Early Substance Use Cessation Improves Cognition-10 Years Outcome in First-Episode Psychosis Patients

被引:6
作者
Weibell, Melissa A. [1 ,2 ]
Johannessen, Jan Olav [1 ,2 ]
Auestad, Bjorn [3 ,4 ]
Bramness, Jorgen [5 ,6 ]
Bronnick, Kolbjorn [1 ]
Haahr, Ulrik [4 ]
Joa, Inge [1 ,2 ]
Larsen, Tor Ketil [1 ,7 ]
Melle, Ingrid [6 ,8 ]
Opjordsmoen, Stein [6 ,8 ]
Rund, Bjorn Rishovd [9 ,10 ]
Rossberg, Jan Ivar [6 ,8 ]
Simonsen, Erik [11 ,12 ]
Vaglum, Per [13 ]
Stain, Helen [14 ]
Friis, Svein [6 ,8 ]
Hegelstad, Wenche ten Velden [1 ]
机构
[1] Stavanger Univ Hosp, Div Psychiat, TIPS Ctr Clin Res Psychosis, Stavanger, Norway
[2] Univ Stavanger, Fac Hlth, Stavanger, Norway
[3] Univ Stavanger, Dept Math & Phys, Stavanger, Norway
[4] Stavanger Univ Hosp, Res Dept, Stavanger, Norway
[5] Innland Hosp Trust, Norwegian Natl Advisory Unit Concurrent Subst Abu, Hamar, Norway
[6] Univ Oslo, Inst Clin Med, Fac Med, Oslo, Norway
[7] Univ Bergen, Inst Psychiat, Bergen, Norway
[8] Oslo Univ Hosp, Div Mental Hlth & Addict, Oslo, Norway
[9] Univ Oslo, Dept Psychol, Oslo, Norway
[10] Vestre Viken Hosp Trust, Drammen, Norway
[11] Psychiat Reg Zealand, Psychiat Res Unit, Slagelse, Denmark
[12] Univ Copenhagen, Fac Hlth & Med Sci, Inst Clin Med, Copenhagen, Denmark
[13] Univ Oslo, Dept Behav Sci Med, Oslo, Norway
[14] Leeds Trinity Univ, Sch Social & Hlth Sci, Leeds, W Yorkshire, England
来源
FRONTIERS IN PSYCHIATRY | 2019年 / 10卷
关键词
psychosis; substance use; cognition; neurocognition; first-episode psychosis; 1ST EPISODE PSYCHOSIS; 10-YEAR FOLLOW-UP; CANNABIS USE; USE DISORDER; PREMORBID ADJUSTMENT; ANTIPSYCHOTIC MEDICATION; NEUROCOGNITIVE FUNCTION; SCHIZOPHRENIA; DEFICITS; RISPERIDONE;
D O I
10.3389/fpsyt.2019.00495
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Background: Cognitive impairment may be a risk factor for, as well as a consequence of, psychosis. Non-remitting symptoms, premorbid functioning, level of education, and socioeconomic background are known correlates. A possible confounder of these associations is substance use, which is common among patients with psychosis and linked to worse clinical outcomes. Studies however show mixed results for the effect of substance use on cognitive outcomes. In this study, the long-term associations of substance use with cognition in a representative sample of first-episode psychosis patients were examined. Methods: The sample consisted of 195 patients. They were assessed for symptom levels, function, and neurocognition at 1, 2, 5, and 10 years after first treatment. Test scores were grouped into factor analysis-based indices: motor speed, verbal learning, visuomotor processing, verbal fluency, and executive functioning. A standardized composite score of all tests was also used. Patients were divided into four groups based on substance-use patterns during the first 2 years of treatment: persistent users, episodic users, stop-users, and nonusers. Data were analyzed using linear mixed effects modeling. Results: Gender, premorbid academic functioning, and previous education were the strongest predictors of cognitive trajectories. However, on motor speed and verbal learning indices, patients who stopped using substances within the first 2 years of follow-up improved over time, whereas the other groups did not. For verbal fluency, the longitudinal course was parallel for all four groups, while patients who stopped using substances demonstrated superior performances compared with nonusers. Persistent users demonstrated impaired visuomotor processing speed compared with nonusers. Within the stop- and episodic use groups, patients with narrow schizophrenia diagnoses performed worse compared with patients with other diagnoses on verbal learning and on the overall composite neurocognitive index. Discussion: This study is one of very few long-term studies on cognitive impairments in first-episode psychosis focusing explicitly on substance use. Early cessation of substance use was associated with less cognitive impairment and some improvement over time on some cognitive measures, indicating a milder illness course and superior cognitive reserves to draw from in recovering from psychosis.
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页数:9
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