Screening for substance use disorders in first-episode psychosis: Implications for readmission

• Published in: Schizophrenia research 2013-05, Vol.146 (1), p.125-131
• Main Authors: Batalla, Albert, Garcia-Rizo, Clemente, Castellví, Pere, Fernandez-Egea, Emili, Yücel, Murat, Parellada, Eduard, Kirkpatrick, Brian, Martin-Santos, Rocío, Bernardo, Miguel
• Format: Article
• Language: English
• Subjects: Addictive behaviors; Adolescent; Adult; Adult and adolescent clinical studies; Age Factors; Biological and medical sciences; Cannabis; Drug addiction; Female; First-episode psychosis; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Life Style; Male; Medical sciences; Middle Aged; Other psychotic disorders; Patient Readmission - statistics & numerical data; Proportional Hazards Models; Psychiatric Status Rating Scales; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychometrics. Diagnostic aid systems; Psychopathology. Psychiatry; Psychoses; Psychotic Disorders - etiology; Psychotic Disorders - prevention & control; Readmission; ROC Curve; Screening; Sex Factors; Substance use; Substance-Related Disorders - classification; Substance-Related Disorders - complications; Techniques and methods; Young Adult
• ISSN: 0920-9964; 1573-2509
• DOI: 10.1016/j.schres.2013.02.031

Abstract Introduction Screening of substance use may prove useful to prevent readmission after the first episode of psychosis. The aim of the present study was to evaluate the influence of drug use on readmission risk in a first-episode psychosis sample, and to determine whether the cannabis/cocaine subscale of the Dartmouth Assessment of Lifestyle Inventory (DALI) is a better predictive instrument than urinary analysis. Methods After admission, first-episode psychotic patients were interviewed for substance use and assessed with the DALI scale. They also underwent blood and urine sampling. Time to readmission was studied as a dependent outcome. The Kaplan–Meier estimator was applied to estimate the survival curves for bivariate analysis. The Cox proportional hazards model for multivariate analysis was assessed in order to control for potential confounders. ROC curve and validity parameters were used to assess validity to detect readmission. Results Fifty-eight patients were included. The DALI cannabis/cocaine subscale and urinalysis were associated with increased readmission risk in survival curves, mainly the first five years of follow-up. After controlling for potential confounding variables for readmission, only the DALI cannabis/cocaine subscale remained as a significant risk factor. In terms of validity, the DALI cannabis/cocaine subscale was more sensitive than urinalysis. Alcohol assessments were not related to readmission. Conclusions The findings demonstrated that a quick screening self-report scale for cannabis/cocaine use disorders is superior to urinary analysis for predicting readmission. Future research should consider longitudinal assessments of brief validated screening tests in order to evaluate their benefits in preventing early readmission in first-episode psychosis.