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: 7.99). 07/2007; 190(6):515-20. DOI: 10.1192/bjp.bp.106.024448
Source: PubMed


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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Available from: James Kirkbride, Jan 05, 2016
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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.
    Full-text · Article · Mar 2015 · Psychological Medicine
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    • "The most likely reason for this could be that the services taking part focus mainly on alcohol and opiates with some response provided for stimulants and cocaine, but no robust treatment response is offered to those using cannabis as a primary drug. Given that we know cannabis to be one of the most prevalent substances used by those with combined severe mental illness and substance misuse,2,7,12,13 this finding may highlight a gap in service provision within our study area that may also be present in other UK services. The findings suggest that although individuals who use cannabis and have a diagnosis of serious mental health problem are more likely to be in contact and engaged with severe mental health problem services, those for whom a mental health problem has not been identified but who are using cannabis may not be engaged in substance misuse services and hence have no contact with services at all. "
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    ABSTRACT: Aims and method The study reports findings of an investigation into the presence of severe and enduring mental health problems within the four statutory and non-statutory teams of an established substance misuse treatment partnership. Results Of a total of 772 clients in the four teams surveyed, 69 (8.9%) were identified as having severe and enduring mental health problems and problem substance use in the past 12 months. Alcohol was the most prevalent substance used by this predominantly male group. Different rates were found across the four teams, with higher numbers in the non-statutory teams. The clients displayed significant levels of self-harm and suicide risk and were responsible for 131 acute service contacts over the past 12 months. Clinical implications Clients with severe and enduring mental health problems engaged with substance misuse services display high levels of complex need. It is important to identify the best and most effective service response to this group.
    Full-text · Article · Oct 2014
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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: Unlabelled: 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. Methods: Urine samples from 220 psychiatric inpatients admitted to either an acute drug and alcohol unit or acute psychiatric unit were analyzed for drugs by the standard hospital assay (KIMS) and by a more sensitive ELISA and GC-MS basic drug screening protocol. Results: The standard hospital toxicology (KIMS) was inferior to the ELISA and GC-MS methods in terms of both assay sensitivity and in detecting a broader number of drugs. The KIMS tests failed to identify opiates and amphetamine/methamphetamine in 50% of the patients. The KIMS screen did not identify zolpidem, buprenorphine and a number of synthetic drugs of abuse including cathinone and tryptamines. Conclusion: In order to reliably identify substance abuse in patients with altered mental status in inpatient settings, analytical methodologies with adequate assay sensitivity and range to detect the vast majority of commonly abused illicit drugs and prescription medications are required for optimal clinical assessment and treatment.
    Full-text · Article · Sep 2014 · Journal of Psychiatric Research
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