Correlates of substance use in a large naturalistic cohort of young people with early and emerging psychosis

Abstract

Background Substance use remains a barrier to recovery for young people accessing early intervention services for psychosis. While correlates of use have been explored in populations experiencing a first episode of psychosis (FEP), sample sizes have been small and less research assesses cohorts at ultrahigh risk of psychosis (UHR). Methods This study uses data from a naturalistic cohort including UHR and FEP participants (N = 1252) to elucidate clinical correlates of use in the past 3 months of any illicit substance, amphetamine-type stimulants (ATS), cannabis, and tobacco. Moreover, network analysis based on use of these substances and additionally alcohol, cocaine, hallucinogens, sedatives, inhalants, and opioids was completed. Results Young people with FEP used substances at significantly higher rates than those at UHR. High concurrence of use was seen between substances. In the FEP group, participants who had used any illicit substance, ATS, and/or tobacco had increased positive symptoms and decreased negative symptoms. Young people with FEP who used cannabis had increased positive symptoms. In the UHR group, participants who had used any illicit substance, ATS, and/or cannabis in the past 3 months showed decreased negative symptoms compared to those who had not. Conclusion A distinct clinical picture of more florid positive symptoms and alleviated negative symptoms seen in those who use substances in the FEP group appears muted in the UHR cohort. Treating young people at UHR in early intervention services represents the earliest opportunity to address substance use early to improve outcomes.

Contingency Management for Dually Diagnosed Inpatients with Psychosis

“…Studies report that about 40 to 50% of patients with a psychotic disorder have a co-occurring SUD [1,2]. These patients have been shown to experience higher levels of psychopathology, especially positive symptoms, experience higher relapse and hospitalization rates, report lower quality of life, display greater disability, and have a younger age at death and higher suicide rates than patients with psychosis who do not experience substance abuse [1,[3][4][5][6][7][8][9][10][11]. Continuing substance use seems to be a determining risk factor in this poor outcome.…”