Stone J M, Fisher H L, Major B, Chisholm B, Woolley J, Lawrence J, Rahaman N, Joyce J, Hinton M, Johnson S, Young A H
Imperial College London, London, UK.
Institute of Psychiatry, King's College London, London, UK.
Psychol Med. 2014 Feb;44(3):499-506. doi: 10.1017/S0033291713000883. Epub 2013 May 24.
Cannabis use has been reported to be associated with an earlier onset of symptoms in patients with first-episode psychosis, and a worse outcome in those who continue to take cannabis. In general, studies have concentrated on symptoms of psychosis rather than mania. In this study, using a longitudinal design in a large naturalistic cohort of patients with first-episode psychosis, we investigated the relationship between cannabis use, age of presentation to services, daily functioning, and positive, negative and manic symptoms.
Clinical data on 502 patients with first-episode psychosis were collected using the MiData audit database from seven London-based Early Intervention in psychosis teams. Individuals were assessed at two time points--at entry to the service and after 1 year. On each occasion, the Positive and Negative Syndrome Scale, Young Mania Rating Scale and Global Assessment of Functioning Scale disability subscale were rated. At both time points, the use of cannabis and other drugs of abuse in the 6 months preceding each assessment was recorded.
Level of cannabis use was associated with a younger age at presentation, and manic symptoms and conceptual disorganization, but not with delusions, hallucinations, negative symptoms or daily functioning. Cannabis users who reduced or stopped their use following contact with services had the greatest improvement in symptoms at 1 year compared with continued users and non-users. Continued users remained more symptomatic than non-users at follow-up.
Effective interventions for reducing cannabis use may yield significant health benefits for patients with first-episode psychosis.
据报道，首次发作精神病患者使用大麻与症状更早出现有关，且持续使用大麻的患者预后更差。总体而言，研究主要集中在精神病症状而非躁狂症状上。在本研究中，我们采用纵向设计，对一大群首次发作精神病患者进行自然主义队列研究，调查了大麻使用、就诊年龄、日常功能以及阳性、阴性和躁狂症状之间的关系。
使用来自伦敦七个早期干预精神病团队的MiData审计数据库收集了502例首次发作精神病患者的临床数据。在两个时间点对个体进行评估——进入服务时和1年后。每次评估时，评定阳性与阴性症状量表、青年躁狂评定量表和功能总体评定量表残疾分量表。在两个时间点，均记录每次评估前6个月内大麻及其他滥用药物的使用情况。
大麻使用水平与就诊时年龄较小、躁狂症状和概念紊乱有关，但与妄想、幻觉、阴性症状或日常功能无关。与持续使用者和非使用者相比，在接触服务后减少或停止使用大麻的使用者在1年后症状改善最大。随访时，持续使用者的症状仍比非使用者更严重。
减少大麻使用的有效干预措施可能会给首次发作精神病患者带来显著的健康益处。
