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David Baxter

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Substance misuse present in most patients with first-episode psychosis
04 June 2007
Br J Psychiatry 2007; 190: 515?520

Most people with first-episode psychosis have a history of substance misuse, which can have major implications for management, UK researchers say.

?Identification and reduction of substance use and misuse should be a key therapeutic target for early intervention services and has implications for staff training,? the authors write in the British Journal of Psychiatry.

?This study suggests that dual diagnosis services should become part of early intervention efforts.?

Jennifer Barnett, from Addenbrooke?s Hospital in Cambridge, and colleagues examined the prevalence of substance use in 123 individuals with first-episode psychosis.

Substance use was assessed using the St George?s Substance Abuse Assessment Questionnaire.

All participants reported alcohol use, with 43.1% of the patients meeting DSM-IV criteria for alcohol abuse or dependence at some point in their lives. The remaining 56.1% reported alcohol use but not abuse.

Of 122 participants, 80.3% reported using cannabis at some point in their lives, and 50.8% met DSM-IV criteria for cannabis abuse or dependence.

Approximately half of the participants reported amphetamine or class A drug use.

In the majority of patients, first substance use was several years prior to the appearance of the first psychotic symptoms.

Lifetime prevalence of substance use among first-episode psychosis patients was significantly greater than national estimates from the British Crime Survey.

?The overall prevalence of substance use in people with first-episode psychosis was approximately double that in the general population of similar age,? the researchers note.

Barnett and co-workers conclude: ?The high prevalence of substance use reported in this sample of people with first-episode psychosis has important clinical implications.

?Substance misuse in people with psychotic disorders is robustly associated with non-adherence to treatment and poorer outcomes, whereas a reduction in substance use after diagnosis is associated with a reduction in subsequent admissions and psychotic symptoms.?

Abstract
 

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