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35th AM (2025) - Poster Session
Improving Treatment Strategies for First-episode S ...
Improving Treatment Strategies for First-episode Substance-induced Psychosis
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Pdf Summary
This study investigates treatment and outcomes in patients experiencing first-episode substance-induced psychosis (SIP) compared to those with first-episode psychosis (FEP) without substance induction. A retrospective analysis of 174 patients aged 18-39 admitted to a Seattle tertiary hospital from 2021 to 2024 assessed demographics, long-acting injectable antipsychotic (LAI-AP) use, and rates of rehospitalization/ED visits.<br /><br />Key findings include that patients with first-episode SIP (n=84) were more likely to use cannabis (74%) than FEP patients (53%). Despite this, providers showed significantly less intent to initiate LAI-AP treatment in SIP patients (1.2%) versus FEP patients (33.3%), although actual LAI-AP administration was low in both groups (11.1% FEP; 1.2% SIP). Bayesian regression confirmed lower provider intent to prescribe LAI-AP to SIP patients. <br /><br />Kaplan-Meier analyses revealed no statistically significant differences in rehospitalization or emergency department visits within one year post-discharge between SIP and FEP groups, though SIP patients showed a trend toward higher rehospitalization risk (HR 1.75, 95% CI 0.99-3.12). Overall, both groups had comparable clinical risks despite differences in treatment approaches.<br /><br />The study highlights limited use of maintenance LAI-APs in SIP despite their efficacy and the evident risk of adverse outcomes similar to FEP. Lack of evidence-based guidelines for SIP management and provider hesitancy to use antipsychotic maintenance when substance use is suspected are noted challenges.<br /><br />Future directions include exploring clinician attitudes toward managing SIP, implementing standardized risk assessments (especially regarding cannabis), and studying comparative effectiveness of oral versus LAI antipsychotics in SIP to inform targeted interventions. Effective risk stratification and treatment guidelines for SIP are urgently needed to improve patient outcomes.<br /><br />Contact: johneun@uw.edu (University of Washington Psychiatry)
Keywords
substance-induced psychosis
first-episode psychosis
long-acting injectable antipsychotics
cannabis use
rehospitalization rates
emergency department visits
Bayesian regression analysis
Kaplan-Meier survival analysis
treatment hesitancy
risk stratification
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