Dartmouth Medical School and Dartmouth Psychiatric Research Center, Lebanon, NH 03766, USA.
Am J Psychiatry. 2011 Jul;168(7):742-8. doi: 10.1176/appi.ajp.2011.10071051. Epub 2011 Mar 31.
The authors examined treatment utilization and outcomes over 2 years among patients admitted to emergency departments with early-phase primary or substance-induced psychosis. The main hypothesis was that patients with substance-induced psychosis would have a more benign course of illness than those with primary psychosis
Using a prospective naturalistic cohort study design, the authors compared 217 patients with early-phase primary psychosis plus substance use and 134 patients with early-phase substance-induced psychosis who presented to psychiatric emergency departments at hospitals in Upper Manhattan. Assessments at baseline and at 6, 12, 18, and 24 months included psychiatric diagnoses, service use, and institutional outcomes using the Psychiatric Research Interview for Substance and Mental Disorders; psychiatric symptoms using the Positive and Negative Syndrome Scale; social, vocational, and family functioning using the World Health Organization Psychiatric Disability Assessment Schedule; and life satisfaction using the Quality of Life Interview. Longitudinal analyses were conducted using generalized estimating equations.
Participants with primary psychosis were more likely to receive antipsychotic and mood-stabilizing medications, undergo hospitalizations, and have outpatient psychiatric visits; those with substance-induced psychosis were more likely to receive addiction treatments. Only a minority of each group received minimally adequate treatments. Both groups improved significantly over time on substance dependence, psychotic symptoms, homelessness, and psychosocial outcomes, and few group-by-time interactions emerged.
Patients presenting to Upper Manhattan emergency departments with either early-phase primary psychosis or substance-induced psychosis improved steadily over 2 years despite minimal use of mental health and substance abuse services.
作者研究了在急诊部门因早期原发性或物质诱发的精神病入院的患者在 2 年内的治疗利用和结局。主要假设是物质诱发的精神病患者的疾病过程会比原发性精神病患者更良性。
使用前瞻性自然队列研究设计，作者比较了在曼哈顿上城区医院精神科急诊就诊的 217 例早期原发性精神病合并物质使用和 134 例早期物质诱发精神病患者。基线和 6、12、18 和 24 个月的评估包括使用物质和精神障碍的精神病研究访谈进行的精神病诊断、服务利用和机构结局；使用阳性和阴性综合征量表评估精神病症状；使用世界卫生组织精神残疾评估量表评估社会、职业和家庭功能；使用生活质量访谈评估生活满意度。使用广义估计方程进行了纵向分析。
原发性精神病患者更有可能接受抗精神病药和情绪稳定剂治疗、住院治疗和门诊精神病治疗；物质诱发精神病患者更有可能接受成瘾治疗。每个组中只有少数人接受了最低限度的充分治疗。两组在物质依赖、精神病症状、无家可归和心理社会结局方面均随着时间的推移显著改善，很少出现组间时间交互作用。
尽管精神卫生和药物滥用服务的使用很少，但在曼哈顿上城区急诊就诊的早期原发性精神病或物质诱发精神病患者在 2 年内稳步改善。
