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Substance misuse is widespread among individuals with early-phase psychotic disorders and is associated with a worse illness course. Thorough assessment of patterns of substance misuse at admission for psychiatric care is often lacking and can compromise the accuracy of a diagnostic assessment that distinguishes between a primary psychosis and one that is substance induced. Given the risk to recovery from psychosis posed by substance misuse, close monitoring of the course and treatment of early-phase psychosis that is accompanied by substance misuse is indicated and could inform the development of more effective dual-diagnosis treatments.
The stability of the diagnostic distinction between a substance-induced
psychosis and a primary psychotic disorder co-occurring with substance
use is not established.
To describe DSM – IV diagnostic changes over 1 year and determine the
predictive validity of baseline indicators of the substance-induced
psychosis v. primary psychosis distinction.
We conducted a 1-year follow-up study of 319 psychiatric emergency
department admissions with diagnoses of early-phase psychosis and
substance use comorbidity.
Of those with a baseline DSM—IV diagnosis of substance-induced psychosis,
25% had a diagnosis of primary psychosis at follow-up. These patients had
poorer premorbid functioning, less insight into psychosis and greater
family mental illness than patients with a stable diagnosis of
substance-induced psychosis. Reclassifying change cases to primary
psychoses on follow-up, key baseline predictors of the
primary/substance-induced distinction at 1 year also included greater
family history of mental illness in the primary psychosis group.
Further study of substance-induced psychoses should employ
neuroscientific and behavioural approaches. Study findings can guide more
accurate diagnoses at first treatment.
The question of where to place the chronically mentally disabled in the community is essential in this era of brief hospitalization practices. This report examines the effects of the social conditions of the environment on the length of stay in the community for a sample of 119 multiple admission schizophrenics in New York City. Patients returned to a variety of family and non-family living arrangements in poor and depressed areas of the city. The relationship between characteristics of the living arrangements and the patients' clinical functioning and rate of rehospitalization was examined. The findings show that there is no significant differential effect of the type of living arrangement on rehospitalization or clinical functioning, and that these factors did not contribute significantly to the prediction of successful adjustment. However, the socio-emotional characteristics of the environment - i.e. social support and interpersonal stress - together are stronger predictors of outcome than are available out-patient treatment programmes. The findings emphasize the importance of environmental variables as factors independent of the effect of treatment on rehospitalization.
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