Sara Grant E, Burgess Philip M, Malhi Gin S, Whiteford Harvey A, Hall Wayne C
InforMH, Macquarie Hospital, PO Box 169, North Ryde NSW 1670 Australia (
J Clin Psychiatry. 2014 Apr;75(4):349-56. doi: 10.4088/JCP.13m08878.
Substance abuse adds to diagnostic uncertainty in psychosis and may increase the risk of transition from brief and affective psychoses to schizophrenia. This study examined whether comorbid substance disorder was associated with diagnostic instability and progression from other psychosis diagnoses to schizophrenia and whether effects differed for cannabis and stimulant-related disorders.
We identified 24,306 individuals admitted to hospital with an ICD-10 psychosis diagnosis between 2000 and 2011. We examined agreement between initial diagnosis and final diagnosis over 2-5 years and predictors of diagnostic change toward and away from a final diagnosis of schizophrenia.
Nearly half (46%) of participants with initial brief, atypical, or drug-induced psychoses were later diagnosed with schizophrenia. Persisting illicit drug disorders did not increase the likelihood of progression to schizophrenia (OR = 0.97; 95% CI, 0.89-1.04) but increased the likelihood of revision of index psychosis diagnosis away from schizophrenia (OR = 1.55; 95% CI, 1.40-1.71). Cannabis disorders predicted an increased likelihood of progression to schizophrenia (OR =1.12; 95% CI, 1.01-1.24), while stimulant disorders predicted a reduced likelihood (OR = 0.81; 95% CI, 0.67-0.97). Stimulant disorders were associated with greater overall diagnostic instability.
Many people with initial diagnoses of brief and affective psychoses are later diagnosed with schizophrenia. Cannabis disorders are associated with diagnostic instability and greater likelihood of progression to schizophrenia. By contrast, comorbid stimulant disorders may be associated with better prognosis in psychosis, and it may be important to avoid premature closure on a diagnosis of schizophrenia when stimulant disorders are present.
物质滥用增加了精神病诊断的不确定性，并可能增加从短暂性和情感性精神病转变为精神分裂症的风险。本研究探讨了共病物质障碍是否与诊断不稳定性以及从其他精神病诊断进展为精神分裂症有关，以及大麻和兴奋剂相关障碍的影响是否存在差异。
我们确定了2000年至2011年间因国际疾病分类第十版（ICD-10）精神病诊断而住院的24306名个体。我们研究了2至5年内初始诊断与最终诊断之间的一致性，以及诊断向精神分裂症最终诊断转变和远离该诊断的预测因素。
近一半（46%）最初被诊断为短暂性、非典型性或药物性精神病的参与者后来被诊断为精神分裂症。持续存在的非法药物障碍并未增加进展为精神分裂症的可能性（比值比[OR]=0.97；95%置信区间[CI]，0.89-1.04），但增加了索引精神病诊断从精神分裂症转变的可能性（OR=1.55；95%CI，1.40-1.71）。大麻障碍预示着进展为精神分裂症的可能性增加（OR=1.12；95%CI，1.01-1.24），而兴奋剂障碍则预示着可能性降低（OR=0.81；95%CI，0.67-0.97）。兴奋剂障碍与总体诊断不稳定性更大有关。
许多最初被诊断为短暂性和情感性精神病的人后来被诊断为精神分裂症。大麻障碍与诊断不稳定性以及进展为精神分裂症的可能性更大有关。相比之下，共病兴奋剂障碍可能与精神病的预后较好有关，当存在兴奋剂障碍时，避免过早确诊为精神分裂症可能很重要。
