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- Publisher Website: 10.1001/jamapsychiatry.2023.3582
- Scopus: eid_2-s2.0-85175741281
- PMID: 37755727
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Article: Transition to Schizophrenia Spectrum Disorder Following Emergency Department Visits Due to Substance Use with and Without Psychosis
Title | Transition to Schizophrenia Spectrum Disorder Following Emergency Department Visits Due to Substance Use with and Without Psychosis |
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Authors | |
Issue Date | 2023 |
Citation | JAMA Psychiatry, 2023, v. 80, n. 11, p. 1169-1174 How to Cite? |
Abstract | Importance: Episodes of substance-induced psychosis are associated with increased risk of developing a schizophrenia spectrum disorder. However, there are limited data on the transition risk for substance use without psychosis. Objectives: To quantify the risk of transition to schizophrenia spectrum disorder following an incident emergency department (ED) visit for (1) substance-induced psychosis and (2) substance use without psychosis and to explore factors associated with transition. Design, Settings, and Participants: A population-based retrospective cohort study (January 2008 to March 2022) of all individuals, aged 14 to 65 years, in Ontario, Canada, with no history of a psychotic disorder. Individuals with incident ED visits for substance use with and without psychosis were compared with members of the general population. Main Outcomes and Measures: Transition to schizophrenia spectrum disorder using a chart-validated algorithm. Associations between ED visits for substance use and subsequent transition were estimated using cause-specific hazard models. Results: The study included 9844497 individuals, aged 14 to 65 years (mean [SD] age, 40.2 [14.7] years; 50.2% female) without a history of psychosis. There were 407737 individuals with an incident ED visit for substance use, of which 13784 (3.4%) ED visits were for substance-induced psychosis. Individuals with substance-induced psychosis were at a 163-fold (age- and sex-adjusted hazard ratio [aHR], 163.2; 95% CI, 156.1-170.5) increased risk of transitioning, relative to the general population (3-year risk, 18.5% vs 0.1%). Individuals with an ED visit for substance use without psychosis had a lower relative risk of transitioning (aHR, 9.8; 95% CI, 9.5-10.2; 3-year risk, 1.4%), but incurred more than 3 times the absolute number of transitions (9969 vs 3029). Cannabis use had the highest transition risk among visits with psychosis (aHR, 241.6; 95% CI, 225.5-258.9) and the third-highest risk among visits without psychosis (aHR, 14.3; 95% CI, 13.5-15.2). Younger age and male sex were associated with a higher risk of transition, and the risk of male sex was greater in younger compared with older individuals, particularly for cannabis use. Conclusions and Relevance: The findings of this cohort study suggest that ED visits for substance use were associated with an increased risk of developing a schizophrenia spectrum disorder. Although substance-induced psychoses had a greater relative transition risk, substance use without psychosis was far more prevalent and resulted in a greater absolute number of transitions. Several factors were associated with higher transition risk, with implications for counseling and early intervention. |
Persistent Identifier | http://hdl.handle.net/10722/347079 |
ISSN | 2023 Impact Factor: 22.5 2023 SCImago Journal Rankings: 6.241 |
DC Field | Value | Language |
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dc.contributor.author | Myran, Daniel T. | - |
dc.contributor.author | Harrison, Lyndsay D. | - |
dc.contributor.author | Pugliese, Michael | - |
dc.contributor.author | Solmi, Marco | - |
dc.contributor.author | Anderson, Kelly K. | - |
dc.contributor.author | Fiedorowicz, Jess G. | - |
dc.contributor.author | Perlman, Christopher M. | - |
dc.contributor.author | Webber, Colleen | - |
dc.contributor.author | Finkelstein, Yaron | - |
dc.contributor.author | Tanuseputro, Peter | - |
dc.date.accessioned | 2024-09-17T04:15:14Z | - |
dc.date.available | 2024-09-17T04:15:14Z | - |
dc.date.issued | 2023 | - |
dc.identifier.citation | JAMA Psychiatry, 2023, v. 80, n. 11, p. 1169-1174 | - |
dc.identifier.issn | 2168-622X | - |
dc.identifier.uri | http://hdl.handle.net/10722/347079 | - |
dc.description.abstract | Importance: Episodes of substance-induced psychosis are associated with increased risk of developing a schizophrenia spectrum disorder. However, there are limited data on the transition risk for substance use without psychosis. Objectives: To quantify the risk of transition to schizophrenia spectrum disorder following an incident emergency department (ED) visit for (1) substance-induced psychosis and (2) substance use without psychosis and to explore factors associated with transition. Design, Settings, and Participants: A population-based retrospective cohort study (January 2008 to March 2022) of all individuals, aged 14 to 65 years, in Ontario, Canada, with no history of a psychotic disorder. Individuals with incident ED visits for substance use with and without psychosis were compared with members of the general population. Main Outcomes and Measures: Transition to schizophrenia spectrum disorder using a chart-validated algorithm. Associations between ED visits for substance use and subsequent transition were estimated using cause-specific hazard models. Results: The study included 9844497 individuals, aged 14 to 65 years (mean [SD] age, 40.2 [14.7] years; 50.2% female) without a history of psychosis. There were 407737 individuals with an incident ED visit for substance use, of which 13784 (3.4%) ED visits were for substance-induced psychosis. Individuals with substance-induced psychosis were at a 163-fold (age- and sex-adjusted hazard ratio [aHR], 163.2; 95% CI, 156.1-170.5) increased risk of transitioning, relative to the general population (3-year risk, 18.5% vs 0.1%). Individuals with an ED visit for substance use without psychosis had a lower relative risk of transitioning (aHR, 9.8; 95% CI, 9.5-10.2; 3-year risk, 1.4%), but incurred more than 3 times the absolute number of transitions (9969 vs 3029). Cannabis use had the highest transition risk among visits with psychosis (aHR, 241.6; 95% CI, 225.5-258.9) and the third-highest risk among visits without psychosis (aHR, 14.3; 95% CI, 13.5-15.2). Younger age and male sex were associated with a higher risk of transition, and the risk of male sex was greater in younger compared with older individuals, particularly for cannabis use. Conclusions and Relevance: The findings of this cohort study suggest that ED visits for substance use were associated with an increased risk of developing a schizophrenia spectrum disorder. Although substance-induced psychoses had a greater relative transition risk, substance use without psychosis was far more prevalent and resulted in a greater absolute number of transitions. Several factors were associated with higher transition risk, with implications for counseling and early intervention. | - |
dc.language | eng | - |
dc.relation.ispartof | JAMA Psychiatry | - |
dc.title | Transition to Schizophrenia Spectrum Disorder Following Emergency Department Visits Due to Substance Use with and Without Psychosis | - |
dc.type | Article | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1001/jamapsychiatry.2023.3582 | - |
dc.identifier.pmid | 37755727 | - |
dc.identifier.scopus | eid_2-s2.0-85175741281 | - |
dc.identifier.volume | 80 | - |
dc.identifier.issue | 11 | - |
dc.identifier.spage | 1169 | - |
dc.identifier.epage | 1174 | - |