اختلالات مصرف مواد در میان بیماران روان پریشی اپیزود اول با درمان ساده

Objectives To examine the prevalence of substance use among treatment naïve patients with first episode psychosis presenting to a psychiatry outpatient clinic in India. Methods The study sample consisted of 139 first episode treatment naïve patients with psychosis from in and around Bangalore, a city in South India. Self as well as informant-reported data on type, use and duration of substance use as well as the severity of psychotic symptoms were collected using structured instruments. Urine toxicology screen was also conducted for six common drugs of abuse. Breath alcohol analysis was performed in all patients. Results Acute and transient psychosis was the most common diagnosis (42.4%). Overall, 20% of the population reported current substance use disorder (excluding nicotine). Current alcohol dependence was diagnosed among 17.3%, whereas cannabis dependence in 3.6%. Life time as well as current use of cannabis was less than 6%. While one patient reported inhalant abuse none reported use of amphetamine or opioids. There was very high concordance between reported drug use and urine toxicology screen. Conclusion The use of illicit drugs is substantially less among first episode drug naïve patients with psychosis in an Indian urban clinical setting compared to rates reported from developed countries like North America, Canada and UK.

Substance use among patients with psychotic disorders is reportedly higher than in the general population. Studies done in North America, Canada and UK have reported substance misuse in 20–50% first episode psychotic disorders [1], [2], [3], [4] and [5]. Cannabis, LSD, alcohol, amphetamine, cocaine etc. can induce psychotic symptoms. Cannabis and alcohol misuse have been found to be consistently higher among patients with first episode psychosis. High prevalence of smoking has also been reported [5]. In view of such a common association between substance use and psychosis, it is recommended that all first episode psychosis patients undergo thorough medical as well as neurological investigations and urine toxicological testing for drugs of abuse [6]. Standard guideline and text books recommend routine medical history of substance use along with urine toxicology screen as a part of initial assessment [7], [8] and [9]. The outcome of schizophrenia is reported to be better in developing country like India. Such a relatively better prognosis is attributed to a host of socio-cultural factors like lower expressed emotions, good social support as well as low prevalence of comorbid substance use disorder [10], [11] and [12]. Whether this holds true for psychosis in general or not, is a matter of debate. There is a marked variation in the use of substances across different parts of India. A large scale epidemiological study had reported alcohol as the most common substance of use followed by cannabis (3%) and opioids (0.7%). This study also reported about one third of alcohol users fulfilled the ICD 10 criteria for dependence [13]. A study specific to this area i.e. Karnataka has reported higher prevalence of alcohol use i.e. among men was 23% in rural areas and 41% in urban areas [14]. Thirty five percent of adults in India use some form of tobacco. Among them 21% adults use only smokeless tobacco, 9% only smoke and 5% smoke as well as use smokeless tobacco. Smokeless tobacco use is more common than smoking both in male and females [15]. In recent time, there is an increase in abuse of pharmaceuticals i.e. opioids, benzodiazepine in India as well as Southeast Asia [16]. Although India is reported to be one of the major exporters of amphetamine type stimulants (ATS), the reported use in the general population as well as clinical settings is very low. Presently, there are no data available on the prevalence of substance use among patients with first episode psychosis in clinical settings in India. Hence the current study was planned to look at prevalence of substance use among first episode, treatment naïve patients presenting with psychosis. To strengthen the study finding as well as to find the utility, we have included urine toxicological screen [17] for substance along with the routine assessment.