Thursday, February 16, 2017

Addressing Substance Use Early in Psychosis May Be Key to Better Outcomes

Substance use—known to be common in people with psychosis—is associated with poorer outcomes, including more severe psychopathology, higher relapse rates, and lower life expectancy. While previous studies have suggested discontinuing substance use early in the course of illness can improve symptoms and function, most of these were short-term trials. 

A study in Schizophrenia Bulletin that tracked the relationship between substance use, early abstinence, and psychosis longitudinally over 10 years now suggests the detrimental effects of substance use on mental health may be reversed if the person quits early on.

A global team of researchers, led by a group in Norway, analyzed data from a long-term study of people enrolled at one of four Scandinavian health care sectors. From this population, the researchers identified 301 patients with first-episode psychosis. These patients were followed up at three months and then again one, two, five, and 10 years later. 

Of these 301 patients, 266 could be classified into one of four groups based on their patterns of substance use in the first two years after diagnosis: persistent users (n=43), episodic users (n=48), stop-users (stopped substance use within two years after diagnosis, n=34), and nonusers (n=141).

After 10 years, stop-users had similar symptom profiles as nonusers, and both groups had fewer symptoms than episodic or persistent users. In fact, while persistent users had Positive and Negative Syndrome Scale negative scores that increased over the 10-year period, the negative scores of stop-users decreased over time.

“Our results, showing improvement in negative symptoms with cessation of substance use, are of interest as these are symptoms difficult to treat with antipsychotics. In addition, these symptoms are closely linked to daily and social functioning and quality of life.” the authors concluded. “The fact that harm can be substantially minimized with early discontinuation gives a hopeful message for patients who struggle with addiction and psychosis.”

For related information, see the Psychiatric Services article “Substance Use Disorder Among People With First-Episode Psychosis: A Systematic Review of Course and Treatment” and the Focus article “Substance Use Disorders and Schizophrenia.”

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