Objective:

The objective of this study was to clarify the etiology of substance-induced psychotic disorder and its progression to schizophrenia in a Swedish national sample.

Methods:

Individuals with a registration of substance-induced psychotic disorder between 1997 and 2015 in national medical registries (N=7,606) were followed up for a mean of 84 months. Data from medical, criminal, and pharmacy registries on first-degree through third-degree relatives were used to calculate familial risk scores for nonaffective psychosis, drug abuse, and alcohol use disorder.

Results:

Individuals with substance-induced psychotic disorder had large elevations in standardized familial risk scores for drug abuse (+1.09, 95% CI=1.02, 1.15) and alcohol use disorder (+0.98, 95% CI=0.93, 1.03) and modest elevations for nonaffective psychosis (+0.35, 95% CI=0.30, 0.41). The cumulative risk for progression to schizophrenia was 11.3%; it was lowest for alcohol-induced and highest for cannabis-induced psychotic disorder, and it was predicted by early age at diagnosis of substance-induced psychotic disorder, male sex, and further registrations for episodes of drug abuse, alcohol use disorder, and substance-induced psychotic disorder. A risk prediction model found that 47% of individuals who converted to schizophrenia were in the upper 20% of risk. Familial risk scores for drug abuse and alcohol use disorder did not significantly discriminate those who converted to schizophrenia from those who did not, while familial risk score for nonaffective psychosis did (0.67, 95% CI=0.40, 0.95, versus 0.33, 95% CI=0.28, 0.39). Familial risk scores for nonaffective psychosis were indistinguishable between individuals with schizophrenia with and without prior substance-induced psychosis. Assignment of early retirement by the Swedish Social Insurance Agency strongly discriminated between individuals with substance-induced psychotic disorder with and without later schizophrenia.

Conclusions:

Substance-induced psychotic disorder appears to result from substantial drug exposure in individuals at high familial risk for substance abuse and moderately elevated familial risk for psychosis. Familial risk for psychosis, but not substance abuse, predicts progression from substance-induced psychosis to schizophrenia. Schizophrenia following substance-induced psychosis is likely a drug-precipitated disorder in highly vulnerable individuals, not a syndrome predominantly caused by drug exposure.

中文翻译：

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瑞典国家样本中物质诱发的精神病性疾病发作及其发展为精神分裂症的预测。

客观的：

这项研究的目的是在瑞典国家样本中阐明物质诱发的精神病性疾病的病因及其向精神分裂症的进展。

方法：

在1997年至2015年间，在国家医学注册机构（N = 7,606）中对物质诱发的精神病性疾病进行注册的个体平均接受了84个月的随访。从一级，三级亲属的医学，刑事和药学登记处获得的数据用于计算非情感性精神病，药物滥用和饮酒障碍的家族风险评分。

结果：

物质诱发的精神病患者的标准药物滥用家族风险评分（+1.09，95％CI = 1.02，1.15）和酒精使用障碍（+0.98，95％CI = 0.93，1.03）都有较大的升高非情感性精神病（+0.35，95％CI = 0.30，0.41）。进展为精神分裂症的累积风险为11.3％；对于酒精引起的精神病性疾病最低，而对大麻引起的精神病性疾病的发生率最高，并且在诊断为药物诱发的精神病性疾病，男性，以及药物滥用，酒精滥用症和药物发作的进一步登记时，可以根据年龄的预测进行预测。引起的精神病。风险预测模型发现，转化为精神分裂症的个体中有47％处于风险的最高20％。药物滥用和饮酒障碍的家族风险评分没有明显地区分未转化为精神分裂症的人与未转化为精神分裂症的人，而非情感性精神病的家族风险评分则为（0.67，95％CI = 0.40，0.95，0.33，95％CI = 0.28，0.39）。非情感性精神病的家族性风险评分在患有精神分裂症的患者与没有接受过物质诱发的精神病的患者之间是无法区分的。瑞典社会保险局分配的提前退休，在有精神分裂症和没有精神分裂症的情况下，强烈区分了患有物质诱发性精神病的人。非情感性精神病的家族性风险评分在患有精神分裂症的患者与没有接受过物质诱发的精神病的患者之间是无法区分的。瑞典社会保险局分配的提前退休，在有精神分裂症和没有精神分裂症的情况下，强烈区分了患有物质诱发性精神病的人。非情感性精神病的家族性风险评分在患有精神分裂症的患者与没有接受过物质诱发的精神病的患者之间是无法区分的。瑞典社会保险局分配的提前退休，在有精神分裂症和没有精神分裂症的情况下，强烈区分了患有物质诱发性精神病的人。

结论：

物质诱发的精神病性疾病似乎是由于药物滥用的家族性风险高而精神病的家族性风险中度升高的个体大量接触药物引起的。家族性精神病的风险，而非药物滥用的风险，预示着从物质诱发的精神病向精神分裂症的发展。物质诱发的精神病后的精神分裂症在高度脆弱的人群中很可能是药物引起的疾病，而不是主要由药物暴露引起的综合征。