Substance use and the course of early psychosis: a 2-year follow-up of first-admitted subjects

Abstract

Persistent substance misuse after a first admission for psychosis has a deleterious impact on clinical outcome. Early identification and treatment of substance use is essential in the care of subjects with incipient psychosis.

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

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

Stimulant use disorders and psychosis: prevalence, correlates and impacts

“…Substance use is associated with earlier onset of psychosis (Foti et al, 2010;Large et al, 2011;Compton et al, 2009), and greater severity of positive psychotic symptoms both in early psychosis (Wade et al, 2007;González-Pinto et al, 2011;Sorbara et al, 2003;Grech et al, 2005) and in chronic psychotic disorders (Foti et al, 2010;van Os et al, 2002). People with psychosis who also use substances are less likely to continue their medication (van Rossum et al, 2009;Faridi et al, 2012;Wade et al, 2007) and less likely to remain engaged with follow-up care (Miller et al, 2009;Stowkowy et al, 2012).…”

“…People with psychosis who also use substances are less likely to continue their medication (van Rossum et al, 2009;Faridi et al, 2012;Wade et al, 2007) and less likely to remain engaged with follow-up care (Miller et al, 2009;Stowkowy et al, 2012). They are more likely to experience relapse or readmission (Hides et al, 2006;Sorbara et al, 2003;Wade et al, 2006a;Strakowski et al, 2007;Linszen et al, 1994) and involuntary hospitalisation (Opsal et al, 2011). They are more likely to have a continuous course of illness (Bertelsen et al, 2009) with lower rates of remission and recovery (Lambert et al, 2005;Petersen et al, 2008) and reduced function in social and other domains (Chouljian et al, 1995;Wade et al, 2007;González-Pinto et al, 2011;Menezes et al, 2009;Faber et al, 2012).…”

“…Substances may trigger recurrence of symptoms and relapse of illness (González-Pinto et al, 2011;Wade et al, 2006a;Wade et al, 2007;Sorbara et al, 2003;Bertelsen et al, 2009;Malla et al, 2008) and therefore may increase the likelihood of progression towards enduring psychoses such as schizophrenia. However, findings on this issue are conflicting; comorbid substance use in brief or affective psychoses has been associated with reduced (Schwartz et al, 2000;Bromet et al, 2011), increased (Whitty et al, 2005), or unchanged (Naz et al, 2003) likelihood of diagnostic shift to schizophrenia.…”

“…This provided a population-based sample with sufficient power to examine diagnostic stability in brief psychoses (including brief, atypical and drug-induced psychoses) and affective psychoses (bipolar disorder and psychotic depression), and to examine the effects of cannabis and stimulant comorbidity separately and in combination. We focused on substance problems occurring during the follow up period rather than at the first (index) admission, because baseline substance problems have been shown to have a more limited effect on outcome in psychosis than ongoing substance use (González-Pinto et al, 2011;Sorbara et al, 2003;Wade et al, 2006a).…”