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Stability of early-phase primary psychotic disorders with concurrent substance use and substance-induced psychosis

Department of Psychiatry, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, New York 10032

DEBORAH S. HASIN, PhD

Mailman School of Public Health, New York State Psychiatric Institute, Columbia University, New York

PATRICK E. SHROUT, PhD

Department of Psychology, New York University, New York

ROBERT E. DRAKE, MD, PhD

Department of Psychiatry, Dartmouth Medical School, Lebanon

BOANERGES DOMINGUEZ, MS

Mailman School of Public Health, Columbia University, New York

MICHAEL B. FIRST, MD and SHARON SAMET, MSW

New York State Psychiatric Institute, New York

BELLA SCHANZER, MD

Department of Psychiatry, Columbia University, New York, New York, USA

Correspondence: Professor Carol L. M. Caton, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, New York 10032, USA. Email: clc3{at}columbia.edu

Declaration of interest None. Funding detailed in Acknowledgements.

Background The stability of the diagnostic distinction between a substance-induced psychosis and a primary psychotic disorder co-occurring with substance use is not established.

Aims To describe DSM–IV diagnostic changes over 1 year and determine the predictive validity of baseline indicators of the substance-induced psychosis v. primary psychosis distinction.

Method We conducted a 1-year follow-up study of 319 psychiatric emergency department admissions with diagnoses of early-phase psychosis and substance use comorbidity.

Results Of those with a baseline DSM–IV diagnosis of substance-induced psychosis, 25% had a diagnosis of primary psychosis at follow-up. These patients had poorer premorbid functioning, less insight into psychosis and greater family mental illness than patients with a stable diagnosis of substance-induced psychosis. Reclassifying change cases to primary psychoses on follow-up, key baseline predictors of the primary/substance-induced distinction at 1 year also included greater family history of mental illness in the primary psychosis group.

Conclusions Further study of substance-induced psychoses should employ neuroscientific and behavioural approaches. Study findings can guide more accurate diagnoses at first treatment.

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BJP 2007 190: 915-91. [Full Text]