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Impact of persistent substance misuse on 1-year outcome in first-episode psychosis

  • Aidan Turkington (a1), Ciaran C. Mulholland (a1), Teresa M. Rushe (a2), Rick Anderson (a3), Rosalind McCaul (a3), Suzanne L. Barrett (a3), Ruth S. Barr (a3) and Stephen J. Cooper (a3)...

Abstract

Background

Substance misuse is a common comorbid problem in people presenting with first-episode psychosis and is associated with a poor short-term outcome.

Aims

The aim of this study is to examine differences in baseline characteristics and 1-year outcome between individuals with first-episode psychosis who have never misused substances, those who stop misusing substances after initial presentation and those who persistently misuse substances over the 1-year assessment period.

Method

Patients were recruited to the Northern Ireland First Episode Psychosis Study (n = 272). Clinical assessments were performed at baseline and at 1 year (n = 194) and data were collected from the case notes.

Results

Individuals with persistent substance misuse had more severe depression, more positive symptoms, poorer functional outcome and greater rates of relapse at 1 year than those who stopped and those who had never misused substances. There were no differences in outcome between people who had never misused substances and those who stopped misusing after presentation.

These results support assertive intervention targeted at comorbid substance misuse in individuals with first-episode psychosis.

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Copyright

Corresponding author

Aidan Turkington, Department of Psychiatry, Whitla Medical Building, 97 Lisburn Road, Belfast BT9 7BL, UK. Email: aidant@doctors.org.uk

Footnotes

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Conclusions

15 Dec 2008

Funded by the Research and Development Office of the Northern Ireland Health and Personal Social Services.

Declaration of interest

None.

Footnotes

References

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1 Regier, DA, Farmer, ME, Rae, DS, Locke, BZ, Keith, SJ, Judd, LL, et al. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990; 264: 2511–8.
2 Cantwell, R, Brewin, J, Glazebrook, C, Dalkin, T, Fox, R, Medley, I, et al. Prevalence of substance misuse in first-episode psychosis. Br J Psychiatry 1999; 174: 150–3.
3 Van Mastrigt, S, Addington, J, Addington, D. Substance misuse at presentation to an early psychosis program. Soc Psychiatry Psychiatr Epidemiol 2004; 39: 6972.
4 Lambert, M, Conus, P, Lubman, DI, Wade, D, Yuen, H, Moritz, S, et al. The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis. Acta Psychiatr Scand 2005; 112: 141–8.
5 Barnes, TRE, Mutsatsa, SH, Hutton, SB, Watt, HC, Joyce, EM. Comorbid substance use and age at onset of schizophrenia. Br J Psychiatry 2006; 188: 237–42.
6 Wade, D, Harrigan, S, Edwards, J, Burgess, PM, Whelan, G, McGorry, PD. Substance misuse in first-episode psychosis: 15-month prospective follow-up study. Br J Psychiatry 2006; 189: 229–34.
7 Larsen, TK, Melle, I, Auestad, B, Friis, S, Haahr, U, Johannessen, JO, et al. Substance abuse in first-episode non-affective psychosis. Schizophr Res 2006; 88: 5562.
8 Barnett, JH, Werners, U, Secher, SM, Hill, KE, Brazil, R, Masson, K, et al. Substance use in a population-based clinic sample of people with first-episode psychosis. Br J Psychiatry 2007; 190: 515–20.
9 Veen, ND, Selten, JP, van der Tweel, I, Feller, WG, Hoek, HW, Kahn, RS., Cannabis use and age at onset of schizophrenia. Am J Psychiatry 2004; 161: 501–6.
10 Addington, J, Addington, D. Effect of substance misuse in early psychosis. Br J Psychiatry 1998; 172 (suppl 33): s1346.
11 Linszen, DH, Dingemans, PM, Lenior, ME. Cannabis abuse and the course of recent-onset schizophrenic disorders. Arch Gen Psychiatry 1994; 51: 273–9.
12 Grech, A, Van Os, J, Jones, PB, Lewis, SW, Murray, RM. Cannabis use and outcome of recent onset psychosis. Eur Psychiatry 2005; 20: 349–53.
13 Wade, D, Harrigan, S, McGorry, P, Burgess, PM, Whelan, G. Impact of severity of substance use disorder on symptomatic and functional outcome in young individuals with first-episode psychosis. J Clin Psychiatry 2007; 68: 767–74
14 Kay, SR, Fiszbein, A, Opler, LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 261–76.
15 Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561–71.
16 Jablensky, A, Sartorius, N, Ernberg, G, Anker, M, Korten, A, Cooper, JE, et al. Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychol Med Monogr Suppl 1992; 20: 197.
17 Endicott, J, Spitzer, RL, Fleiss, JL, Cohen, J. The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 1976; 33: 766–71.
18 McGuffin, P, Farmer, A, Harvey, I. A polydiagnostic application of operational criteria in studies of psychotic illness. Development and reliability of the OPCRIT system. Arch Gen Psychiatry 1991; 48: 764–70.
19 World Health Organization. The ICD–10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
20 Sevy, S, Robinson, DG, Holloway, S, Alvir, JM, Woerner, MG, Bilder, R, et al. Correlates of substance misuse in patients with first-episode schizophrenia and schizoaffective disorder. Acta Psychiatr Scand 2001; 104: 367–74.
21 Verdoux, H, Lengronne, J, Liraud, F, Gonzales, B, Assens, F, Abalan, F, et al. Medication adherence in psychosis: predictors and impact on outcome. A 2-year follow-up of first-admitted subjects. Acta Psychiatr Scand 2000; 102: 203–10.
22 Coldham, EL, Addington, J, Addington, D. Medication adherence of individuals with a first episode of psychosis. Acta Psychiatr Scand 2002; 106: 286–90.
23 Startup, M, Jackson, MC, Bendix, S. The concurrent validity of the Global Assessment of Functioning (GAF). Br J Clin Psychol 2002; 41: 417–22.
24 Sorbara, F, Liraud, F, Assens, F, Abalan, F, Verdoux, H. Substance use and the course of early psychosis: a 2-year follow-up of first-admitted subjects. Eur Psychiatry 2003; 18: 133–6.
25 Addington, J, Addington, D. Patterns, predictors and impact of substance use in early psychosis: a longitudinal study. Acta Psychiatr Scand 2007; 115: 304–9.
26 Margolese, HC, Carlos Negrete, J, Tempier, R, Gill, K. A 12-month prospective follow-up study of patients with schizophrenia-spectrum disorders and substance abuse: changes in psychiatric symptoms and substance use. Schizophr Res. 2006; 83: 6575.
27 Malla, A, Norman, R, Bechard-Evans, L, Schmitz, N, Manchanda, R, Cassidy, C. Factors influencing relapse during a 2-year follow-up of first-episode psychosis in a specialized early intervention service. Psychol Med 2008; 21: 19.
28 Manchanda, R, Norman, RM, Malla, AK, Harricharan, R, Northcott, S. Persistent psychoses in first episode patients. Schizophr Res 2005; 80: 113–6.
29 Dunnell, K. The changing demographic picture of the UK: national statistician's annual article on the population. Popul Trends 2007; 130: 921.
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Impact of persistent substance misuse on 1-year outcome in first-episode psychosis

  • Aidan Turkington (a1), Ciaran C. Mulholland (a1), Teresa M. Rushe (a2), Rick Anderson (a3), Rosalind McCaul (a3), Suzanne L. Barrett (a3), Ruth S. Barr (a3) and Stephen J. Cooper (a3)...
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eLetters

Definitions and confounders

Stephen Owens, Core trainee 1
30 June 2010

I would like to make a few comments on the prospective analytical observational study conducted by Turkington et al 2009 that looked at impact of persistent substance misuse on 1-year outcome in first episode psychosis al published in the BJP September 2009. Firstly while there was consideration for medication adherence I noted the lack of adjustment for expressed emotion, related to both outcome (relapse) and exposure (psychosis), when looking at rates of relapse. I wonder if this important confounder had been adjusted for how the outcome would have different. This brings me to the author’s definition of “relapse” which included those patients who had a continuous illness over the first year, I consider this to be an inappropriate definition for such an important outcome measure, and the results of which should be interpreted with considered thought. Perhaps those with persistent illness should have beentreated as a separate group and not included in the “relapse” data at all?I feel this should be additional limitation of the study. Unfortunately the process of participant recruitment & precise details of the population of patient’s included (inpatient, outpatient or both) is lacking which makes extrapolation of the data to our own population of patients difficult and raises the question of whether the data in relevant. Finally, I propose that if such observational studies are undertaken inthe future consideration should be given to looking at potential associations between persistent substance misuse and mortality: I note three participants (of working age) died during the short follow up period, their modes of death is of interest to us. Was there an association between persistent substance misuse and mortality? If so this adds weight to the authors conclusion regarding assertive intervention targeted at substance misuse in first-episode psychosis. ... More

Conflict of interest: None Declared

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Substance misuse and first episode psychosis

Aadil Jan Shah, Speciality Registrar,Early Intervention Team,Chester
22 October 2009

The prospective study done by Turkington et al, 2009 provides us withan important message that substance misuse is associated with a problematic recovery from recent-onset psychosis but the most important question is how to deal with this problem. This study shows that the baseline substance misuse in the total sample was 43% which is quite significant.(1) It means that targeting this group of 43% will significantly improve their outcome and our aim is to reduce the number ofpersistent illicit substance users. Obviously as mentioned by the authors in this study, early Intervention teams have a major role to play in identifying and offering the appropriate help to this group but most of the early intervention teams deal only with 16-35 yrs of age group. What happens to patients not falling in this age range? Do community mental health teams (CMHTs) need to develop the same assertive approach as early intervention teams in dealing with this group? Have CMHTs got these resources, especially in current financial circumstances? Do GPs need moretraining in early recognition, offering support and signposting of these patients? What is the role of primary care mental health teams? What happens to the patients in this group who are homeless? What is the role of substance misuse services and psychological services? All these questions need to be answered and looked into but it is worth mentioning that the services do vary across UK. The bottom line is that we have got the evidence that targeting substance misuse in first episodes of psychosis may improve the natural course of these disorders and it is everybody’s job to keep this in mind. This along with early intervention may help these patients experience better outcome in terms of overall quality of life and social functioning and have shorter average hospital stays. Also, targeting substance misuse in these patients could help to accelerate remission, minimize adverse reactions to the experience of psychosis and depression, promote and consolidate recovery, and improve socio-occupational functioning. The overall care package needs to be very robust and apart from a therapeutic engagement, low-dosage atypical antipsychotics, individual psychotherapy, relapse prevention, vocational assistance, family or caregiver support, and help with accommodation and benefits could be very helpful. Motivational interviewing regarding medication compliance and substance misuse can be very beneficial.(2) Psycho education, providing the general awareness about substance misuse and its impact on the mental health can be helpful. We should also try to recognize those patients with first episode psychosis who are at risk of becoming substance abusers. To conclude, substance abuse among patients with first episode psychosis is more amenable to treatment than substance abuse among patients with more chronic forms of the disorder like schizophrenia. Therefore we not only have a duty of treating psychosis butalso for detecting and reducing substance abuse among individuals experiencing a first episode of psychosis.

References

1. Turkington A, Mulholland CC, Rushe TM, Anderson R, McCaul R,Barrett SL, et al.Impact of persistent substance misuse on 1-year outcome in first-episode psychosis .The British Journal of Psychiatry 2009; 195: 242-248.

2. Singh SP, Fisher HL Early intervention in psychosis:obstacles andopportunities. Advances in Psychiatric Treatment (2005); 11: 71-78.
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