The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis
The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis
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DOI：
10.1111/j.1600-0447.2005.00554.x
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发表时间：
2005-08-01
影响因子：
6.7
通讯作者：
Schimmelmann, BG
中科院分区：
文献类型：
--
作者：
Lambert, M;Conus, P;Schimmelmann, BG
调查共病物质使用障碍 (SUD) 对精神病的影响的研究往往侧重于横截面数据，很少有研究考察物质使用过程对临床结果的影响。本研究的主要目的是评估基线 SUD 和 SUD 病程对阳性症状缓解的影响。早期精神病预防和干预中心在 1998 年至 2000 年间收治了 786 名首发精神病 (FEP) 患者。SUD 和临床结果的数据来自 643 名符合纳入标准的患者的病历 (MR)。SUD 的终生患病率为 74%，其中 62% 在基线。在 EPPIC 计划完成 18 个月治疗的患者中，这一比例下降至 36%。 Cox 回归分析表明，减少或停止物质使用会显着增加缓解的可能性，而持续性 SUD 会大大降低这种可能性。此外，减少使用药物的患者在 18 个月时似乎比从未使用过药物的患者有更好的结果。未发现基线 SUD 对症状缓解有任何显着影响。出现 FEP 的患者 SUD 发生率较高。专业服务机构内对精神病的有效管理与治疗过程中 SUD 的减少有关，尽管持续使用药物与不依从、治疗中途退出和缓解率低有关。因此，应该为患有 FEP 和合并药物滥用的年轻人提供针对这两种疾病的综合治疗。
Studies investigating the impact of comorbid substance use disorders (SUD) in psychosis have tended to focus on cross-sectional data, with few studies examining the effects of substance use course on clinical outcome. The main aim of the present study was to assess the impact of baseline SUD and course of SUD on remission of positive symptoms.The Early Psychosis Prevention and Intervention Centre admitted 786 first-episode psychosis (FEP) patients between 1998 and 2000. Data on SUD and clinical outcome were collected from patients' medical records (MR) of 643 patients who met inclusion criteria.Lifetime prevalence of SUD was 74%, with 62% having a SUD at baseline. This reduced to 36% in those patients who completed 18 months of treatment at the EPPIC program. A Cox regression analysis indicated that a decrease or cessation of substance use significantly increased the probability of remission, whilst persistent SUD substantially reduced the likelihood. In addition, patients who reduced use appeared to have better outcomes at 18 months than those patients who had never used substances. Baseline SUD was not found to have any significant influence on symptom remission.Patients presenting with FEP have high rates of SUD. Effective management of psychosis within a specialized service is associated with reductions in SUD over the course of treatment, although persistent substance use is associated with non-compliance, treatment drop-out and poor remission rates. As such, young people with FEP and comorbid substance use should be offered integrated treatment that addresses both disorders.