Involuntary hospitalization of first-episode psychosis with substance abuse during a 2-year follow-up
Objective: To investigate whether substance abuse (alcohol or illegal drugs) in patients with first-episode psychosis (FEP) influenced treatment outcomes such as involuntary hospitalization during follow-up.
First-episode psychosis patients (n = 103) with consecutive admissions to a comprehensive early psychosis program were included and followed for 2 years. Assessment measures were the Positive and Negative Syndrome Scale, Global Assessment of Functioning, and the Clinician Rating Scale (for substance abuse).
Twenty-four per cent of patients abused either alcohol or drugs at baseline. The dropout rate at 2 years was the same for substance abusers as for non-abusers. Substance use was not reduced over the 2-year period. At 2-year follow-up, 72% of substance abusers and 31% of non-abusers had experienced at least one occasion of involuntary hospitalization. Patients with substance abuse had significantly higher risk for involuntary hospitalization during follow-up (OR 5.2).
To adequately treat patients with FEP, clinicians must emphasize treatment of the substance abuse disorder, as well as the psychotic illness. Patients with defined comorbid substance use disorders and FEP are likely to have poorer treatment response than those with psychosis alone.