Treatment targets identified in first-episode psychosis
medwireNews: Addressing multiple substance use disorder (SUD) should be a key aim of treatment in people with a first episode of psychosis who report substance use, Australian researchers say.
They also recommend focusing on patients’ social and occupational goals in order to “prevent SUDs becoming more severe or entrenched,” according to the report in EarlyIntervention in Psychiatry.
The research, by Shane Rebgetz (Queensland University of Technology, Caboolture) and colleagues, was a retrospective analysis of 432 people aged 16–29 years who were diagnosed with first-episode psychosis and comorbid SUD. Three-quarters of participants were male and 72% were diagnosed with a nonaffective psychosis.
All were enrolled into the Early Psychosis Prevention and Intervention Centre (EPPIC) program, which includes psychiatric assessments, outpatient case management, cognitive behavioral therapy, low-dose antipsychotic therapy, support groups, and mobile crisis intervention.
During the mean 14.5-month follow-up period, 61% of the cohort reduced their substance use compared with pre-admission levels.
Multivariate analysis identified two baseline variables that were significantly and independently associated with a reduction in substance use – namely, better premorbid functioning (measured on the Scale of Occupational and Functional Assessment) and use of cannabis only (as opposed to multiple substances), with adjusted odds ratios of 1.05 and 1.57, respectively.
Noting that this is the largest study conducted into the issue to date, Rebgetz et al conclude: “Further longitudinal research on the predictors of recovery from [substance use] in [early psychosis] is clearly required to refine our understanding of key targets for intervention and maximize positive outcomes.
“In addition, examination of outcomes with different substances is warranted and may lead to different treatments for different substances.”
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By Joanna Lyford, Senior medwireNews Reporter