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Specific impact of stimulant, alcohol and cannabis use disorders on first-episode psychosis: 2-year functional and symptomatic outcomes

Published online by Cambridge University Press:  20 April 2017

C. Ouellet-Plamondon ,
A. Abdel-Baki ,
É. Salvat  and
S. Potvin
C. Ouellet-Plamondon
Affiliation:
Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
A. Abdel-Baki*
Affiliation:
Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
É. Salvat
Affiliation:
Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
S. Potvin
Affiliation:
Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada Centre de recherche, Institut universitaire en santé mentale de Montréal (IUSMM), Montreal, Quebec, Canada
*
*Address for correspondence: A. Abdel-Baki, M.D., M.Sc., Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada and Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada. (Email: [email protected])
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Abstract

Background

Many studies have concluded that cannabis use disorder (CUD) negatively influences outcomes in first-episode psychosis (FEP). However, few have taken into account the impact of concurrent misuse of other substances.

Methods

This 2-year, prospective, longitudinal study of FEP patients, aged between 18 and 30 years, admitted to early intervention programs in Montreal, Quebec, Canada, examined the specific influence of different substance use disorders (SUD) (alcohol, cannabis, cocaine, amphetamines) on service utilization, symptomatic and functional outcomes in FEP.

Results

Drugs and alcohol were associated with lower functioning, but drugs had a greater negative impact on most measures at 2-year follow-up. Half of CUD patients and more than 65% of cocaine or amphetamine abusers presented polysubstance use disorder (poly-SUD). The only group that deteriorated from years 1 to 2 (symptoms and functioning) were patients with persistent CUD alone. Outcome was worse in CUD than in the no-SUD group at 2 years. Cocaine, amphetamines and poly-SUD were associated with worse symptomatic and functional outcomes from the 1st year of treatment, persisting over time with higher service utilization (hospitalization).

Conclusion

The negative impact attributed to CUD in previous studies could be partly attributed to methodological flaws, like including polysubstance abusers among cannabis misusers. However, our investigation confirmed the negative effect of CUD on outcome. Attention should be paid to persistent cannabis misusers, since their condition seems to worsen over time, and to cocaine and amphetamine misusers, in view of their poorer outcome early during follow-up and high service utilization.

Keywords

Amphetaminecannabiscocainefirst-episode psychosisfunctional outcomesymptomatic outcome
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 14 , October 2017 , pp. 2461 - 2471
Copyright
Copyright © Cambridge University Press 2017 

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