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31 March 2006
Study findings suggest that schizophrenia may be precipitated by substance use or that the early-onset of psychotic symptoms could be a risk factor for such use.
Thomas Barnes (Imperial College Faculty of Medicine, London, UK) and colleagues found an earlier age at onset of psychosis in patients who reported a lifetime history of comorbid substance use, highlighting the need for systematic assessment of substance use in people who have recently developed schizophrenia.
A total of 152 people participating in the West London First-Episode Schizophrenia Study provided information on their drug and alcohol use, as well as age at onset of psychosis. The patients' mental state, cognition, and social function were also assessed.
Among the participants, 60% were smokers, 27% reported a history of problems with alcohol use, 35% reported current substance use not including alcohol, and 68% reported lifetime substance use, with cannabis and psychostimulants those most commonly used.
Overall, patients with a history of substance use, compared with those without such a history, were significantly younger at the time of their first psychiatric contact, at an average of 24.4 years versus 27.8 years, and at the onset of their psychotic symptoms, at 23.3 years versus 26.1 years.
Analysis indicated that both cannabis use and gender had independent effects on age at onset of psychosis, after adjusting for alcohol misuse and use of other drugs.
The age at onset of psychosis was, on average, 4.2 years older for women than for men, after adjusting for substance use, while cannabis use, compared with no use, was significantly associated with a younger onset, by an average of 5 years.
Writing in the British Journal of Psychiatry, the researchers note that there was no difference between those with and without comorbid substance use with regard to IQ or cognition, and both groups had similar levels of social function.
"These results confirm the high prevalence of lifetime substance use in first-episode patients with schizophrenia," say Barnes and co-workers.
"From a clinical perspective, given that such substance use tends to predict a poorer initial outcome, our findings reinforce the need to routinely assess and consider appropriate treatment intervention for substance use in people with schizophrenia when they first present to psychiatric services."
Source: Br J Psychiatry 2006; 188: 237–242
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