Centre hospitalier de l'Université de Montréal (CRCHUM),Montreal, Quebec,Canada
| | - S Potvin
- Department of Psychiatry, Faculty of Medicine,Université de Montréal,Montreal, Quebec,Canada
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18
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Whiteley L, Warner JL, Ahuja M, Curtis V, Kessimian M, Ryoo HJ, Brown LK. The Impact of Comorbid Cannabis and Alcohol Use Disorders on the Functioning of College Students with Psychiatric Disorders. Int J Ment Health Addict 2017. [DOI: 10.1007/s11469-017-9815-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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19
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Symptomatic and functional outcomes of substance use disorder persistence 2 years after admission to a first-episode psychosis program. Psychiatry Res 2017; 247:113-119. [PMID: 27888680 DOI: 10.1016/j.psychres.2016.11.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/12/2016] [Accepted: 11/05/2016] [Indexed: 11/23/2022]
Abstract
Substance use disorders (SUD) in first-episode psychosis (FEP) are highly prevalent and linked with poor outcomes. However, most longitudinal studies investigating their impacts in FEP have not reported proportions of patients who ceased SUD. Our aim was to examine the influence of SUD course on functional and symptomatic outcomes as well as service use in FEP. We performed a 2-year longitudinal study of 212 FEP patients, aged between 18 and 30 years, admitted to 2 early psychosis services in Montréal, Québec, Canada. We observed that cannabis was the first substance abused (42.9% at baseline), followed by alcohol (19.3%). The SUD rate decreased by approximately 30% during the first year. Patients with persistent SUD had worse functional outcomes (Quality of Life Scale, Social and Occupational Functioning Assessment Scale, employment), more symptoms (Positive and Negative Symptoms Scale) and heavier service use (emergency and hospitalization). SUD persistence was associated with illness severity, homelessness and cluster-B personality. Those living with their parents and financially supported by them were more likely to cease SUD. Our results indicate that SUD course was more significant than having SUD at admission; persistent SUD was associated with worse outcomes. SUD decreased during a general early psychosis intervention program (with no specialized SUD treatment). An integrated, specialized approach targeting FEP patients with predictive factors of SUD persistence during the first years of treatment might increase SUD cessation and possibly improve outcomes.
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20
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Núñez C, Ochoa S, Huerta-Ramos E, Baños I, Barajas A, Dolz M, Sánchez B, Del Cacho N, Usall J. Differential effects of sex on substance use between first episode psychosis patients and healthy people. Compr Psychiatry 2016; 69:169-78. [PMID: 27423358 DOI: 10.1016/j.comppsych.2016.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 05/26/2016] [Accepted: 05/30/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Substance use in psychosis is an important field of study given that it can be a risk factor for the development of psychosis and can give rise to psychotic symptoms. Studies of substance use in first episode psychosis patients do not frequently assess non-pathological substance consumption among patients, but rather the prevalence of substance abuse or dependence disorders. Moreover, most of these studies do not address the effects of sex in sufficient depth, and the consumption of caffeine or tobacco, which are two of the most frequently used substances, is often not assessed. OBJECTIVES The aim of this study was to compare patterns and quantities of substance use between first episode psychosis patients and healthy controls and between men and women, and explore the potential interactive effects between group (patients or controls) and sex. METHODS A total of 158 participants (82 first episode psychosis patients and 76 healthy controls) were included in the study. Both adults and adolescents were included in the study. Frequency and amount of use of caffeine, tobacco, alcohol, cannabis, cocaine, hallucinogens, stimulants, and opiates were gathered. RESULTS A significant main effect of sex was found for the frequency of use of tobacco (p=.050). Main effects of group were found for the quantity of tobacco (p<.001) and cannabis (p<.001) consumed, as well as main effects of sex for the quantity of alcohol (p=.003) and cannabis (p=.017) consumed. There were also interaction effects between group and sex for the frequency of use of tobacco (p=.005) and cannabis (p=.009), and for the amount of cannabis consumed (p=.049). Qualitative differences between males and females regarding combined substance use are also reported. CONCLUSIONS Among patients, men used tobacco more frequently than women, but this sex difference was not the same for the control group, in which women smoked more often than men. Regarding cannabis, men smoked cannabis more frequently and in larger amounts than women, but only in the patients group, whereas no sex differences for cannabis were found for the controls. Main effects of group and sex for tobacco and alcohol, as well as the lack of differences for the frequency and amount of use of caffeine, are also commented. This is the first study to assess the different effects of sex on substance use in first episode psychosis patients and healthy controls.
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Affiliation(s)
- Christian Núñez
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Elena Huerta-Ramos
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Iris Baños
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Ana Barajas
- Research Unit, Centre d'Higiene Mental Les Corts, Barcelona, Spain
| | - Montserrat Dolz
- Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain; Psychiatry Department, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Bernardo Sánchez
- Psychiatry Department, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Núria Del Cacho
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | | | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
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Ottosen C, Petersen L, Larsen JT, Dalsgaard S. Gender Differences in Associations Between Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder. J Am Acad Child Adolesc Psychiatry 2016; 55:227-34.e4. [PMID: 26903256 DOI: 10.1016/j.jaac.2015.12.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/09/2015] [Accepted: 12/21/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine gender differences in the association between attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD), and to explore the impact of comorbid psychiatric conditions. METHOD This was a cohort study of all children born in Denmark in 1990 to 2003 (n = 729,560). By record linkage across nationwide registers, we merged data on birth characteristics, socioeconomic status, familial psychiatric history, and diagnoses of ADHD (N = 19,645), comorbidities, and SUD. Hazard ratios (HR) with 95% CIs were estimated by Cox regression and adjusted for a range of variables. RESULTS ADHD increased the risk of alcohol abuse (HRfemales = 1.72 [95% CI = 1.42-2.08], HRmales = 1.57 [1.37-1.79]), cannabis abuse (HRfemales = 2.72 [2.12-3.47], HRmales = 2.24 [1.86-2.70]), and other illicit substance abuse (HRfemales = 2.05 [1.54-2.73], HRmales = 2.42 [1.98-2.96]), compared to individuals without ADHD. In the overall estimates, no gender differences were found. Among individuals with ADHD without comorbidities, females had a higher SUD risk than males, as did females with ADHD and conduct disorder (CD). Comorbid CD, depression, bipolar disorder, and schizophrenia further increased the risk of SUD in ADHD, compared to non-ADHD. Autism spectrum disorder in males with ADHD lowered the SUD risk. CONCLUSION ADHD increased the risk of all SUD outcomes. Individuals with ADHD without comorbidities were also at increased risk, and some comorbid disorders further increased the risk. Females and males with ADHD had comparable risks of SUD, although females had higher risk of some SUDs than males. Females with ADHD may be perceived as less impaired than males, but they are at equally increased risk of SUD.
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Affiliation(s)
- Cæcilie Ottosen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark, Centre for Intergrated Register-based Research at Aarhus University (CIRRAU), Aarhus, Denmark and the Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus
| | - Liselotte Petersen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark, Centre for Intergrated Register-based Research at Aarhus University (CIRRAU), Aarhus, Denmark and the Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus
| | - Janne Tidselbak Larsen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark, Centre for Intergrated Register-based Research at Aarhus University (CIRRAU), Aarhus, Denmark and the Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus
| | - Søren Dalsgaard
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark, Centre for Intergrated Register-based Research at Aarhus University (CIRRAU), Aarhus, Denmark and the Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus; Hospital of Telemark, Kragerø, Norway.
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Meyer PS, Gottlieb JD, Penn D, Mueser K, Gingerich S. Individual Resiliency Training: An Early Intervention Approach to Enhance Well-Being in People with First-Episode Psychosis. Psychiatr Ann 2015. [DOI: 10.3928/00485713-20151103-06] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Substance use disorders in schizophrenia, bipolar disorder, and depressive illness: a registry-based study. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1267-76. [PMID: 25680837 DOI: 10.1007/s00127-015-1025-2] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 02/09/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE To compare the prevalence and pattern of comorbid substance use disorders (SUD) between patients with schizophrenia, bipolar disorder, and depressive illness. METHODS Data on presence of alcohol use disorder (AUD) and non-alcohol drug use disorder (DUD) were retrieved from the Norwegian Patient Register for individuals born between 1950 and 1989 who in the period 2009-2013 were diagnosed with schizophrenia, bipolar disorder or depressive illness according to the 10th version of the WHO International Classification of Diseases. The prevalence of AUD only, DUD only, or both was compared between men and women across age and diagnostic groups. RESULTS The prevalence of SUD was 25.1 % in schizophrenia (AUD: 4.6 %, DUD: 15.6 %, AUD and DUD: 4.9 %), 20.1 % in bipolar disorder (AUD: 8.1 %, DUD: 7.6 %, AUD and DUD: 4.4 %), and 10.9 % in depressive illness (AUD: 4.4 %, DUD: 4.3 %, AUD and DUD: 2.2 %). Middle-aged men with bipolar disorder had the highest prevalence of AUD (19.1 %) and young men with schizophrenia had the highest prevalence of DUD (29.6 %). Of the specific DUDs, all but sedative use disorder were more prevalent in schizophrenia than the other groups. Cannabis and stimulant use disorder was found among 8.8 and 8.9 %, respectively, of the men with schizophrenia. CONCLUSIONS The alarmingly high prevalence of DUD among young patients with severe mental disorders should encourage preventive efforts to reduce illicit drug use in the adolescent population.
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Schiffman J, Stephan SH, Hong LE, Reeves G. School-based approaches to reducing the duration of untreated psychosis. Child Adolesc Psychiatr Clin N Am 2015; 24:335-51. [PMID: 25773328 DOI: 10.1016/j.chc.2014.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Students with emerging psychosis often experience delays in diagnosis and treatment that impact mental health and academic outcomes. School systems have tremendous potential to improve early identification and treatment of adolescent psychosis. As a community-based resource, schools can support outreach, education, and screening for adolescents with psychosis and engage identified students and their families for treatment. The concept of duration of untreated psychosis (DUP; the gap between symptom onset and treatment initiation) in adolescent psychosis and the potential role of schools in reducing DUP are reviewed. Future directions for clinical care and research needed to support school-based interventions are proposed.
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Affiliation(s)
- Jason Schiffman
- Department of Psychology, University of Maryland, 1000 Hilltop Circle, Baltimore County, Baltimore, MD 21250, USA.
| | - Sharon Hoover Stephan
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, 701 Pratt Street, Baltimore, MD 21201, USA
| | - L Elliot Hong
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, MPRC - Tawes, PO Box 21247, Baltimore, MD 21228, USA
| | - Gloria Reeves
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, 701 Pratt Street, Baltimore, MD 21201, USA
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Arranz B, Safont G, Corripio I, Ramirez N, Dueñas RM, Perez V, Alvarez E, San L. Substance Use in Patients With First-Episode Psychosis: Is Gender Relevant? J Dual Diagn 2015; 11:153-60. [PMID: 26513726 DOI: 10.1080/15504263.2015.1113761] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Only a few studies in patients with first-episode psychosis have included gender in the study hypothesis or considered this a primary study variable. The aim of this study was to explore the influence of gender in the pattern of substance use in patients with first-episode psychosis. METHODS This is a sub-analysis of a randomized open clinical trial that compared 1-year treatment retention rates of patients with first-episode psychosis randomized to haloperidol, olanzapine, quetiapine, risperidone, or ziprasidone. Our sub-analysis included 85 men and 29 women. RESULTS Substance use was relatively high among these patients and differed significantly by gender. Men were more likely to use substances overall than women (89.4% for men vs. 55.2% for women), χ(2) = 16.2, df = 1, p <.001, and were also more likely to use alcohol (χ(2) = 13, df = 1, p <.001), cannabis (χ(2) = 9.9; df = 1, p <.002), and cocaine (χ(2) = 10.3; df = 1, p <.001), compared to women. While there were no gender differences in age at first consumption of alcohol or cocaine, men were significantly younger at first consumption of cannabis (M = 16.08 years, SD = 2.1) than women (M = 18.0 years, SD = 3.8), F(1, 59) = 5, p <.02. When analyzed separately by gender, women showed no significant differences in the influence of number of substances used on age at onset of psychosis, F(3, 29) = 1.2, p =.30. However, there was a significant difference among men, with earlier onset of psychosis noted in men consuming multiple substances; F(4, 85) = 5.8, p <.0001. Regarding prediction of age at onset of psychosis, both male gender and the use of a higher number of substances significantly predicted an earlier age at onset of psychosis. CONCLUSIONS Our study provides some evidence of gender differences in the pattern of substance use in patients with first-episode psychosis, suggesting the possible need for gender-specific approaches in the interventions performed in these patients. This study is registered as #12610000954022 with the Australian New Zealand Clinical Trials Registry (www.anzctr.org.au).
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Affiliation(s)
- Belen Arranz
- a Parc Sanitari Sant Joan de Deu , Barcelona , Spain
| | - Gemma Safont
- b Hospital Mútua de Terrassa , Barcelona , Spain
| | | | | | | | | | | | - Luis San
- a Parc Sanitari Sant Joan de Deu , Barcelona , Spain
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26
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Løberg EM, Helle S, Nygård M, Berle JØ, Kroken RA, Johnsen E. The Cannabis Pathway to Non-Affective Psychosis may Reflect Less Neurobiological Vulnerability. Front Psychiatry 2014; 5:159. [PMID: 25477825 PMCID: PMC4235385 DOI: 10.3389/fpsyt.2014.00159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/24/2014] [Indexed: 12/19/2022] Open
Abstract
There is a high prevalence of cannabis use reported in non-affective psychosis. Early prospective longitudinal studies conclude that cannabis use is a risk factor for psychosis, and neurochemical studies on cannabis have suggested potential mechanisms for this effect. Recent advances in the field of neuroscience and genetics may have important implications for our understanding of this relationship. Importantly, we need to better understand the vulnerability × cannabis interaction to shed light on the mediators of cannabis as a risk factor for psychosis. Thus, the present study reviews recent literature on several variables relevant for understanding the relationship between cannabis and psychosis, including age of onset, cognition, brain functioning, family history, genetics, and neurological soft signs (NSS) in non-affective psychosis. Compared with non-using non-affective psychosis, the present review shows that there seem to be fewer stable cognitive deficits in patients with cannabis use and psychosis, in addition to fewer NSS and possibly more normalized brain functioning, indicating less neurobiological vulnerability for psychosis. There are, however, some familiar and genetic vulnerabilities present in the cannabis psychosis group, which may influence the cannabis pathway to psychosis by increasing sensitivity to cannabis. Furthermore, an earlier age of onset suggests a different pathway to psychosis in the cannabis-using patients. Two alternative vulnerability models are presented to integrate these seemingly paradoxical findings.
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Affiliation(s)
- Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Siri Helle
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Merethe Nygård
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Jan Øystein Berle
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rune A. Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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27
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Donoghue K, Doody GA, Murray RM, Jones PB, Morgan C, Dazzan P, Hart J, Mazzoncini R, Maccabe JH. Cannabis use, gender and age of onset of schizophrenia: data from the ÆSOP study. Psychiatry Res 2014; 215:528-32. [PMID: 24461684 DOI: 10.1016/j.psychres.2013.12.038] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 12/23/2013] [Accepted: 12/26/2013] [Indexed: 11/19/2022]
Abstract
An earlier age of onset of schizophrenia has been identified as a poor prognostic indicator. The current study examines the interaction effect of gender and cannabis use on age of onset of schizophrenia and schizoaffective disorder. This research forms part of a two-centre epidemiological study of first-episode psychosis and included individuals with a diagnosis of schizophrenia or schizoaffective disorder and an age of onset between age 16 and 45. Kaplan-Meier curves and Cox proportional hazards regression were used to compare the effects of cannabis use and gender on age of first symptom of schizophrenia. Akaike's information criteria were used to find the model with the best fit to the data. Cannabis users had an earlier age of first symptom than non-users. There was an interaction with gender; the gender difference in age of onset was diminished in cannabis smokers compared with non-cannabis smokers. The model including cannabis use interacting with gender was the most parsimonious model, followed by cannabis use alone. The addition of other illegal drug use did not improve the model. Cannabis use is associated with an earlier age of onset of schizophrenia, and the gender difference in age of onset is reduced among cannabis smokers.
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Affiliation(s)
- Kim Donoghue
- Addictions Department, Institute of Psychiatry, King's College London, 4 Windsor Walk, London SE5 8BB, England, UK.
| | - Gillian A Doody
- Division of Psychiatry, University of Nottingham, England, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, England, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, England, UK
| | - Craig Morgan
- Section of Social Psychiatry, Institute of Psychiatry, King's College London, England, UK
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, England, UK
| | - Jozella Hart
- Section of Social Psychiatry, Institute of Psychiatry, King's College London, England, UK
| | - Rodolfo Mazzoncini
- Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
| | - James H Maccabe
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, England, UK
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Berry K, Allott R, Emsley R, Ennion S, Barrowclough C. Perceived empowerment in people with a dual diagnosis of schizophrenia spectrum disorder and substance misuse. Soc Psychiatry Psychiatr Epidemiol 2014; 49:377-84. [PMID: 24141697 DOI: 10.1007/s00127-013-0776-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 10/04/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE The aims of the present study were to validate a measure of empowerment in a British population of people with a dual diagnosis of schizophrenia and substance misuse and assess relationships between empowerment and other key outcomes. METHOD Patients participating in a large randomised control trial for Motivational Interviewing for Drug and Alcohol misuse in Schizophrenia or psychosis (MIDAS trial) completed measures of empowerment, symptoms, global functioning and substance use at baseline, 12- and 24-month follow-ups. RESULTS A three factor model of empowerment: self-efficacy and control; power and anger; and activism provided the best fit of the data across all three time points. There was some evidence of associations between empowerment and both symptoms and global functioning, although these associations were not consistent across subscales. Changes in empowerment predicted changes in symptoms and functioning at follow-up. CONCLUSIONS Empowerment is a broadly defined construct and its meaning may differ across different populations of people with severe and enduring mental health problems. Empowerment is a key component of recovery and should be assessed in treatments in addition to more traditional outcome measures of symptoms and functioning.
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Affiliation(s)
- Katherine Berry
- School of Psychological Sciences, University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK,
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29
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Lange EH, Nesvåg R, Ringen PA, Hartberg CB, Haukvik UK, Andreassen OA, Melle I, Agartz I. One year follow-up of alcohol and illicit substance use in first-episode psychosis: does gender matter? Compr Psychiatry 2014; 55:274-82. [PMID: 24262129 DOI: 10.1016/j.comppsych.2013.08.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 07/05/2013] [Accepted: 08/04/2013] [Indexed: 11/19/2022] Open
Abstract
Longitudinal studies on first-episode psychosis (FEP) patients have shown a decrease of substance use disorders (SUDs) over the first years of illness, but there has been less focus on the gender aspect. The present study examines stability of alcohol and illicit substance use, with specific focus on gender, in a one year follow-up investigation of 154 FEP patients (91 men, 63 women) in Oslo, Norway, using criteria for DSM-IV substance use disorder diagnosis, the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT). The results show that cannabis was the most frequently used illicit substance at both times. Significantly more men (34%) than women (13%) had a current illicit SUD at baseline. At follow-up, the rate of illicit SUDs was significantly reduced in men (18%) but not in women (11%). There were no significant gender differences in the rate of current alcohol use disorders (AUD) (men 14%; women 8%) at baseline, and no significant reduction in AUD in any of the genders at follow-up. At follow-up, total AUDIT and DUDIT scores were reduced in men only. In conclusion, the high and persistent rate of SUDs, particularly of cannabis, among men and women during the first year of treatment for psychosis should be addressed in the clinical management of the patients. Female FEP patients who are also substance users may be particularly vulnerable in this regard and warrant closer attention.
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Affiliation(s)
- Elisabeth Heffermehl Lange
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Psychiatry Section, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.
| | - Ragnar Nesvåg
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Petter Andreas Ringen
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Psychiatry Section, University of Oslo, Oslo, Norway; KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Cecilie Bhandari Hartberg
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Psychiatry Section, University of Oslo, Oslo, Norway; Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Unn Kristin Haukvik
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Psychiatry Section, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ole Andreas Andreassen
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Psychiatry Section, University of Oslo, Oslo, Norway; KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Psychiatry Section, University of Oslo, Oslo, Norway; KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Agartz
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Psychiatry Section, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
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30
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Melle I, Ann Barrett E. Insight and suicidal behavior in first-episode schizophrenia. Expert Rev Neurother 2014; 12:353-9. [DOI: 10.1586/ern.11.191] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Peritogiannis V, Mantas C, Tatsioni A, Mavreas V. Rates of first episode of psychosis in a defined catchment area in Greece. Clin Pract Epidemiol Ment Health 2014; 9:251-4. [PMID: 24396392 PMCID: PMC3881103 DOI: 10.2174/1745017901309010251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/23/2013] [Accepted: 05/26/2013] [Indexed: 11/24/2022]
Abstract
This is the first Greek study presenting epidemiologic data on first-episode psychosis (FEP) patients in a defined catchment area. Data for first episode psychotic patients during a two-year period (2008 and 2009) were obtained by all the mental health providers in the area, public or private. A total of 132 FEP patients were examined in the 2-year period in the catchment area. Most of the patients (61.4%) were diagnosed and treated by private practicing psychiatrists. Statistical analysis showed no differences between the two sectors in terms of patients’ age, gender, family and social status, profession and duration of untreated psychosis (median duration 6 months). Patients who were abusing substances and had no family psychiatric history were less likely been treated in the public sector. Immigrants comprised only a small proportion of the patients, probably because they have difficulties in accessing the mental health system.
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Affiliation(s)
- Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Christos Mantas
- Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece
| | - Athina Tatsioni
- Department of Internal Medicine, University of Ioannina, Medical School, Ioannina, Greece
| | - Venetsanos Mavreas
- Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece
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Picci RL, Versino E, Oliva F, Giaretto RM, Ostacoli L, Trivelli F, Venturello S, Furlan PM. Does substance use disorder affect clinical expression in first-hospitalization patients with schizophrenia? Analysis of a prospective cohort. Psychiatry Res 2013; 210:780-6. [PMID: 24053973 DOI: 10.1016/j.psychres.2013.08.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 05/06/2013] [Accepted: 08/18/2013] [Indexed: 10/26/2022]
Abstract
Although several papers reported a wide range of negative outcomes among patients with both schizophrenia and Substance Use Disorder (SUD), only a few studies evaluated the impact of SUD on psychopathology and thus on the length of first-hospitalization. The aim of the present study was to compare clinical expression of first-episode of schizophrenia between inpatients with and without SUD, giving close attention to the length of stay. One hundred and thirty inpatients at first-episode of schizophrenia were assigned to either SUD or not SUD group depending on SUD diagnosis and were assessed through BPRS at admission, during hospitalization and at discharge. Cross-sectional and longitudinal statistical analysis were performed to investigate differences between groups and also a linear regression was used to evaluate relationship between length of stay and BPRS scores. SUD group showed more disorganization at admission, less marked improvement of symptoms (disorganization, thought disturbance, anergia), and longer hospital stay than not SUD group. Moreover BPRS total score during hospitalization was a significant positive predictor for length of stay. Taken together, these findings suggest that SUD patients have a more severe and drug-resistant expression of schizophrenia, hence, they need longer treatment to achieve the overall symptoms improvement required for discharge.
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Affiliation(s)
- Rocco Luigi Picci
- Department of Clinical and Biological Sciences, "San Luigi Gonzaga" Medical School, University of Turin, 10043 Orbassano, (TO) Turin, Italy
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Substance abuse and smoking among a Canadian cohort of first episode psychosis patients. Community Ment Health J 2013; 49:815-21. [PMID: 23775243 DOI: 10.1007/s10597-013-9634-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
Abstract
Individuals experiencing their first psychotic episode report rates of substance and tobacco use that are higher than observed in the general population. In this sample of individuals diagnosed with first episode psychosis, rural/non-rural variations in substance use and smoking behaviour were evaluated. Analyses were performed utilizing data from a sample of individuals enrolled in early intervention programs located throughout the province of Ontario. Based upon population density, two geographical regions were developed: rural and non-rural. Illicit drug use, alcohol consumption, and smoking behaviour were assessed. The total sample consisted of 152 individuals experiencing their first episode of psychosis. Of these individuals, 82 and 70 resided in rural and non-rural areas, respectively. Rural vs non-rural residence was not significantly associated with substance or tobacco use. Regardless of geographical location, early intervention programs for individuals experiencing their first psychotic episode need to incorporate interventions that address substance use.
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Weibell MA, Joa I, Bramness J, Johannessen JO, McGorry PD, ten Velden Hegelstad W, Larsen TK. Treated incidence and baseline characteristics of substance induced psychosis in a Norwegian catchment area. BMC Psychiatry 2013; 13:319. [PMID: 24279887 PMCID: PMC4222718 DOI: 10.1186/1471-244x-13-319] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 11/18/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Substance misuse is a well-recognized co-morbidity to psychosis and has been linked to poor prognostic outcomes in patients. Researchers have yet to investigate the difference in rates and characteristics between first-episode Substance Induced Psychosis (SIP) and primary psychosis. We aimed at comparing patients with SIP to primary psychosis patients with or without substance misuse at baseline. METHODS Thirty SIP patients, 45 primary psychosis patients with substance misuse (PS) and 66 primary psychosis patients without substance misuse (PNS) in a well-defined Norwegian catchment area were included from 2007-2011. Assessments included symptom levels (PANSS), diagnostic interviews (SCID), premorbid function scale (PAS) and global functioning (GAF f/s). RESULTS Treated incidence for SIP was found to be 6.5/100 000 persons per year, 9.7/100 000 persons per year for PS and 24.1/100 000 persons per year for PNS (15-65 yrs). Patients who had substance misuse (PS and SIP) were more likely to be male. Duration of Untreated Psychosis (DUP) was significantly shorter in the SIP group (5.0 wks., p = 0.003) and these had more positive symptoms on the PANSS (p = 0.049). SIP patients also did poorer on early youth academic levels on the PAS. CONCLUSIONS Yearly treated incidence of SIP is 6.5/100 000 persons per year in a Norwegian catchment area. SIP patients have short DUPs, are more likely to be male, have more positive symptoms at baseline and poorer premorbid academic scores in early adolescence. Follow-up will evaluate stability of diagnosis and characteristics.
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Affiliation(s)
- Melissa A Weibell
- Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Armauer Hansensvei, 4014 Stavanger, Norway.
| | - Inge Joa
- Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Armauer Hansensvei, 4014 Stavanger, Norway,Faculty of Social Sciences, Institute of Health, University of Stavanger, Kjell Arholmsgt 41, 4021 Stavanger, Norway
| | - Jørgen Bramness
- Norwegian Centre for Addiction Research, University of Oslo, P.O box 1039, 0315 Oslo, Norway,Norwegian Institute of Public Health, P.O. box 4404, 0403 Oslo, Norway
| | - Jan Olav Johannessen
- Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Armauer Hansensvei, 4014 Stavanger, Norway,Faculty of Social Sciences, Institute of Health, University of Stavanger, Kjell Arholmsgt 41, 4021 Stavanger, Norway
| | - Patrick D McGorry
- ORYGEN Research Centre, University of Melbourne, Locked bag 10, Parkville, Melbourne, VIC 3052, Australia
| | - Wenche ten Velden Hegelstad
- Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Armauer Hansensvei, 4014 Stavanger, Norway
| | - Tor Ketil Larsen
- Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Armauer Hansensvei, 4014 Stavanger, Norway
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Batalla A, Garcia-Rizo C, Castellví P, Fernandez-Egea E, Yücel M, Parellada E, Kirkpatrick B, Martin-Santos R, Bernardo M. Screening for substance use disorders in first-episode psychosis: implications for readmission. Schizophr Res 2013; 146:125-31. [PMID: 23517662 PMCID: PMC4390132 DOI: 10.1016/j.schres.2013.02.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/05/2013] [Accepted: 02/24/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Screening of substance use may prove useful to prevent readmission after the first episode of psychosis. The aim of the present study was to evaluate the influence of drug use on readmission risk in a first-episode psychosis sample, and to determine whether the cannabis/cocaine subscale of the Dartmouth Assessment of Lifestyle Inventory (DALI) is a better predictive instrument than urinary analysis. METHODS After admission, first-episode psychotic patients were interviewed for substance use and assessed with the DALI scale. They also underwent blood and urine sampling. Time to readmission was studied as a dependent outcome. The Kaplan-Meier estimator was applied to estimate the survival curves for bivariate analysis. The Cox proportional hazards model for multivariate analysis was assessed in order to control for potential confounders. ROC curve and validity parameters were used to assess validity to detect readmission. RESULTS Fifty-eight patients were included. The DALI cannabis/cocaine subscale and urinalysis were associated with increased readmission risk in survival curves, mainly the first five years of follow-up. After controlling for potential confounding variables for readmission, only the DALI cannabis/cocaine subscale remained as a significant risk factor. In terms of validity, the DALI cannabis/cocaine subscale was more sensitive than urinalysis. Alcohol assessments were not related to readmission. CONCLUSIONS The findings demonstrated that a quick screening self-report scale for cannabis/cocaine use disorders is superior to urinary analysis for predicting readmission. Future research should consider longitudinal assessments of brief validated screening tests in order to evaluate their benefits in preventing early readmission in first-episode psychosis.
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Affiliation(s)
- Albert Batalla
- Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, Centro de Investigación Biomédica en Red en Salud Mental, 08036 Barcelona, Spain.
| | - Clemente Garcia-Rizo
- Schizophrenia Program, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, IDIBAPS, CIBERSAM, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Pere Castellví
- Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain, Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), and CIBER Epidemiología y Salud Pública (CIBERESP), Doctor Aiguader 88, 08033, Barcelona, Spain, CIBER Epidemiología y Salud Pública (CIBERESP), Doctor Aiguader 88, 08033, Barcelona, Spain
| | - Emili Fernandez-Egea
- Good Outcome Schizophrenia Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, UK, Department of Psychiatry and Behavioural and Clinical Neuroscience Institute (BCNI), University of Cambridge, Forvie Site, Cambridge CB2 0SZ, UK
| | - Murat Yücel
- School of Psychology and Psychiatry, Monash University, Clayton Campus, Melbourne, Victoria 3800, Australia
| | - Eduard Parellada
- Schizophrenia Program, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, IDIBAPS, CIBERSAM, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Brian Kirkpatrick
- Department of Psychiatry, Texas A&M University College of Medicine, Scott & White Healthcare, 1901 South Veterans Memorial Drive, 76504, Temple, TX, United States
| | - Rocío Martin-Santos
- Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain, Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Miguel Bernardo
- Schizophrenia Program, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, IDIBAPS, CIBERSAM, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
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Auther AM, McLaughlin D, Carrión RE, Nagachandran P, Correll CU, Cornblatt BA. Prospective study of cannabis use in adolescents at clinical high risk for psychosis: impact on conversion to psychosis and functional outcome. Psychol Med 2012; 42:2485-97. [PMID: 22716931 PMCID: PMC3459073 DOI: 10.1017/s0033291712000803] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Clinical and epidemiological studies suggest an association between cannabis use and psychosis but this relationship remains controversial. METHOD Clinical high-risk (CHR) subjects (age 12-22 years) with attenuated positive symptoms of psychosis (CHR+, n=101) were compared to healthy controls (HC, n=59) on rates of substance use, including cannabis. CHR+ subjects with and without lifetime cannabis use (and abuse) were compared on prodromal symptoms and social/role functioning at baseline. Participants were followed an average of 2.97 years to determine psychosis conversion status and functional outcome. RESULTS At baseline, CHR+ subjects had significantly higher rates of lifetime cannabis use than HC. CHR+ lifetime cannabis users (n=35) were older (p=0.015, trend), more likely to be Caucasian (p=0.002), less socially anhedonic (p<0.001) and had higher Global Functioning: Social (GF:Social) scores (p<0.001) than non-users (n=61). CHR+ cannabis users continued to have higher social functioning than non-users at follow-up (p<0.001) but showed no differences in role functioning. A small sample of CHR+ cannabis abusers (n=10) showed similar results in that abusers were older (p=0.008), less socially anhedonic (p=0.017, trend) and had higher baseline GF:Social scores (p=0.006) than non-abusers. Logistic regression analyses revealed that conversion to psychosis in CHR+ subjects (n=15) was not related to lifetime cannabis use or abuse. CONCLUSIONS The current data do not indicate that low to moderate lifetime cannabis use is a major contributor to psychosis or poor social and role functioning in clinical high-risk youth with attenuated positive symptoms of psychosis.
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Affiliation(s)
- A M Auther
- The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY 11004, USA.
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Cascio MT, Cella M, Preti A, Meneghelli A, Cocchi A. Gender and duration of untreated psychosis: a systematic review and meta-analysis. Early Interv Psychiatry 2012; 6:115-27. [PMID: 22380467 DOI: 10.1111/j.1751-7893.2012.00351.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM Duration of untreated psychosis (DUP) can influence the prognosis of schizophrenia. Previous studies have suggested that gender may influence the length of DUP. This study reports the result of the first systematic literature review and meta-analysis on the role of gender in influencing DUP in first-episode psychosis. METHOD Systematic literature search in PubMed/Medline and Ovid/PsychINFO. Twenty-seven studies presenting data on 4721 patients diagnosed with psychosis at their first episode (2834 males and 1887 females) were included in the analysis. RESULTS Samples had a higher proportion of males: odds ratio = 2.5 (95% confidence interval: 1.8-3.3). Mean age at first contact was 25.4 for males and 27.5 for females. Patients from non-Western countries were older at first contact than patients from Western countries. Average DUP in schizophrenia was 64 weeks and did not differ between genders but was shorter in Western compared with non-Western countries. CONCLUSION Earlier age at first contact and larger incidence in males support the existence of specific gender differences in first-episode psychosis; however, these are not associated with DUP length.
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Affiliation(s)
- Maria Teresa Cascio
- Programma 2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
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Langås AM, Malt UF, Opjordsmoen S. Substance use disorders and comorbid mental disorders in first-time admitted patients from a catchment area. Eur Addict Res 2012; 18:16-25. [PMID: 22042311 DOI: 10.1159/000332234] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 08/27/2011] [Indexed: 11/19/2022]
Abstract
AIM To describe lifetime mental disorders in patients with substance use disorders (SUD) admitted for the first time to specialized treatment for psychiatric or addiction problems from a catchment area. METHODS Special efforts were made to include all eligible patients and secure completion of thorough assessments, including the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) and the Structured Clinical Interview for DSM-IV axis II personality disorders (SCID-II). The strength of this study lies in its rigorous patient recruitment and assessment methods. RESULTS Of 61 patients, 53 had alcohol use disorder (AUD). Of these, 28 had AUD only, and 25 had an additional drug use disorder (DUD). 89% had comorbid axis I (85%) or axis II (46%) disorders. The most prevalent axis I disorders were major depressive disorder (71%), social phobia (31%) and posttraumatic stress disorder (18%). Among those with comorbid psychiatric disorders (n = 54), 25 (41% of the sample) had disorders considered to be independent of their substance use only, 4 patients (7%) had substance-induced disorders only, and 23 patients (38%) had both independent and substance-induced disorders. CONCLUSION Comorbid mental disorders were remarkably prevalent in these SUD patients who were admitted for the first time.
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Abstract
TOPIC This critical review of the literature integrates findings across varied literatures and identifies areas for continued study on the prevalence, correlates, and impact of substance use (alcohol and illicit drugs) on social role functioning among emerging adults with serious mental health conditions. PURPOSE This population is of interest because of high comorbidity rates between substance use and serious mental health conditions and the added difficulties posed by their co-occurrence during the transition to adulthood. This critical review presents the epidemiology of substance use in emerging adults with serious mental health conditions compared to emerging adults without these conditions, as well as what is known about predictors and consequences of substance use in this population. SOURCES USED PsychINFO and PubMed along with relevant published literature. RESULTS This review summarizes what is known about the impact of these co-occurring problems on the transition of emerging adults from school and training environments to adult work roles. Though this group presents with unique challenges, few programs have been developed to address their specific needs. This paper synthesizes what is known empirically about approaches with this population, discussing those that might be useful for emerging adults with comorbid serious mental health conditions and substance use problems, particularly in supporting their educational and vocational development. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Emerging adults with co-occurring serious mental health conditions and substance use problems are underserved by current mental health systems. Recommendations focus on how to promote mental health and social role functioning through comprehensive intervention programs that provide continuity of care through the transition to adulthood.
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Gender differences in remission and recovery of schizophrenic and schizoaffective patients: preliminary results of a prospective cohort study. SCHIZOPHRENIA RESEARCH AND TREATMENT 2012; 2012:576369. [PMID: 22966440 PMCID: PMC3420715 DOI: 10.1155/2012/576369] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 11/18/2011] [Indexed: 11/17/2022]
Abstract
The aim of the paper was to evaluate rates of clinical remission and recovery according to gender in a cohort of chronic outpatients attending a university community mental health center who had been diagnosed with schizophrenia and schizoaffective disorder according to DSM-IV-TR. A sample of 100 consecutive outpatients (70 males and 30 females) underwent comprehensive psychiatric evaluation using the Structured Clinical Interview for Diagnosis of Axis I and II DSM-IV (SCID-I and SCID-II, Version R) and an assessment of psychopathology, social functioning, clinical severity, subjective wellbeing, and quality of life, respectively by means of PANSS (Positive and Negative Syndrome Scale), PSP (Personal and Social Performance), CGI-SCH (Clinical Global Impression-Schizophrenia scale), SWN-S (Subjective Well-being under Neuroleptics-scale), and WHOQOL (WHO Quality of Life). Rates of clinical remission and recovery according to different criteria were calculated by gender. Higher rates of clinical remission and recovery were generally observed in females than males, a result consistent with literature data. Overall findings from the paper support the hypothesis of a better outcome of the disorders in women, even in the very long term.
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Opsal A, Clausen T, Kristensen O, Elvik I, Joa I, Larsen TK. Involuntary hospitalization of first-episode psychosis with substance abuse during a 2-year follow-up. Acta Psychiatr Scand 2011; 124:198-204. [PMID: 21418161 DOI: 10.1111/j.1600-0447.2011.01700.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether substance abuse (alcohol or illegal drugs) in patients with first-episode psychosis (FEP) influenced treatment outcomes such as involuntary hospitalization during follow-up. METHOD First-episode psychosis patients (n = 103) with consecutive admissions to a comprehensive early psychosis program were included and followed for 2 years. Assessment measures were the Positive and Negative Syndrome Scale, Global Assessment of Functioning, and the Clinician Rating Scale (for substance abuse). RESULTS Twenty-four per cent of patients abused either alcohol or drugs at baseline. The dropout rate at 2 years was the same for substance abusers as for non-abusers. Substance use was not reduced over the 2-year period. At 2-year follow-up, 72% of substance abusers and 31% of non-abusers had experienced at least one occasion of involuntary hospitalization. Patients with substance abuse had significantly higher risk for involuntary hospitalization during follow-up (OR 5.2). CONCLUSION To adequately treat patients with FEP, clinicians must emphasize treatment of the substance abuse disorder, as well as the psychotic illness. Patients with defined comorbid substance use disorders and FEP are likely to have poorer treatment response than those with psychosis alone.
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Affiliation(s)
- A Opsal
- Addiction Unit, Sørlandet Hospital, Kristiansand, Norway.
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Tandberg M, Ueland T, Sundet K, Haahr U, Joa I, Johannessen JO, Larsen TK, Opjordsmoen S, Rund BR, Røssberg JI, Simonsen E, Vaglum P, Melle I, Friis S, McGlashan T. Neurocognition and occupational functioning in patients with first-episode psychosis: a 2-year follow-up study. Psychiatry Res 2011; 188:334-42. [PMID: 21575993 DOI: 10.1016/j.psychres.2011.04.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 04/18/2011] [Accepted: 04/20/2011] [Indexed: 11/19/2022]
Abstract
Neurocognitive deficits are a core feature of schizophrenia that is associated with poor occupational functioning. Few studies have investigated this relationship in patients with first-episode psychosis. The current study examined the characteristics of employed and unemployed patients with first-episode psychosis at baseline and 2-year follow-up, and the predictive value of neurocognition on employment status. One-hundred and twenty-two first-episode psychosis patients were assessed with clinical and neurocognitive measures at baseline. Occupational status was assessed at baseline and 2-year follow-up. Those unemployed at baseline were rated lower on global functioning and were more likely to have a schizophrenia spectrum disorder. Total employment rates were 41% at baseline and 38% at 2-year follow-up. Four employment paths emerged at follow-up, defined as persistently employed, becoming unemployed, entering employment and persistently unemployed. The persistently employed group had the highest global functioning score. For the total sample, baseline employment status and sustained attention predicted employment status at follow-up. For those employed at baseline, better sustained attention, higher global functioning, more positive symptoms and less alcohol use predicted persistent employment at follow-up. For those unemployed at baseline, none of the variables predicted change in employment status. Implications of these results are discussed.
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Affiliation(s)
- Marte Tandberg
- Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway.
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Casadio P, Fernandes C, Murray RM, Di Forti M. Cannabis use in young people: the risk for schizophrenia. Neurosci Biobehav Rev 2011; 35:1779-87. [PMID: 21530584 DOI: 10.1016/j.neubiorev.2011.04.007] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 03/09/2011] [Accepted: 04/06/2011] [Indexed: 12/13/2022]
Abstract
Cannabis is one of the most commonly used illicit drugs, and despite the widely held belief that it is a safe drug, its long-term use has potentially harmful consequences. To date, the research on the impact of its use has largely been epidemiological in nature and has consistently found that cannabis use is associated with schizophrenia outcomes later in life, even after controlling for several confounding factors. While the majority of users can continue their use without adverse effects, it is clear from studies of psychosis that some individuals are more vulnerable to its effects than others. In addiction, evidence from both epidemiological and animal studies indicates that cannabis use during adolescence carries particular risk. Further studies are warranted given the increase in the concentration of the main active ingredient (Δ(9)-tetrahydrocannabinol) in street preparations of cannabis and a decreasing age of first-time exposure to cannabis.
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Affiliation(s)
- Paola Casadio
- Mental Health Department, AUSL Ravenna, Via Baliatico 3, Faenza (RA), Italy.
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Pre-illness cannabis use and the early course of nonaffective psychotic disorders: associations with premorbid functioning, the prodrome, and mode of onset of psychosis. Schizophr Res 2011; 126:71-6. [PMID: 21036542 PMCID: PMC3052993 DOI: 10.1016/j.schres.2010.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 09/29/2010] [Accepted: 10/04/2010] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Limited research indicates that pre-illness cannabis use may result in an earlier age at onset of psychosis, though little is known about the influence of prior cannabis use on the premorbid and prodromal phases. This study examined the effects of prior or concurrent cannabis (as well as nicotine and alcohol) use on: (1) early adolescent (12-15 years) premorbid functioning, (2) late adolescent (16-18 years) premorbid functioning, (3) two features of the prodrome, and (4) mode of onset of psychosis. METHODS Participants included 109 well-characterized first-episode patients hospitalized in public-sector settings. Assessments included ages at initiation of first, weekly, and daily use of substances, the Premorbid Adjustment Scale, the Symptom Onset in Schizophrenia inventory, and a consensus-based best estimate of mode of onset. RESULTS Participants having used cannabis at ≤15 years had better early adolescence social functioning than those who had not used cannabis (p=0.02). Conversely, those who had used cannabis at ≤18 years had poorer late adolescence academic functioning (p<0.001). Participants having used cannabis before onset of psychotic symptoms did not differ from those who had not in terms of having had an identifiable prodrome or the number of prodromal symptoms experienced. Whereas 42% of those having used cannabis daily had an acute mode of onset of psychosis, only 20% of those without prior daily cannabis use had an acute onset (p=0.04). CONCLUSIONS Findings suggest that cannabis use is associated with premorbid social and academic functioning and mode of onset. Further research is warranted to elucidate the complex associations between cannabis use and diverse early-course features.
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Langås AM, Malt UF, Opjordsmoen S. Comorbid mental disorders in substance users from a single catchment area--a clinical study. BMC Psychiatry 2011; 11:25. [PMID: 21314980 PMCID: PMC3042931 DOI: 10.1186/1471-244x-11-25] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 02/12/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The optimal treatment of patients with substance use disorders (SUDs) requires an awareness of their comorbid mental disorders and vice versa. The prevalence of comorbidity in first-time-admitted SUD patients has been insufficiently studied. Diagnosing comorbidity in substance users is complicated by symptom overlap, symptom fluctuations, and the limitations of the assessment methods. The aim of this study was to diagnose all mental disorders in substance users living in a single catchment area, without any history of treatment for addiction or psychiatric disorders, admitted consecutively to the specialist health services. The prevalence of substance-induced versus substance-independent disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), in SUD patients will be described. METHODS First-time consecutively admitted patients from a single catchment area, aged 16 years or older, admitted to addiction clinics or departments of psychiatry as outpatients or inpatients will be screened for substance-related problems using the Alcohol Use Disorder Identification Test and the Drug Use Disorder Identification Test. All patients with scores above the cutoff value will be asked to participate in the study. The patients included will be diagnosed for SUD and other axis I disorders by a psychiatrist using the Psychiatric Research Interview for Substance and Mental Disorders. This interview was designed for the diagnosis of primary and substance-induced disorders in substance users. Personality disorders will be assessed according to the Structured Clinical Interview for DSM-IV axis II disorders. The Symptom Checklist-90-Revised, the Inventory of Depressive Symptoms, the Montgomery Asberg Depression Rating Scale, the Young Mania Rating Scale, and the Angst Hypomania Check List will be used for additional diagnostic assessments. The sociodemographic data will be recorded with the Stanley Foundation's Network Entry Questionnaire. Biochemical assessments will reveal somatic diseases that may contribute to the patient's symptoms. DISCUSSION This study is unique because the material represents a complete sample of first-time-admitted treatment seekers with SUD from a single catchment area. Earlier studies have not focused on first-time-admitted patients, so chronically ill patients, may have been overrepresented in those samples. This study will contribute new knowledge about mental disorders in first-time-admitted SUD patients.
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Affiliation(s)
| | - Ulrik F Malt
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway,Oslo University Hospital, Oslo, Norway,Norwegian Research Network on Mood Disorders (NORMOOD), Oslo, Norway
| | - Stein Opjordsmoen
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway,Oslo University Hospital, Oslo, Norway
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The association between substance misuse and first-episode psychosis in a defined UK geographical area during the 1990s. Soc Psychiatry Psychiatr Epidemiol 2011; 46:137-42. [PMID: 20043146 DOI: 10.1007/s00127-009-0175-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 12/09/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to examine the prevalence of all substance use disorders (SUD) and cannabis-specific SUDs reported in two first-episode epidemiological studies, conducted in the same catchment area, 5 years apart. METHODS The prevalence of schizophrenia in Nottingham and Aetiology and Ethnicity of Schizophrenia and Other Psychoses studies included all people with a first-episode of psychosis between 1992 and 1994 and 1997 and 1999, respectively. Those individuals with a comorbid diagnosis of a SUD (ICD-10 harmful use or dependence) were identified. RESULTS An upward (but not statistically significant) trend in all SUDs was found for the first-episode study population as a whole, between the two cohorts (11.9-18.2%). When analysed by age, a significant increase in cannabis-specific SUDs was observed for all first-episode cases aged 16-29 between cohorts (3.2-10.6%). When analysed by age and gender, a significant increase in all SUDs was apparent for female first-episode patients aged 16-29 between cohorts (6.1-24.2%), this same increase was not seen in male patients. CONCLUSIONS Illegal drug misuse is common in patients with a first-episode of psychosis. However, most concerning is that when both age and gender are considered, females with a first-episode of psychosis aged 16-29 show a highly significant rise in the prevalence of all SUDs over the 1990s. More recent drug use data from England and Wales shows that the prevalence of drug use in the 21st century is declining; further epidemiological studies are required to determine whether this is also the case in young female first-episode psychosis populations.
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Abstract
OBJECTIVE People experiencing a first episode of psychosis often have co-occurring substance use, which increases risk of prolonged psychosis and impairs recovery. This article examines the prevalence of substance use in people with first-episode psychosis. METHODS The authors searched MEDLINE and other databases for articles published between 1990 and 2009 that described current or lifetime prevalence of substance use, misuse, abuse, or dependence in individuals with first-episode psychosis. RESULTS Forty-four unique studies provided information. More than 25% of individuals with first-episode psychosis in reviewed studies indicated current or lifetime alcohol use, lifetime alcohol abuse/dependence, current or lifetime cannabis use, or lifetime cannabis abuse or dependence. For all substances, lifetime prevalence of abuse/dependence was higher than current abuse/dependence. CONCLUSIONS Despite variation in assessment methods, findings were generally consistent. Individuals with first-episode psychosis have lower current substance prevalence than lifetime prevalence, suggesting cessation of some substance use prior to seeking treatment for psychosis.
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Affiliation(s)
- Jennifer P Wisdom
- a Columbia University and New York State Psychiatric Institute , New York , New York , USA
| | - Jennifer I Manuel
- a Columbia University and New York State Psychiatric Institute , New York , New York , USA
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Abstract
There is now compelling evidence that cannabis consumption might precipitate psychosis onset. The objective of the present study was to assess the role of individual sensitivity to the psychotogenic effect of cannabis in male patients with schizophrenia. The lifetime diagnosis, disease and substance-use history were determined using a standardized interview in 190 patients with schizophrenia. Of patients with lifetime cannabis use (n=121), 44 were characterized as Cannabis-sensitive (CS) patients if the onset of psychotic symptoms occurred within 1 month following the initiation of cannabis consumption, or following a marked rise of cannabis consumption, or marked aggravation of psychotic symptoms each time the subject used cannabis. Age at onset of psychosis was not different in patients with lifetime cannabis use compared to non-users. By contrast, the first psychotic episode occurred 2.6 yr earlier in CS compared to Non-cannabis-sensitive (NCS) patients (p=0.006). Moreover, a specific excess of family history of psychotic disorder was found in CS patients, but not of any other psychiatric disorder, as well as an earlier age at exposure to cannabis (16.7+/-2.5 yr, p=0.03). Sensitivity to psychotogenic effects of cannabis in schizophrenia patients could be related to both genetic vulnerability to schizophrenia and the influence of cannabis on brain maturation and could modulate the influence of cannabis on the onset of schizophrenia.
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Barrett EA, Sundet K, Faerden A, Nesvåg R, Agartz I, Fosse R, Mork E, Steen NE, Andreassen OA, Melle I. Suicidality before and in the early phases of first episode psychosis. Schizophr Res 2010; 119:11-7. [PMID: 20399077 DOI: 10.1016/j.schres.2010.03.022] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 03/10/2010] [Accepted: 03/14/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The suicide risk in psychotic disorders is highest in the early phases of illness. Studies have typically focused on suicidality from treatment start rather than actual onset of psychosis. This study explored the prevalence and characteristics of suicidality in patients with a first episode of psychosis (FEP) in two time intervals: 1) prior to study entry and 2) explicitly in the period of untreated psychosis. METHOD One hundred seventy FEP-patients were interviewed as soon as possible after treatment start. The interview included assessments of diagnoses, suicidality, symptoms, substance use, and premorbid functioning. RESULTS Nearly 26% of the patients attempted suicide prior to study entry and 14% made suicide attempts during the period of untreated psychosis. Of the patients who had been suicidal (i.e. experienced suicidal ideation or attempts), 70% were suicidal during the period of untreated psychosis. Suicide attempts prior to study entry were associated with female gender, more depressive episodes, younger age at psychosis onset, and history of alcohol disorder. Suicide attempts during untreated psychosis were also associated with more depressive episodes and younger age at illness onset, in addition to drug use the last six months and longer duration of untreated psychosis (DUP). CONCLUSION The prevalence of suicidality before and in the early phases of FEP is high, especially during untreated psychosis. As prolonged DUP is associated with suicide attempts during the period of untreated psychosis, reducing the DUP could have the effect of reducing the prevalence of suicide attempts in patients with FEP.
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