Stefanis Nikos C, Dragovic Milan, Power Brian D, Jablensky Assen, Castle David, Morgan Vera A
School of Psychiatry and Clinical Neurosciences, The University of Western Australia, WA; Clinical Research Centre, North Metropolitan Health Service - Mental Health, Perth, WA.
School of Psychiatry and Clinical Neurosciences, The University of Western Australia, WA; Clinical Research Centre, North Metropolitan Health Service - Mental Health, Perth, WA; Peel and Rockingham Kwinana Mental Health Service, South Metropolitan Area Health Service, Perth, WA.
Schizophr Res. 2014 Jul;156(2-3):211-6. doi: 10.1016/j.schres.2014.04.003. Epub 2014 May 13.
We aimed to examine the association between illicit substance use and age at onset in psychotic disorders in an Australian cohort.
Retrospectively acquired information on substance use during the year prior to illness onset was collected from 1642 participants enrolled in the Australian National 2010 Survey of High Impact Psychosis study (SHIP), with an ICD-10 diagnosis of schizophrenia spectrum or affective psychosis. Latent class analysis was performed according to illicit substance use, using age as an active covariate; identified classes were subsequently validated. Cox regression was used to examine the independent contribution of the identified substance use classes and several confounding variables to the prediction of age at onset of psychosis.
Three classes according to substance use were identified: non-users (n=803), cannabis predominant users (n=582), and polysubstance users (n=257). For participants with schizophrenia spectrum disorders, cannabis predominant users had a higher hazard of earlier age at onset than for non-users (adjusted HR=1.38, 95% CI=1.2-1.6); polysubstance users had an even higher hazard (adjusted HR=1.95, 95% CI=1.5-2.4). In contrast, for participants with affective psychosis, cannabis predominant users (adjusted HR=1.10, 95% CI=0.8-1.4) and polysubstance users (adjusted HR=0.87, 95% CI=0.6-1.3) did not have a higher hazard of earlier age at onset compared with non-users.
Illicit substance use in the 12 months prior to psychosis onset has a differential effect on age at onset in schizophrenia spectrum and affective psychotic disorders. Our findings are compatible with the notion that illicit drugs bring forward age at onset in schizophrenia spectrum disorders but not affective psychotic disorders.
我们旨在研究澳大利亚一个队列中非法药物使用与精神障碍发病年龄之间的关联。
从参加2010年澳大利亚国家高影响力精神病研究（SHIP）的1642名参与者中，回顾性收集疾病发作前一年的药物使用信息，这些参与者的国际疾病分类第十版（ICD - 10）诊断为精神分裂症谱系或情感性精神病。根据非法药物使用情况进行潜在类别分析，将年龄作为一个活跃的协变量；随后对识别出的类别进行验证。使用Cox回归来检验识别出的药物使用类别和几个混杂变量对精神病发病年龄预测的独立贡献。
根据药物使用情况识别出三类：非使用者（n = 803）、以大麻为主的使用者（n = 582）和多物质使用者（n = 257）。对于精神分裂症谱系障碍的参与者，以大麻为主的使用者发病年龄较早的风险高于非使用者（调整后风险比[HR]=1.38，95%置信区间[CI]=1.2 - 1.6）；多物质使用者的风险更高（调整后HR = 1.95，95% CI = 1.5 - 2.4）。相比之下，对于情感性精神病的参与者，以大麻为主的使用者（调整后HR = 1.10，95% CI = 0.8 - 1.4）和多物质使用者（调整后HR = 0.87，95% CI = 0.6 - 1.3）与非使用者相比，发病年龄较早的风险并没有更高。
精神病发作前12个月内使用非法药物对精神分裂症谱系障碍和情感性精神病的发病年龄有不同影响。我们的研究结果与非法药物使精神分裂症谱系障碍发病年龄提前但不使情感性精神病发病年龄提前这一观点相符。
