Queen Margaret Hospital,Whitefield Road,Dunfermline,Fife, KY12 0SU,UK.
Hairmyres Hospital,Eaglesham Road,East Kilbride,Glasgow G75 8RG,UK.
Psychol Med. 2017 Oct;47(14):2548-2555. doi: 10.1017/S0033291717001118. Epub 2017 May 3.
The potential for drugs of abuse to induce acute psychotic symptoms is well recognised. However, the likelihood of transition from initial substance-induced psychotic disorder (SIPD) to chronic psychosis is much less well understood. This study investigated the rate of SIPD transition to schizophrenia (F20), the time to conversion and other possible related factors.
Using data from the Scottish Morbidity Record, we examined all patients (n = 3486) since their first admission to psychiatric hospital with a diagnosis of SIPD [International Classification of Diseases, Tenth Revision (ICD-10) codes F10-F19, with third digit five] from January 1997 to July 2012. Patients were followed until first episode of schizophrenia (ICD-10 code F20, with any third digit) or July 2012. Any change in diagnosis was noted in the follow-up period, which ranged from 1 day to 15.5 years across the groups.
The 15.5-year cumulative hazard rate was 17.3% (s.e. = 0.007) for a diagnosis of schizophrenia. Cannabis, stimulant, opiate and multiple drug-induced psychotic disorder were all associated with similar hazard rates. The mean time to transition to a diagnosis of schizophrenia was around 13 years, although over 50% did so within 2 years and over 80% of cases presented within 5 years of SIPD diagnosis. Risk factors included male gender, younger age and longer first admission.
SIPD episodes requiring hospital admission for more than 2 weeks are more likely to be associated with later diagnosis of schizophrenia. Follow-up periods of more than 2 years are needed to detect the majority of those individuals who will ultimately develop schizophrenia.
药物滥用导致急性精神病症状的可能性已得到充分认识。然而，从最初的物质引起的精神病障碍（SIPD）向慢性精神病过渡的可能性则知之甚少。本研究调查了 SIPD 向精神分裂症（F20）过渡的发生率、转换时间和其他可能的相关因素。
使用苏格兰发病率记录的数据，我们检查了 1997 年 1 月至 2012 年 7 月期间首次因 SIPD [国际疾病分类，第十版（ICD-10）编码 F10-F19，第三位数为 5]入院的所有患者（n = 3486）。患者随访至首次出现精神分裂症（ICD-10 编码 F20，任何第三位数）或 2012 年 7 月。在随访期间记录了任何诊断的变化，各组的随访时间从 1 天到 15.5 年不等。
15.5 年的累积危险率为 17.3%（标准误=0.007），诊断为精神分裂症。大麻、兴奋剂、阿片类药物和多种药物引起的精神病障碍的危险率相似。从 SIPD 诊断到转换为精神分裂症的平均时间约为 13 年，尽管超过 50%的患者在 2 年内发生，超过 80%的病例在 SIPD 诊断后 5 年内出现。危险因素包括男性、年龄较小和首次入院时间较长。
需要住院治疗超过 2 周的 SIPD 发作更有可能与随后的精神分裂症诊断相关。需要超过 2 年的随访期才能发现大多数最终会发展为精神分裂症的个体。
