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Substance abuse and recent-onset psychosis
1. Diagnosis
9
with multiple admissions, we found that African-American patients were more than twice as likely to have more than two admissions (continuity corrected x2=8.76, Fisher's exact test p<.01) and men were more than twice as likely to have more than two admissions compared to women (continuity corrected x2=6.92, Fisher's exact test p<.01). Grouping this sample of individuals into separate diagnostic categories we found that patients with schizophrenia diagnoses are significantly more likely to have repeated admissions (continuity corrected x2=6.692, Fisher's exact test p<.01). No significant differences were found with regard to gender. Finally, the schizophrenia group has significantly more African-Americans with multiple admissions (continuity corrected x2= 14.725, Fisher's exact test p<.001). These preliminary findings suggest that while the rate of recidivism overall for our state hospital appears relatively high, this results from the frequent readmission of a small select group of individuals. These people could be considered treatment resistant or refractory, requiring more frequent hospitalizations and increased services. As researchers we need to determine what are the significant predictors in determining the frequency of readmission and as clinicians we need to recognize this group as an independent treatment challenge and begin to develop treatment options that address the complexity of these clients needs.
HAVE YOU SUFFERED VEXATION, GRIEF OR REVERSE OF FORTUNE? D. J. Smith,* K. Elkins, R M c G o r r y ORYGEN Research Centre, ORYGEN Youth Health, Parkville, VIC, Australia It has long been recognized that posttraumatic stress disorder (PTSD) coexists with a number of psychiatric diagnosis. Unrecognised postpsychotic PTSD may cloud the clinical formulation even in young people with first episode psychosis & if unrecognized may be untreated. PTSD symptoms such as withdrawal, amotivation, avoidance, and substance abuse may also militate against recovery from psychosis. Van der Kolk et al., (1996) suggested that symptoms of PTSD could be part of a multifaceted response (cognitive, affective, behavioural) to psychological trauma rather than the direct experience of external events or that trauma maybe subjectively as well as objectively perceived. Thus in the view of some, the experience of psychosis, which falls outside normal human experience, or the various treatment regimes used in the treatment of psychosis could be sufficient to precipitate the development of PTSD symptoms or caseness. We aimed to replicate an earlier study by McGorry et al ( 1991) which estimated the level of caseness of PTSD in a recent onset sample and examine the relationship between the potentially traumatic experiences of hospitalisation and psychotic and co-morbid psychopathology. The present study also aimed to validate Friedmans (1986) PTSD scale. Lower levels of PTSD cases were noted than in the original study, but still a significant proportion experienced problems. The mean level of PTSD symptomatology was reduced but was markedly less than noted casewise. Good concurrent validity was noted between the structured interview and the self-report measure for PTSD, with Cronbach's alpha showing good reliability. Compared to the 1991 study similar levels of correlation between depression and PTSD symptoms were found. PTSD symptoms were not correlated with the number or duration of traumatic events, admission status or time spent in high dependency care. Arousal and intrusive recollections were associated with subjective levels of stress during hospitalisation but avoidance symptoms of PTSD were not.
STABILITY OF EXPRESSION OF SCHIZOTYPAL NEGATIVE AND POSITIVE DIMENSIONS FROM ADOLESCENCE TO YOUNG ADULTHOOD E. Squires-Wheeler,* A. E. Skodol, L. E r l e n m e y e r - K i m l i n g Department of Medical Genetics, New York State Psychiatric Institute, New York, NY, USA While the negative and positive dimensions of schizotypal traits occur together in individuals at greater than chance level, (eg. r=.40[.000], r=.24[.000] and r=.35[.000] at assessment periods at average age 15, 24 and 28 years respectively), we have previously reported that the dimensions differ in terms of the pattern of cognitive correlates, the level of familial aggregation, and the pattern of comorbidity with Axis I and Axis II disorders. This differential pattern of external correlates suggests that negative and positive dimensions may differ in terms of underlying pathophysiology and etiology. We report here on 340 subjects drawn for the New York High Risk Project (excluding those individuals who developed an Axis I psychotic disorder) who were evaluated for negative and positive dimensions on at least two of three assessment periods. These subjects were evaluated by trained interviewers using standard structured diagnostic interviews with established reliability. Interviewers were blind to parental diagnostic status. The continuity of dimensions (quantified as correlations) between dimensional scores at ages 15 to 24, ages 15 to 28, and ages 24 to 28 are r=.36[.000], r=.32[.000] and r=.27[.000] for negative dimensions and r=.06[.39], r=-.03[.68] and r=.36[.000] for positive dimensions. We conclude that there is modest continuity of expression of negative dimensions from adolescence to young adulthood. Modest stability of expression of positive dimensions is limited to the young adulthood age period. The different longitudinal patterns offer some support for the independence of schizotypal dimensions. Further analyses of independence considering cross correlations over time (e.g., the correlation of negative dimensions at age 15 with positive dimensions at age 24) will be outlined. In summary, the results support the assumption that negative dimensions constitute traits while positive dimensions may be state-like phenomenon. Follow-up evaluation will be required to determine the robustness of this tentative conclusion.
SUBSTANCE ABUSE AND RECENT-ONSET PSYCHOSIS D. Wade,* R McGorry, S. Harrigan, G. W h e l a n , R B u r g e s s EPPIC, Orygen Research Centre, Parkville, VIC, Australia The evidence to date supports the notion that substance use disorders (SUDs) can adversely affect the course of serious mental illness in dual diagnosis patients, and that remission of SUDs results in greater clinical stability. However, the majority of studies to date have focussed on patient groups with chronic psychotic conditions. The present study utilizes a prospective design to follow-up patients (N=126) with a recent-onset psychosis for a period of 15 months. The design allows comparison of 3 patient groups, based on the course of SUD (never; ceased in post-psychotic phase; continued in post-psychotic phase), on outcome measures of clinical and global functioning. Results will be presented including: the rate and type of SUDs prior to the onset of psychosis; clinical and demographic predictors of SUDs; the rate of remission of SUDs in the recovery phase; and comparison of the 3 patient groups on outcome measures.
International Congress on Schizophrenia Research 2003
9
with multiple admissions, we found that African-American patients were more than twice as likely to have more than two admissions (continuity corrected x2=8.76, Fisher's exact test p<.01) and men were more than twice as likely to have more than two admissions compared to women (continuity corrected x2=6.92, Fisher's exact test p<.01). Grouping this sample of individuals into separate diagnostic categories we found that patients with schizophrenia diagnoses are significantly more likely to have repeated admissions (continuity corrected x2=6.692, Fisher's exact test p<.01). No significant differences were found with regard to gender. Finally, the schizophrenia group has significantly more African-Americans with multiple admissions (continuity corrected x2= 14.725, Fisher's exact test p<.001). These preliminary findings suggest that while the rate of recidivism overall for our state hospital appears relatively high, this results from the frequent readmission of a small select group of individuals. These people could be considered treatment resistant or refractory, requiring more frequent hospitalizations and increased services. As researchers we need to determine what are the significant predictors in determining the frequency of readmission and as clinicians we need to recognize this group as an independent treatment challenge and begin to develop treatment options that address the complexity of these clients needs.
HAVE YOU SUFFERED VEXATION, GRIEF OR REVERSE OF FORTUNE? D. J. Smith,* K. Elkins, R M c G o r r y ORYGEN Research Centre, ORYGEN Youth Health, Parkville, VIC, Australia It has long been recognized that posttraumatic stress disorder (PTSD) coexists with a number of psychiatric diagnosis. Unrecognised postpsychotic PTSD may cloud the clinical formulation even in young people with first episode psychosis & if unrecognized may be untreated. PTSD symptoms such as withdrawal, amotivation, avoidance, and substance abuse may also militate against recovery from psychosis. Van der Kolk et al., (1996) suggested that symptoms of PTSD could be part of a multifaceted response (cognitive, affective, behavioural) to psychological trauma rather than the direct experience of external events or that trauma maybe subjectively as well as objectively perceived. Thus in the view of some, the experience of psychosis, which falls outside normal human experience, or the various treatment regimes used in the treatment of psychosis could be sufficient to precipitate the development of PTSD symptoms or caseness. We aimed to replicate an earlier study by McGorry et al ( 1991) which estimated the level of caseness of PTSD in a recent onset sample and examine the relationship between the potentially traumatic experiences of hospitalisation and psychotic and co-morbid psychopathology. The present study also aimed to validate Friedmans (1986) PTSD scale. Lower levels of PTSD cases were noted than in the original study, but still a significant proportion experienced problems. The mean level of PTSD symptomatology was reduced but was markedly less than noted casewise. Good concurrent validity was noted between the structured interview and the self-report measure for PTSD, with Cronbach's alpha showing good reliability. Compared to the 1991 study similar levels of correlation between depression and PTSD symptoms were found. PTSD symptoms were not correlated with the number or duration of traumatic events, admission status or time spent in high dependency care. Arousal and intrusive recollections were associated with subjective levels of stress during hospitalisation but avoidance symptoms of PTSD were not.
STABILITY OF EXPRESSION OF SCHIZOTYPAL NEGATIVE AND POSITIVE DIMENSIONS FROM ADOLESCENCE TO YOUNG ADULTHOOD E. Squires-Wheeler,* A. E. Skodol, L. E r l e n m e y e r - K i m l i n g Department of Medical Genetics, New York State Psychiatric Institute, New York, NY, USA While the negative and positive dimensions of schizotypal traits occur together in individuals at greater than chance level, (eg. r=.40[.000], r=.24[.000] and r=.35[.000] at assessment periods at average age 15, 24 and 28 years respectively), we have previously reported that the dimensions differ in terms of the pattern of cognitive correlates, the level of familial aggregation, and the pattern of comorbidity with Axis I and Axis II disorders. This differential pattern of external correlates suggests that negative and positive dimensions may differ in terms of underlying pathophysiology and etiology. We report here on 340 subjects drawn for the New York High Risk Project (excluding those individuals who developed an Axis I psychotic disorder) who were evaluated for negative and positive dimensions on at least two of three assessment periods. These subjects were evaluated by trained interviewers using standard structured diagnostic interviews with established reliability. Interviewers were blind to parental diagnostic status. The continuity of dimensions (quantified as correlations) between dimensional scores at ages 15 to 24, ages 15 to 28, and ages 24 to 28 are r=.36[.000], r=.32[.000] and r=.27[.000] for negative dimensions and r=.06[.39], r=-.03[.68] and r=.36[.000] for positive dimensions. We conclude that there is modest continuity of expression of negative dimensions from adolescence to young adulthood. Modest stability of expression of positive dimensions is limited to the young adulthood age period. The different longitudinal patterns offer some support for the independence of schizotypal dimensions. Further analyses of independence considering cross correlations over time (e.g., the correlation of negative dimensions at age 15 with positive dimensions at age 24) will be outlined. In summary, the results support the assumption that negative dimensions constitute traits while positive dimensions may be state-like phenomenon. Follow-up evaluation will be required to determine the robustness of this tentative conclusion.
SUBSTANCE ABUSE AND RECENT-ONSET PSYCHOSIS D. Wade,* R McGorry, S. Harrigan, G. W h e l a n , R B u r g e s s EPPIC, Orygen Research Centre, Parkville, VIC, Australia The evidence to date supports the notion that substance use disorders (SUDs) can adversely affect the course of serious mental illness in dual diagnosis patients, and that remission of SUDs results in greater clinical stability. However, the majority of studies to date have focussed on patient groups with chronic psychotic conditions. The present study utilizes a prospective design to follow-up patients (N=126) with a recent-onset psychosis for a period of 15 months. The design allows comparison of 3 patient groups, based on the course of SUD (never; ceased in post-psychotic phase; continued in post-psychotic phase), on outcome measures of clinical and global functioning. Results will be presented including: the rate and type of SUDs prior to the onset of psychosis; clinical and demographic predictors of SUDs; the rate of remission of SUDs in the recovery phase; and comparison of the 3 patient groups on outcome measures.
International Congress on Schizophrenia Research 2003