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Rates and Predictors of Conversion to Schizophrenia or Bipolar Disorder Following Substance-Induced Psychosis
American Journal of Psychiatry ( IF 17.7 ) Pub Date : 2017-11-28 , DOI: 10.1176/appi.ajp.2017.17020223
Marie Stefanie Kejser Starzer 1 , Merete Nordentoft 1 , Carsten Hjorthøj 1
Affiliation  

Objective:

The authors investigated the rates of conversion to schizophrenia and bipolar disorder after a substance-induced psychosis, as well as risk factors for conversion.

Method:

All patient information was extracted from the Danish Civil Registration System and the Psychiatric Central Research Register. The study population included all persons who received a diagnosis of substance-induced psychosis between 1994 and 2014 (N=6,788); patients were followed until first occurrence of schizophrenia or bipolar disorder or until death, emigration, or August 2014. The Kaplan-Meier method was used to obtain cumulative probabilities for the conversion from a substance-induced psychosis to schizophrenia or bipolar disorder. Cox proportional hazards regression models were used to calculate hazard ratios for all covariates.

Results:

Overall, 32.2% (95% CI=29.7–34.9) of patients with a substance-induced psychosis converted to either bipolar or schizophrenia-spectrum disorders. The highest conversion rate was found for cannabis-induced psychosis, with 47.4% (95% CI=42.7–52.3) converting to either schizophrenia or bipolar disorder. Young age was associated with a higher risk of converting to schizophrenia. Self-harm after a substance-induced psychosis was significantly linked to a higher risk of converting to both schizophrenia and bipolar disorder. Half the cases of conversion to schizophrenia occurred within 3.1 years after a substance-induced psychosis, and half the cases of conversion to bipolar disorder occurred within 4.4 years.

Conclusions:

Substance-induced psychosis is strongly associated with the development of severe mental illness, and a long follow-up period is needed to identify the majority of cases.



中文翻译:

物质诱发的精神病后转化为精神分裂症或双相情感障碍的比率和预测因素

客观的:

作者研究了物质诱发的精神病后转化为精神分裂症和躁郁症的比率,以及转化的危险因素。

方法:

所有患者信息均摘自丹麦民事登记系统和精神病学中央研究登记册。研究人群包括1994年至2014年间所有被诊断为物质诱发的精神病的人(N = 6,788);随访患者直至首次出现精神分裂症或双相情感障碍或死亡,移民或2014年8月。使用Kaplan-Meier方法获得从物质诱发的精神病向精神分裂症或双相情感障碍转化的累积概率。使用Cox比例风险回归模型来计算所有协变量的风险比。

结果:

总体而言,有32.2%(95%CI = 29.7-34.9)的物质引起的精神病患者转变为躁郁症或精神分裂症患者。大麻引起的精神病转化率最高,有47.4%(95%CI = 42.7-52.3)转化为精神分裂症或躁郁症。年龄越小,患精神分裂症的风险就越高。物质诱发的精神病后的自我伤害与转化为精神分裂症和躁郁症的较高风险显着相关。转化为精神分裂症的病例中有一半发生在物质诱发的精神病发生后的3.1年内,而转化为躁郁症的病例中有一半发生在4.4年内。

结论:

物质诱发的精神病与严重的精神疾病的发展密切相关,需要较长的随访期才能确定大多数病例。

更新日期:2018-04-01
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