Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
Nova Scotia Early Psychosis Program, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada.
Can J Psychiatry. 2020 Jun;65(6):426-435. doi: 10.1177/0706743720905201. Epub 2020 Feb 4.
Alcohol and cannabis misuse are common in patients with early phase psychosis (EPP); however, research has tended to focus primarily on cannabis misuse and EPP outcomes, with a relative lack of data on alcohol misuse. This retrospective cross-sectional EPP study investigated the relationship between cannabis, alcohol, and cannabis combined with alcohol misuse, on age, gender, psychotic, depressive and anxiety symptom severity, and social/occupational functioning, at entry to service.
Two-hundred and sixty-four EPP patients were divided into 4 groups based on substance use measured by the Alcohol, Smoking and Substance Involvement Screening Test: (1) no to low-level cannabis and alcohol misuse (LU), (2) moderate to high alcohol misuse only (AU), (3) moderate to high cannabis misuse only (CU), and (4) moderate to high alcohol and cannabis misuse (AU + CU).
We found significant between group differences in age (with the AU group being the oldest and AU + CU group the youngest) as well as gender (with the CU group having the highest percentage of men). There were also group differences in positive psychotic symptoms (lowest in AU group), trait anxiety (highest in AU + CU group), and social/occupational functioning (highest in AU group). Further regression analyses revealed a particularly strong relationship between AU + CU group and trait anxiety (3-fold increased odds of clinical trait anxiety for combined misuse of alcohol and cannabis compared to non/low users).
This study demonstrates the unique demographic and clinical characteristics found in the EPP population at entry to care associated with alcohol and cannabis misuse both separately and in combination. This work highlights the importance of including the assessment of alcohol misuse in addition to cannabis misuse in future treatment guidelines and research.
酒精和大麻滥用在早期精神病患者（EPP）中很常见；然而，研究往往主要集中在大麻滥用和 EPP 结果上，关于酒精滥用的数据相对较少。这项回顾性横断面 EPP 研究调查了进入服务时，大麻、酒精和大麻与酒精混合使用与年龄、性别、精神病、抑郁和焦虑症状严重程度以及社会/职业功能之间的关系。
根据酒精、吸烟和物质参与筛查测试（Alcohol, Smoking and Substance Involvement Screening Test）测量的物质使用情况，将 264 名 EPP 患者分为 4 组：（1）低水平的大麻和酒精滥用（LU），（2）中高水平的酒精滥用（AU），（3）中高水平的大麻滥用（CU），（4）中高水平的酒精和大麻滥用（AU + CU）。
我们发现组间在年龄（AU 组年龄最大，AU + CU 组年龄最小）和性别（CU 组男性比例最高）方面存在显著差异。在阳性精神病症状（AU 组最低）、特质焦虑（AU + CU 组最高）和社会/职业功能（AU 组最高）方面也存在组间差异。进一步的回归分析显示，AU + CU 组与特质焦虑之间存在特别强的关系（与非/低使用者相比，同时滥用酒精和大麻的患者出现临床特质焦虑的几率增加了 3 倍）。
这项研究表明，在进入护理时，EPP 人群中存在独特的人口统计学和临床特征，这些特征与酒精和大麻的单独和联合滥用有关。这项工作强调了在未来的治疗指南和研究中，除了大麻滥用外，还应包括酒精滥用评估的重要性。
