Substance Use Disorder and the Early Course of Illness in Schizophrenia and Affective Psychosis

Abstract

The relationship between a history of substance use disorder and the early course of psychotic illness was examined in 96 subjects with schizophrenia and 106 subjects with affective psychosis followed in the Suffolk County Mental Health Project, a longitudinal study of first-admission psychosis. Subjects received a structured diagnostic interview and clinical ratings at baseline assessment and again 6 months later. The 6-month assessment included information about treatment received during the interval. A lifetime history of substance use disorder was associated with worse clinical functioning at 6 months for schizophrenia subjects, but not for those with affective psychosis. There were no significant associations of substance use disorder with type of treatment during the interval or with self-reported compliance with medication. Schizophrenia subjects were more likely than subjects with affective psychosis to report cannabis use during the interval and to meet criteria for cannabis use disorder.

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

“…Kovasznay and colleagues (7), from the Suffolk County (New York) Mental Health Project, followed first-episode clients diagnosed as having schizophrenia or affective psychosis disorders. Six months after the baseline assessment, clients with schizophrenia or affective psychosis and a history of substance use disorders (N=84, 42%) were more likely to use cannabis (N=16, 19%) and to do so at least weekly (N=7, 8%) compared with clients without a history of substance use disorders.…”

“…The proportions are similar for alcohol use disorders (7–9,13,14). Smaller but significant proportions have use disorders related to cocaine, amphetamines, barbiturates, and other drugs (7,8,11,15,16). Overall, approximately half of all clients with first episodes of psychosis present for treatment with a current substance use disorder.…”

“…The emerging literature on first-episode psychosis highlights the high prevalence and adverse consequences of substance use, misuse, or disorder (4–8). Approximately one-half of first-episode clients have a history of cannabis abuse or dependence and one-third have a current cannabis use disorder (7–12). The proportions are similar for alcohol use disorders (7–9,13,14).…”

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

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