Drug abuse does not always lead to psychosis readmission

By Laura Cowen, medwireNews Reporter

Cannabis or stimulant abuse disorders do not necessarily predict a negative outcome for patients with first-episode psychosis, Australian researchers report.

“Young people with substance comorbidities may have both the best and worst of outcomes, depending on whether problematic substance use is discontinued,” write Grant Sara (Macquarie Hospital, North Ryde, New South Wales) and colleagues in the British Journal of Psychiatry.

In their study of 7269 people (66% men) aged 15–29 years admitted with first-episode psychosis, the researchers found that baseline cannabis or stimulant (cocaine and amphetamines) abuse did not predict readmission within 2 years in multivariate analysis.

However, patients admitted with stimulant use disorder diagnoses prior to the first psychosis admission were a significant 36% more likely to be readmitted within 2 years of first psychosis than patients without such disorders after adjustment for age, gender and diagnostic subtype.

“This suggests that it is important not only to identify current substance use at first admission with psychosis but also to obtain a detailed history of the type, severity and duration of past substance use,” Sara and co-authors remark.

Of the patients studied, 30% had a comorbid cannabis use disorder and 16% had a comorbid stimulant use disorder at baseline. The most common diagnoses at first admission were schizophrenia or delusional disorders (36%) and drug-induced psychosis (22%). One in six (16%) patients had prior admissions for mental health or substance-related problems without a psychosis diagnosis.

The readmission rate within 2 years was 37% and was highest within the first 90 days, at 17% (representing 45% of those readmitted).

The highest rate of readmission within 2 years was among the 1918 patients with an ongoing drug problem, at 66%. This compared with a readmission rate of 50% among the 2209 patients with no drug problem at baseline or during follow-up.

Of note, the 866 patients whose baseline drug problem ceased during follow-up had the lowest rate of readmission, at 40%.

The researchers say that their findings “underline an important and hopeful clinical message”.

“Young people with first-episode psychosis and comorbid substance disorder may have the best outcomes, provided that substance disorder is properly managed.”

They conclude that “[i]t is critical to screen and offer intervention for drug use in early psychoses.”

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