Substance use in people at clinical high-risk for psychosis

BMC Psychiatry

Jesus Perez³  Peter B Jones⁵  Michelle Painter²  Jan Stochl⁴  Debra A Russo¹ 

[1] Block 7, Ida Darwin Site, Fulbourn Hospital, Fulbourn, CB21 5EE, Cambridge, UK;CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK;Department of Psychiatry, University of Cambridge, Cambridge, UK;Department of Health Sciences, University of York, York, UK;NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK

关键词: Substance use;    Psychosis;    High-risk;    Cannabis;    Alcohol;   

Others  :  1090907
DOI  :  10.1186/s12888-014-0361-1

 received in 2014-03-27, accepted in 2014-12-11,  发布年份 2014

【 摘 要 】

Background

Some high-risk (HR) mental states for psychosis may lack diagnostic specificity and predictive value. Furthermore, psychotic-like experiences found in young populations may act not only as markers for psychosis but also for other non-psychotic psychiatric disorders. A neglected consideration in these populations is the effect of substance misuse and its role in the development of such mental states or its influence in the evolution toward full psychotic presentations. Therefore, the main aim of this study was to thoroughly describe past and current substance use profiles of HR individuals by comparing a consecutive cohort of young people at high risk referred to a population-based early intervention clinical service with a random sample of healthy volunteers (HV) recruited from the same geographical area.

Methods

We compared alcohol and substance use profiles of sixty help-seeking HR individuals and 60 healthy volunteers (HV). In addition to identification of abuse/dependence and influence on psychotic-like experiences, differences between HR individuals and HV were assessed for gender, ethnicity, occupational status, age of lifetime first substance use, prevalence and frequency of substance use.

Results

There were no cases of substance use disorder or dependence in either groups. HR individuals were significantly younger than HV when they first started to use substances (p = 0.014). The prevalence of overall HR substance use was similar to that of HV. Although HR individuals reported less cannabinoid use than HV currently (15% vs. 27%), and more in the past (40% vs. 30%), the differences were not statistically significant (p = 0.177 & 0.339 respectively). Current frequency of use was significantly higher for HR individuals than HV for alcohol (p = 0.001) and cannabinoids (p = 0.03). In this sample, only 5% of HR individuals converted to psychosis over a two-year follow-up.

Conclusions

Certain profiles of substance use could potentially play a significant part in the evolution of HR presentations. Therefore, substance use may well represent a clinical domain that requires further emphasis and more detailed consideration in future studies.

【 授权许可】

   
2014 Russo et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Yung AR, Yuen HP, Berger G, Francey S, Hung TC, Nelson B, Phillips L, McGorry P: Declining transition rate in ultra high risk (prodromal) services: dilution or reduction of risk? Schizophr Bull 2007, 33:673-681.
• [2]Fusar-Poli P, Bonoldi I, Yung AR, Borgwardt S, Kempton MJ, Valmaggia L, Barale F, Caverzasi E, McGuire P: Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Arch Gen Psychiatry 2012, 69:220-229.
• [3]Wigman JT, van Nierop M, Vollebergh WA, Lieb R, Beesdo-Baum K, Wittchen HU, van Os J: Evidence that psychotic symptoms are prevalent in disorders of anxiety and depression, impacting on illness onset, risk, and severity - implications for diagnosis and ultra-high risk research. Schizophr Bull 2012, 38:247-257.
• [4]Hui C, Morcillo C, Russo DA, Stochl J, Shelley GF, Painter M, Jones PB, Perez J: Psychiatric morbidity and disability in young people at clinical high risk for psychosis. Schizophr Res 2013, 148:175-180.
• [5]Kelleher I, Keeley H, Corcoran P, Lynch F, Fitzpatrick C, Devlin N, Molloy C, Roddy S, Clarke MC, Harley M, Arseneault L, Wasserman C, Carli V, Sarchiapone M, Hoven C, Wasserman D, Cannon M: Clinicopathological significance of psychotic experiences in non-psychotic young people: evidence from four population-based studies. Br J Psychiatry 2012, 1:26-32.
• [6]Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK: Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990, 21:2511-2518.
• [7]McCreadie RG: Scottish Comorbidity Study Group: Use of drugs, alcohol and tobacco by people with schizophrenia: case – control study. Br J Psychiatry 2002, 181:321-325.
• [8]Barnett JH, Werners U, Secher SM, Hill KE, Brazil R, Masson K, Pernet DE, Kirkbride JB, Murray GK, Bullmore ET, Jones PB: Substance use in a population-based clinic sample of people with first-episode psychosis. Br J Psychiatry 2007, 190:515-520.
• [9]Fergusson DM, Poulton R, Smith PF, Boden JM: Cannabis and psychosis. BMJ 2006, 21:172-175.
• [10]Dragt S, Nieman DH, Schultze-Lutter F, van der Meer F, Becker H, de Haan L, Dingemans PM, Birchwood M, Patterson P, Salokangas RK, Heinimaa M, Heinz A, Juckel G, Graf von Reventlow H, French P, Stevens H, Ruhrmann S, Klosterkötter J, Linszen DH: EPOS group: Cannabis use and age at onset of symptoms in subjects at clinical high risk for psychosis. Acta Psychiatr Scand 2012, 125(1):45-53.
• [11]Addington J, Case N, Saleem MM, Auther AM, Cornblatt BA, Cadenhead KS: Substance use in clinical high risk for psychosis: a review of the literature.Early Interv Psychiatry 2013, doi:10.1111/eip.12100 [Epub ahead of print].
• [12]Cheng F, Kirkbride JB, Lennox BR, Perez J, Masson K, Lawrence K, Hill K, Feeley L, Painter M, Murray GK, Gallagher O, Bullmore ET, Jones PB: Administrative incidence of psychosis assessed in an early intervention service in England: first epidemiological evidence from a diverse, rural and urban setting. Psychol Med 2011, 41:949-958.
• [13]Yung AR, Yuen HP, McGorry PD, Phillips LJ, Kelly D, Dell'Olio M, Francey SM, Cosgrave EM, Killackey E, Stanford C, Godfrey K, Buckby J: Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States. Aust N Z J Psychiatry 2005, 39:964-971.
• [14]Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998, 59:22-33.
• [15]Kay SR, Fiszbein A, Opler LA: The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987, 13:261-276.
• [16]Compton MT, Kelley ME, Ramsay CE, Pringle M, Goulding SM, Esterberg ML, Stewart T, Walker EF: Relations of Pre-Onset Cannabis, Alcohol, and Tobacco Use with the Age at Onset of Prodrome and Age at Onset of Psychosis in First-Episode Patients. Am J Psychiatry 2009, 166:1251-1257.
• [17]Phillips P, Johnson S: How does drug and alcohol misuse develop among people with psychotic illnesses? A literature review. Soc Psychiatry Psychiatr Epidemiol 2001, 36:269-276.
• [18]Hall W, Degenhardt L: Cannabis use and the risk of developing a psychotic disorder. World Psychiatr 2008, 7:68-71.
• [19]Kamali M, McTigue O, Whitty P, Gervin M, Clarke M, Browne S, Larkin C, O'Callaghan E: Lifetime history of substance misuse in first episode psychosis: prevalence and its influence on psychopathology and onset of psychotic symptoms. Early Interv Psychiatry 2009, 3:198-203.
• [20]Winters KC: Assessing Alcohol Problems - A Guide for Clinicians and Researchers Second Edition NIH Publication No. 03–3745 Revised 2003 [http://pubs.niaaa.nih.gov/publications/assessingalcohol/index.htm]
• [21]Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel RR: What does the PANSS mean? Schizophr Res 2005, 79:231-238.
• [22]Addington J, Addington D: Patterns, predictors and impact of substance use in early psychosis: a longitudinal study. Acta Psychiatr Scand 2007, 115:304-309.
• [23]Dragt S, Nieman DH, Becker HE, van de Fliert R, Dingemans PM, de Haan L, van Amelsvoort TA, Linszen DH: Age of onset of cannabis use is associated with age of onset of high-risk symptoms for psychosis. Can J Psychiatry 2010, 55:165-171.
• [24]Korver N, Nieman DH, Becker HE, van de Fliert JR, Dingemans PH, de Haan L, Spiering M, Schmitz N, Linszen DH: Symptomatology and neuropsychological functioning in cannabis using subjects at ultra-high risk for developing psychosis and healthy controls. Aust N Z J Psychiatry 2010, 44:230-236.
• [25]Auther AM, McLaughlin D, Carrión RE, Nagachandran P, Correll CU, Cornblatt BA: Prospective study of cannabis use in adolescents at clinical high risk for psychosis: impact on conversion to psychosis and functional outcome. Psychol Med 2012, 42:2485-2497.
• [26]Nelson B, Yuen H, Wood SJ, Lin A, Spiliotacopoulos D, Bruxner A, Broussard C, Simmons M, Foley DL, Brewerm WJ, Francey SM, Amminger GP, Thompson A, McGorry PD, Yung AR: Long-term follow-up of a group at ultra high risk (“prodromal”) for psychosis: the PACE 400 study. JAMA Psychiatr 2013, 70(8):793-802.
• [27]Barkus E, Murray RM: Substance use in adolescence and psychosis: Clarifying the relationship. Annu Rev Clin Psychol 2010, 6:365-389.