Tarricone Ilaria, Boydell Jane, Panigada Serena, Allegri Fabio, Marcacci Thomas, Minenna Maria Gabriella, Kokona Arnisa, Triolo Federico, Storbini Viviana, Michetti Rossella, Morgan Craig, Di Forti Marta, Murray Robin M, Berardi Domenico
Department of Medical and Surgical Science, Section of Psychiatry, Bologna University, Italy; Bologna West Mental Health Department, Ausl Bologna, Italy; Department of Psychosis Studies, Institute of Psychiatry, King's College London, United Kingdom.
Department of Psychosis Studies, Institute of Psychiatry, King's College London, United Kingdom.
Schizophr Res. 2014 Mar;153(1-3):60-3. doi: 10.1016/j.schres.2014.01.014. Epub 2014 Feb 11.
Substance abuse is a well established risk factor for First-Episode Psychosis (FEP), but its influence on FEP course is less clear. Starting from our baseline observation that substance users were younger than non-users at the psychosis onset, we hypothesized that substance use at baseline could be an independent risk factor for a worse clinical course.
An incidence cohort of patients with FEP collected in an 8year period (2002-2009) at the Bologna West Community Mental Health Centers (CMHCs) was assessed at baseline and at 12month follow-up. Drop-out, hospitalizations and service utilization were used as clinical outcomes.
Most of the patients were still in contact with CMHC at 12month follow up. Substance users had a significantly higher rate of hospitalizations during the follow-up after adjusting for age, gender and other potential confounders (OR 5.84, 95% CI 2.44-13.97, p≤0.001).
This study adds to previous evidence showing the independent effect of substance use on FEP course. The identification of a "potentially modifiable" environmental predictor of the course of the illness such as substance use at psychosis onset allows us to envisage the possibility of ameliorating the course of the illness by managing this factor.
药物滥用是首发精神病（FEP）公认的危险因素，但其对FEP病程的影响尚不清楚。基于我们的基线观察，即精神病发作时药物使用者比非使用者年轻，我们假设基线时的药物使用可能是临床病程恶化的独立危险因素。
对在博洛尼亚西部社区心理健康中心（CMHCs）8年期间（2002 - 2009年）收集的FEP患者发病队列在基线和12个月随访时进行评估。将失访、住院次数和服务利用情况作为临床结局。
在12个月随访时，大多数患者仍与CMHC保持联系。在调整年龄、性别和其他潜在混杂因素后，药物使用者在随访期间的住院率显著更高（比值比5.84，95%置信区间2.44 - 13.97，p≤0.001）。
本研究补充了先前的证据，表明药物使用对FEP病程有独立影响。识别出疾病病程中一个“可能可改变的”环境预测因素，如精神病发作时的药物使用，使我们能够设想通过控制这一因素来改善疾病病程的可能性。
