Symptomatic and functional outcomes of substance use disorder persistence 2 years after admission to a first-episode psychosis program
Symptomatic and functional outcomes of substance use disorder persistence 2 years after admission to a first-episode psychosis program
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DOI：
10.1016/j.psychres.2016.11.007
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发表时间：
2017-01-01
影响因子：
11.3
通讯作者：
Potvin, Stephane
中科院分区：
文献类型：
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作者：
Abdel-Baki, Amal;Ouellet-Plamondon, Clairelaine;Potvin, Stephane
首发精神病（FEP）中的物质使用障碍（SUD）非常普遍，并与不良预后相关。然而，大多数调查其对FEP影响的纵向研究并未报道停用SUD的患者比例。我们的目的是检查SUD疗程对FEP的功能和症状结果以及服务使用的影响。我们对212名年龄在18岁至30岁之间的FEP患者进行了一项为期2年的纵向研究，这些患者在加拿大魁北克省蒙特利尔的2家早期精神病服务机构接受治疗。我们观察到大麻是第一个被滥用的物质（基线时为42.9%），其次是酒精（19.3%）。在第一年，SUD率下降了大约30%。持续性SUD患者的功能结局（生活质量量表、社会和职业功能评估量表、就业）较差，症状较多（阳性和阴性症状量表），服务使用较多（急诊和住院）。SUD持续性与疾病严重程度、无家可归和b型人格相关。那些与父母同住并由父母提供经济支持的人更有可能停止SUD。我们的研究结果表明，SUD病程比入院时SUD更重要；持续的SUD与较差的预后相关。在一般的早期精神病干预计划中（没有专门的SUD治疗），SUD下降。在治疗的头几年，针对具有SUD持续性预测因素的FEP患者，采用一种综合的、专门的方法可能会增加SUD的停止，并可能改善预后。
Substance use disorders (SUD) in first-episode psychosis (FEP) are highly prevalent and linked with poor outcomes. However, most longitudinal studies investigating their impacts in FEP have not reported proportions of patients who ceased SUD. Our aim was to examine the influence of SUD course on functional and symptomatic outcomes as well as service use in FEP. We performed a 2-year longitudinal study of 212 FEP patients, aged between 18 and 30 years, admitted to 2 early psychosis services in Montreal, Quebec, Canada. We observed that cannabis was the first substance abused (42.9% at baseline), followed by alcohol (19.3%). The SUD rate decreased by approximately 30% during the first year. Patients with persistent SUD had worse functional outcomes (Quality of Life Scale, Social and Occupational Functioning Assessment Scale, employment), more symptoms (Positive and Negative Symptoms Scale) and heavier service use (emergency and hospitalization). SUD persistence was associated with illness severity, homelessness and cluster-B personality. Those living with their parents and financially supported by them were more likely to cease SUD. Our results indicate that SUD course was more significant than having SUD at admission; persistent SUD was associated with worse outcomes. SUD decreased during a general early psychosis intervention program (with no specialized SUD treatment). An integrated, specialized approach targeting FEP patients with predictive factors of SUD persistence during the first years of treatment might increase SUD cessation and possibly improve outcomes.