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Few studies have examined the impact of stimulant use on outcome in early psychosis. Ceasing substance use may lead to positive outcomes in psychosis.
To examine whether baseline cannabis or stimulant disorders and ongoing drug use predict readmission within 2 years of a first psychosis admission.
Predictors of readmission were examined with Cox regression in 7269 people aged 15–29 years with a first psychosis admission.
Baseline cannabis and stimulant disorders did not predict readmission. A stimulant disorder diagnosis prior to index psychosis admission predicted readmission, but a prior cannabis disorder diagnosis did not. Ongoing problem drug use predicted readmission. The lowest rate of readmission occurred in people whose baseline drug problems were discontinued.
Prior admissions with stimulant disorder may be a negative prognostic sign in first-episode psychosis. Drug use diagnoses at baseline may be a good prognostic sign if they are identified and controlled.
In 2006, Australia introduced new publicly funded psychological services
for people with affective and anxiety disorders (the Better Access
programme). Despite massive uptake, it has been suggested that Better
Access is selectively treating socioeconomically advantaged people,
including some who do not warrant treatment, and people already receiving
To explore potential disparities in Better Access treatment using
epidemiological data from the 2007 National Survey of Mental Health and
Logistic regression analyses examined patterns and correlates of service
use in two populations: people who used the new psychological services in
the previous 12 months; and people with any ICD–10 12-month affective and
anxiety disorder, regardless of service use.
Most (93.2%) Better Access psychological services users had a 12-month
ICD–10 mental disorder or another indicator of treatment need. Better
Access users without affective or anxiety disorders were not more
socioeconomically advantaged, and received less treatment than those with
these disorders. Among the population with affective or anxiety
disorders, non-service users were less likely to have a severe disorder
and more likely to have anxiety disorder, without a comorbid affective
disorder, than Better Access users. Better Access users comprised more
new allied healthcare recipients than other service users. A substantial
minority of non-service users (13.5%) had severe disorders, but most did
not perceive a need for treatment.
Better Access does not appear to be overservicing individuals without
potential need or contributing to social inequalities in mental
healthcare. It appears to be reaching people who have not previously
received psychological care. Treatment rates could be improved for some
people with anxiety disorders.
The lack of prospective studies and data on male victims leaves major questions regarding associations between child sexual abuse and subsequent psychopathology.
To examine the association between child sexual abuse in both boys and girls and subsequent treatment for mental disorder using a prospective cohort design.
Children (n=16L2; 1327 female) ascertained as sexually abused at the time had their histories of mental health treatment established by data linkage and compared with the general population of the same age over a specified period.
Both male and female victims of abuse had significantly higher rates of psychiatric treatment during the study period than general population controls (12.4% v. 3.6%). Rates were higher for childhood mental disorders, personality disorders, anxiety disorders and major affective disorders, but not for schizophrenia. Male victims were significantly more likely to have had treatment than females (22.8% v. 10.2%).
This prospective study demonstrates an association between child sexual abuse validated at the time and a subsequent increase in rates of childhood and adult mental disorders.
An increased risk of choking associated with antipsychotic medication has been repeatedly postulated.
To examine this association in a large number of cases of choking deaths.
Cases of individuals who had died because of choking were linked with a case register recording contacts with public mental health services. The actual and expected rates of psychiatric disorder and the presence of psychotropic medication in post-mortem blood samples were compared.
The 70 people who had choked to death were over 20 times more likely to have been treated previously for schizophrenia. They were also more likely to have had a prior organic psychiatric syndrome. The risk for those receiving thioridazine or lithium was, respectively, 92 times and 30 times greater than expected. Other antipsychotic and psychotropic drugs were not over-represented.
The increased risk of death in people with schizophrenia may be a combination of inherent predispositions and the use of specific antipsychotic drugs. The increased risk of choking in those with organic psychiatric syndromes is consistent with the consequences of compromised neurological competence.
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