Substance use in a population-based clinic sample of people with first-episode psychosis

Department of Psychiatry, Box 189, University of Cambridge, UK.
The British Journal of Psychiatry (Impact Factor: 7.34). 07/2007; 190:515-20. DOI: 10.1192/bjp.bp.106.024448
Source: PubMed

ABSTRACT Substance use is implicated in the cause and course of psychosis.
To characterise substance and alcohol use in an epidemiologically representative treatment sample of people experiencing a first psychotic episode in south Cambridgeshire.
Current and lifetime substance use was recorded for 123 consecutive referrals to a specialist early intervention service. Substance use was compared with general population prevalence estimates from the British Crime Survey.
Substance use among people with first-episode psychosis was twice that of the general population and was more common in men than women. Cannabis abuse was reported in 51% of patients (n=62) and alcohol abuse in 43% (n=53). More than half (n=68, 55%) had used Class A drugs, and 38% (n=43) reported polysubstance abuse. Age at first use of cannabis, cocaine, ecstasy and amphetamine was significantly associated with age at first psychotic symptom.
Substance misuse is present in the majority of people with first-episode psychosis and has major implications for management. The association between age at first substance use and first psychotic symptoms has public health implications.

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    • "ORIGINAL ARTICLE hallucinogens, opioids, sedatives, stimulants, amphetamines , ecstasy and solvents was either negligible or absent . Cannabis and tobacco use was reportedly higher than in healthy controls (Auther et al. 2012), with similar rates observed amongst those experiencing a first episode of psychosis (Addington & Addington, 2007; Barnett et al. 2007; Cooper et al. 2012). Interestingly, only two of the CHR studies reported a relationship between substance use and transition to psychosis (Kristensen & Cadenhead, 2007; Cannon et al. 2008) whereas others reported no significant relationships between use severity and later transition to psychosis (Phillips et al. 2002; Ruhrmann et al. 2010; Thompson et al. 2011; Auther et al. 2012). "
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    ABSTRACT: A series of research reports has indicated that the use of substances such as cannabis, alcohol and tobacco are higher in youth at clinical high risk (CHR) of developing psychosis than in controls. Little is known about the longitudinal trajectory of substance use, and findings on the relationship between substance use and later transition to psychosis in CHR individuals are mixed. At baseline and 6- and 12-month follow-ups, 735 CHR and 278 control participants completed the Alcohol and Drug Use Scale and a cannabis use questionnaire. The longitudinal trajectory of substance use was evaluated with linear mixed models. CHR participants endorsed significantly higher cannabis and tobacco use severity, and lower alcohol use severity, at baseline and over a 1-year period compared with controls. CHR youth had higher lifetime prevalence and frequency of cannabis, and were significantly younger upon first use, and were more likely to use alone and during the day. Baseline substance use did not differentiate participants who later transitioned to psychosis (n = 90) from those who did not transition (n = 272). Controls had lower tobacco use than CHR participants with a prodromal progression clinical outcome and lower cannabis use than those with a psychotic clinical outcome at the 2-year assessment. In CHR individuals cannabis and tobacco use is higher than in controls and this pattern persists across 1 year. Evaluation of clinical outcome may provide additional information on the longitudinal impact of substance use that cannot be detected through evaluation of transition/non-transition to psychosis alone.
    Psychological Medicine 03/2015; 45(11):1-10. DOI:10.1017/S0033291715000227 · 5.43 Impact Factor
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    • "Moreover , substance abuse exacerbates psychiatric symptoms, is often associated with treatment resistance and often leads to emergency room visits. First Episode of Psychosis (FEP) patients are twice as likely to be substance abusers in comparison with the general population (Barnett et al., 2007). The lifetime prevalence rate of substance use in patients with FEP has been reported as high as 74% (Lambert et al., 2005), and as low as 23% (National Survey on Drug use and Health, 2012). "
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    ABSTRACT: Psychiatric diagnosis mainly relies on behavioral signs and symptoms. Substance abuse can mimic the clinical presentation of primary psychiatric disorders and can also complicate the management of psychiatric patients. The reliability and accuracy of urine toxicology is a vital tool in the optimal treatment of these patients. Current demographics of substance abuse suggest that in addition to the most conventional drugs of abuse (e.g. cocaine, cannabis) that are of concern to treating physicians, prescription medications and new designer drugs also should be when evaluating patients who present with symptoms of psychosis/drug addiction or altered mental status.
    Journal of Psychiatric Research 09/2014; 59. DOI:10.1016/j.jpsychires.2014.08.020 · 4.09 Impact Factor
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    • "In a recent review, Addington et al. (2014) identified ten studies that examined substance use in people who are at clinical high risk (CHR) of developing psychosis. Across these studies, the most commonly used substances were cannabis, alcohol and tobacco, with cannabis and tobacco use being higher than in healthy controls (Auther et al., 2012), and with rates similar to those experiencing a first-episode of psychosis (Sevy et al., 2001; Barnett et al., 2007; Cooper et al., 2012). Fewer studies have examined the relationship between substance use and conversion to psychosis in CHR. "
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    ABSTRACT: Elevated rates of substance use (alcohol, tobacco, cannabis) have been reported in people at clinical high risk (CHR) of developing psychosis and there is some evidence that substance use may be higher in those who convert to a psychosis compared to non-converters. However little is known about the predictive value of substance use on risk of conversion to psychosis in those at CHR of psychosis. In the current study, 170 people at CHR of psychosis were assessed at baseline on severity of alcohol, tobacco and cannabis using the Alcohol and Drug Use Scale. Participants were recruited across three sites over a four year period as part of the Enhancing the Prospective Prediction of Psychosis (PREDICT) study. Predictors of conversion to psychosis were examined using Cox proportional hazards models. Results revealed that low use of alcohol, but neither cannabis use nor tobacco use at baseline, contributed to the prediction of psychosis in the CHR sample. Prediction algorithms incorporating combinations of additional baseline variables known to be associated with psychotic conversion may result in increased predictive power compared with substance use alone.
    Schizophrenia Research 05/2014; 156. DOI:10.1016/j.schres.2014.04.021 · 4.43 Impact Factor
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