Ellilä Venla, Taipale Heidi, Tiihonen Jari, Mittendorfer-Rutz Ellenor, Niemelä Solja
Department of Psychiatry, University of Turku, Turku, Finland.
Niuvanniemi Hospital, Kuopio, Finland.
Addiction. 2025 Jul;120(7):1422-1430. doi: 10.1111/add.70014. Epub 2025 Feb 11.
Substance-induced psychoses (SIP) have the potential to relapse and convert into schizophrenia-spectrum disorders. However, risk factors associated with SIP relapse remain unknown. The aim of this study was to measure the incidence and risk of SIP relapse and associating risk factors.
DESIGN, SETTING AND PARTICIPANTS: Population based register study that identified people with first-time SIP between 2006 and 2016 (n = 7320) from Swedish nation-wide registers to examine incidence of relapse and associated risk factors during 2-year follow-up. Participants were censored to death, emigration and the diagnosis of other psychotic illness. Risk factors associated with relapse were studied using multivariable Cox models.
SIP was measured via related diagnostic codes (ICD-10: F1x.5) collected from the National Patient Register (NPR). SIP relapse was measured as hospitalization due to SIP during 2-year follow-up also collected from the NPR. Potential risk factors included demographic characteristics, psychiatric comorbidities, sickness absence and disability pension collected from nationwide registers.
Of the study population (n = 7320), 20.0% (n = 1463) had a SIP relapse during the follow-up (median time 126 days, interquartile range 56-321) and 83.3% had the same type of SIP as their first SIP. Relapse was most common for those whose first SIP was induced by cannabis (25.7%), followed by multi-substance use (23.8%) and (meth)amphetamine (19.7%). Factors associated with SIP relapse were previous substance use disorder [hazard ratio (HR) = 1.37, 95% confidence interval (CI) = 1.20-1.56], younger age (16-29 years, HR = 1.29, 95% CI = 1.05-1.58, versus 50-65), being born abroad (HR = 1.23, 95% CI = 1.07-1.41), attention deficit hyperactivity disorder (HR = 1.21, 95% CI = 1.05-1.39), having had 1-90 days sick leave during the previous year (HR = 1.19, 95% CI = 1.01-1.44), and cannabis- (HR = 2.42, 95% CI = 1.98-2.96), (meth)amphetamine- (HR = 1.49, 95% CI = 1.23-1.81) or multi-substance- (HR = 1.81, 95% CI = 1.52-2.15) induced psychosis compared with alcohol-induced psychosis.
In Sweden, 20% of people with substance-induced psychosis between 2006 and 2016 had a relapse within 2 years follow-up. Cannabis-induced psychosis had the shortest time lapse between episodes. Risk factors for relapse included attention deficit hyperactivity disorder, substance-use disorder, younger age, previous sickness absence and being born outside Sweden.
物质所致精神病（SIP）有可能复发并转变为精神分裂症谱系障碍。然而，与SIP复发相关的危险因素仍然未知。本研究的目的是测量SIP复发的发生率和风险以及相关危险因素。
设计、背景与参与者：基于人群的登记研究，从瑞典全国登记处识别出2006年至2016年间首次发生SIP的人群（n = 7320），以检查2年随访期间的复发发生率及相关危险因素。参与者因死亡、移民和其他精神病诊断而被截尾。使用多变量Cox模型研究与复发相关的危险因素。
通过从国家患者登记处（NPR）收集的相关诊断代码（ICD - 10：F1x.5）来测量SIP。SIP复发通过2年随访期间因SIP住院来测量，同样从NPR收集。潜在危险因素包括从全国登记处收集的人口统计学特征、精神疾病共病、病假和残疾抚恤金。
在研究人群（n = 7320）中，20.0%（n = 1463）在随访期间出现SIP复发（中位时间126天，四分位间距56 - 321），83.3%的复发类型与首次SIP相同。首次SIP由大麻诱发者复发最为常见（25.7%），其次是多种物质使用（23.8%）和（甲基）苯丙胺（19.7%）。与SIP复发相关的因素包括既往物质使用障碍[风险比（HR）= 1.37，95%置信区间（CI）= 1.20 - 1.56]、年龄较小（16 - 29岁，HR = 1.29，95% CI = 1.05 - 1.58，与50 - 65岁相比）、出生在国外（HR = 1.23，95% CI = 1.07 - 1.41）、注意力缺陷多动障碍（HR = 1.21，95% CI = 1.05 - 1.39）、前一年有1 - 90天病假（HR = 1.19，95% CI = 1.01 - 1.44），以及与酒精所致精神病相比大麻（HR = 2.42，95% CI = 1.98 - 2.96）、（甲基）苯丙胺（HR = 1.49，95% CI = 1.23 - 1.81）或多种物质（HR = 1.81，95% CI = 1.52 - 2.15）所致精神病。
在瑞典，2006年至2016年间20%的物质所致精神病患者在2年随访内复发。大麻所致精神病发作间隔时间最短。复发的危险因素包括注意力缺陷多动障碍、物质使用障碍、年龄较小、既往病假和出生在瑞典境外。
