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Stability of early-phase primary psychotic disorders with concurrent substance use and substance-induced psychosis
- Authors:
- CATON Carol L. M., et al
- Journal article citation:
- British Journal of Psychiatry, 190(2), February 2007, pp.105-111.
- Publisher:
- Cambridge University Press
The stability of the diagnostic distinction between a substance-induced psychosis and a primary psychotic disorder co-occurring with substance use is not established. The aim was to describe DSM–IV diagnostic changes over 1 year and determine the predictive validity of baseline indicators of the substance-induced psychosis v. primary psychosis distinction. The authors conducted a 1-year follow-up study of 319 psychiatric emergency department admissions with diagnoses of early-phase psychosis and substance use comorbidity. Of those with a baseline DSM–IV diagnosis of substance-induced psychosis, 25% had a diagnosis of primary psychosis at follow-up. These patients had poorer premorbid functioning, less insight into psychosis and greater family mental illness than patients with a stable diagnosis of substance-induced psychosis. Reclassifying change cases to primary psychoses on follow-up, key baseline predictors of the primary/substance-induced distinction at 1 year also included greater family history of mental illness in the primary psychosis group. Further study of substance-induced psychoses should employ neuroscientific and behavioural approaches. Study findings can guide more accurate diagnoses at first treatment.
Gender differences in psychotic disorders with concurrent substance use
- Authors:
- CATON Carol L. M., et al
- Journal article citation:
- Journal of Dual Diagnosis, 10(4), 2014, pp.177-186.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Objective: The authors conducted a comparative analysis of gender differences in patients with primary psychotic disorders with concurrent substance use and in those with substance-induced psychoses. Methods: A total of 385 individuals admitted to psychiatric emergency departments with early-onset psychosis and recent substance use were interviewed at baseline and at six-month intervals for two years. Using a standardised research diagnostic assessment instrument, the authors classified patients at baseline into primary and substance-induced psychosis groups and analysed the effects of gender on demographic, family, and clinical characteristics at baseline, the interaction of gender and diagnosis, and gender main effects on illness course, adjustment, and service use over the two-year follow-up period. Results: Women had better premorbid adjustment, less misattribution of symptoms, and a later age at onset of regular drug use compared to men. Women, however, showed greater depression and histories of abuse compared to men. Men had greater arrest histories. No interactions between gender and diagnosis were significant. Both genders in the primary and substance-induced psychosis groups showed clinical and functional improvement over the follow-up period despite the overall minimal use of mental health and substance abuse treatment services. Conclusions: Women and men with psychosis and substance use differ on several dimensions. The findings suggest the need for gender-specific treatment programming across both diagnostic groups. (Edited publisher abstract)