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The association between substance misuse and first-episode psychosis in a defined UK geographical area during the 1990s

Social Psychiatry and Psychiatric Epidemiology volume 46, pages 137–142 (2011)Cite this article

Abstract

Objective

The aim of this study was to examine the prevalence of all substance use disorders (SUD) and cannabis-specific SUDs reported in two first-episode epidemiological studies, conducted in the same catchment area, 5 years apart.

Methods

The prevalence of schizophrenia in Nottingham and Aetiology and Ethnicity of Schizophrenia and Other Psychoses studies included all people with a first-episode of psychosis between 1992 and 1994 and 1997 and 1999, respectively. Those individuals with a comorbid diagnosis of a SUD (ICD-10 harmful use or dependence) were identified.

Results

An upward (but not statistically significant) trend in all SUDs was found for the first-episode study population as a whole, between the two cohorts (11.9–18.2%). When analysed by age, a significant increase in cannabis-specific SUDs was observed for all first-episode cases aged 16–29 between cohorts (3.2–10.6%). When analysed by age and gender, a significant increase in all SUDs was apparent for female first-episode patients aged 16–29 between cohorts (6.1–24.2%), this same increase was not seen in male patients.

Conclusions

Illegal drug misuse is common in patients with a first-episode of psychosis. However, most concerning is that when both age and gender are considered, females with a first-episode of psychosis aged 16–29 show a highly significant rise in the prevalence of all SUDs over the 1990s. More recent drug use data from England and Wales shows that the prevalence of drug use in the 21st century is declining; further epidemiological studies are required to determine whether this is also the case in young female first-episode psychosis populations.

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References

  1. Cantor-Graae E, Nordstrom L, McNeil T (2001) Substance abuse in schizophrenia: a review of the literature and a study of correlates in Sweden. Schizophr Res 48:69–82

    Article  CAS  PubMed  Google Scholar 

  2. Owen RR, Fischer EP, Booth BM, Cuffel BJ (1996) Medication noncompliance and substance abuse among patients with schizophrenia. Psychiatr Serv 47:853–858

    CAS  PubMed  Google Scholar 

  3. Linszen DH, Dingemans PM, Lenior ME (1994) Cannabis abuse and the course or recent-onset schizophrenic disorder. Arch Gen Psychiatry 51:273–279

    CAS  PubMed  Google Scholar 

  4. Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK (1990) Comorbidity of mental disorders with alcohol and other drug abuse: results from the epidemiologic catchment area (ECA) study. JAMA 264:2511–2518

    Article  CAS  PubMed  Google Scholar 

  5. McCreadie RG (2002) Use of drugs, alcohol and tobacco by people with schizophrenia: case-control study. Br J Psychiatry 181:321–325

    Article  PubMed  Google Scholar 

  6. Green B, Young R, Kavanagh D (2005) Cannabis use and misuse prevalence among people with psychosis. Br J Psychiatry 187:306–313

    Article  PubMed  Google Scholar 

  7. Samele C, Patel M, Boydell J, Leese M, Wessely S, Murray R (2007) Physical illness and lifestyle risk factors in people with their first presentation of psychosis. Soc Psychiatry Psychiatr Epidemiol 42:117–124

    Article  PubMed  Google Scholar 

  8. Carrá G, Johnson S (2009) Variation in rates of comorbid substance use in psychosis between mental health settings and geographical areas in the UK: a systematic review. Soc Psychiatry Psychiatr Epidemiol 44:429–447

    Article  PubMed  Google Scholar 

  9. Larsen TK, Melle I, Auestad B, Friis F, Haahr U, Johannessen JO, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, McGlashan TH (2006) Substance abuse in first-episode non-affective psychosis. Schizophr Res 88:55–62

    Article  PubMed  Google Scholar 

  10. Moore TH, Zammit S, Lingford-Hughes A, Barnes TRE, Jones PB, Burke M, Lewis G (2007) Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 370:319–328

    Article  PubMed  Google Scholar 

  11. Hickman M, Vickerman P, Macleod J, Kirkbride J, Jones PB (2007) Cannabis and schizophrenia: model projections of the impact of the rise in cannabis use on historical and future trends in schizophrenia in England and Wales. Addiction 102:597–606

    Article  PubMed  Google Scholar 

  12. Brewin J, Cantwell R, Dalkin T, Fox R, Medley I, Glazebrook C, Kwiecinski R, Harrison G (1997) Incidence of schizophrenia in Nottingham: a comparison of two cohorts, 1978–80 and 1992–94. Br J Psychiatry 171:140–144

    Article  CAS  PubMed  Google Scholar 

  13. Fearon P, Kirkbride JB, Morgan C, Dazzan P, Morgan K, Lloyd T, Hutchinson G, Tarrant J, Fung WA, Holloway J, Mallett R, Harrison G, Leff J, Jones PB, Murray RM (2006) Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC ÆSOP study. Psychol Med 36:1541–1550

    Article  PubMed  Google Scholar 

  14. Jablensky A, Sartorius N, Ernberg G, Anker M, Korten A, Cooper JE, Day R, Bertelsen A (1992) Schizophrenia: manifestations, incidence, and course in different cultures—a World Health Organisation ten-country study. Psychol Med Monogr Suppl 20:1–97

    Article  CAS  PubMed  Google Scholar 

  15. World Health Organisation (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. WHO, Geneva

    Google Scholar 

  16. Cooper JE, Goodhead D, Craig T, Harris M, Howat J, Korer J (1987) The incidence of schizophrenia in Nottingham. Br J Psychiatry 151:619–626

    Article  CAS  PubMed  Google Scholar 

  17. World Health Organisation (1994) Schedules for the assessment in neuropsychiatry (SCAN) version 2.0. WHO, Geneva

    Google Scholar 

  18. Andreasen NC (1982) Negative symptoms in schizophrenia: definition and reliability. Arch Gen Psychiatry 39:784–788

    CAS  PubMed  Google Scholar 

  19. Bernadt MW, Murray RM (1986) Psychiatric disorder, drinking and alcoholism: what are the links? Br J Psychiatry 148:393–400

    Article  CAS  PubMed  Google Scholar 

  20. Kirkbride JB, Fearon P, Morgan C, Dazzan P, Morgan K, Tarrant J, Lloyd T, Holloway J, Hutchinson G, Leff JP, Mallett RM, Harrison GL, Murray RM, Jones PB (2006) Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center ÆSOP study. Arch Gen Psychiatry 63:250–258

    Article  PubMed  Google Scholar 

  21. SPSS for Windows (2005) Rel. 14.0.0 2005. SPSS Inc., Chicago

  22. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Hillsdale, NJ, Erlbaum

  23. Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191

    Article  PubMed  Google Scholar 

  24. Koster A, Lajer M, Lindhardt A, Rosenbaum B (2001) Gender differences in first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 43:940–946

    Article  Google Scholar 

  25. Hambrecht M, Hafner H (1996) Substance abuse and the onset of schizophrenia. Biol Psychiatry 40:1155–1163

    Article  CAS  PubMed  Google Scholar 

  26. Van Mastrigt S, Addington J, Addington D (2004) Substance misuse at presentation to an early psychosis program. Soc Psychiatry Psychiatr Epidemiol 39:69–72

    Article  PubMed  Google Scholar 

  27. Rabinowitz J, Bromet E, Lavelle J, Carlson G, Kovasznay B, Schwartz J (1998) Prevalence and severity of substance use disorders and onset of psychosis in first-admission psychotic patients. Psychol Med 28:1411–1419

    Article  CAS  PubMed  Google Scholar 

  28. Ramsay M, Partridge S (1999) Drug misuse declared in 1998: results from the British crime survey. Home Office Research Study 197. Home Office, London

    Google Scholar 

  29. Wade D, Harrigan S, Edwards J, Burgess PM, Whelan G, McGorry PD (2006) Substance misuse in first-episode psychosis: 15-month prospective follow-up study. Br J Psychiatry 189:229–234

    Article  CAS  PubMed  Google Scholar 

  30. Bartels SJ, Teague GB, Drake RE, Clark RE, Bush PW, Noordsy DL (1993) Substance abuse in schizophrenia: service utilization and costs. J Nerv Ment Dis 181:227–232

    Article  CAS  PubMed  Google Scholar 

  31. Zammit S, Allebeck P, Andreasson S, Lundberg I, Lewis G (2002) Self reported cannabis use as a risk factor for schizophrenia in swedish conscripts of 1969: historical cohort study. BMJ 325:1199–1201

    Article  PubMed  Google Scholar 

  32. Arseneault L, Cannon M, Poulton R, Murray R, Caspi A, Moffitt TE (2002) Cannabis use in adolescents and risk for adult psychosis: longitudinal prospective study. BMJ 325:1212–1213

    Article  PubMed  Google Scholar 

  33. Fergusson DM, Horwood LJ, Swain-Campbell NR (2003) Cannabis dependence and psychotic symptoms in young people. Psychol Med 33:15–21

    CAS  PubMed  Google Scholar 

  34. Bone C, Waldron SJ (1998) New trends in illicit cannabis cultivation in the United Kingdom of Great Britain and Northern Ireland. Bull Narc 50:117–128

    Google Scholar 

  35. Potter DJ, Clark P, Brown M (2005) Potency of R9-Thc and other cannabinoids in cannabis in England in 2005: implications for psychoactivity and pharmacology. J Forensic Sci 53:90–94

    Article  Google Scholar 

  36. Hoare J, Flatley J (2008) Drug misuse declared: findings from the 2007/08 British crime survey. Home Office Statistical Bulletin, 13/08. Home Office, London

    Google Scholar 

  37. Martin G, Wilkinson A, Kapur B (1988) Validation of self-reported cannabis use by urine analysis. Addict Behav 13:147–150

    Article  CAS  PubMed  Google Scholar 

  38. Kedzior K, Badcock J, Martin-Ivorson M (2006) Validity and consistency of self-reports regarding substance use in general research volunteers, including regular cannabis users and schizophrenia patients. Subst Use Misuse 41:743–750

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Psychiatry, Institute of Mental Health, The Sir Colin Campbell Building, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK

    Kim Donoghue & Gillian A. Doody

  2. The Mandala Centre, Gregory Boulevard, Nottingham, UK

    Ian Medley

  3. Nottinghamshire Healthcare NHS Trust, Duncan Macmillan House, Porchester Road, Mapperley, Nottingham, UK

    John Brewin

  4. Division of Psychiatry, University of Nottingham, A Floor, Queens Medical Centre, Nottingham, UK

    Cristine Glazebrook

  5. The Stein Centre, St Catherine’s Hospital, Derby Road, Birkenhead, UK

    Peter Mason

  6. Perinatal Mental Health Service, Department of Psychiatry, Southern General Hospital, 1345 Govan Road, Glasgow, Scotland, UK

    Roch Cantwell

  7. Department of Psychiatry, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Box 789, Cambridge, UK

    Peter B. Jones

  8. Academic Unit of Psychiatry, University of Bristol, Cotham House, Cotham Hill, Bristol, UK

    Glynn Harrison

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  1. Kim Donoghue
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Correspondence to Kim Donoghue.

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Donoghue, K., Medley, I., Brewin, J. et al. The association between substance misuse and first-episode psychosis in a defined UK geographical area during the 1990s. Soc Psychiatry Psychiatr Epidemiol 46, 137–142 (2011). https://doi.org/10.1007/s00127-009-0175-5

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  • DOI: https://doi.org/10.1007/s00127-009-0175-5

Keywords

  • Epidemiology
  • Substance misuse
  • Psychosis