World Congress of Psychiatry 2018
DIAGNOSTICS AND PROGNOSTIC ASSESSMENT OF THE FIRST PSYCHOTIC EPISODE COMORBID WITH THE CANNABIS ABUSE
Bereza, Z., MD.1, Petrova N., MD, PhD.2, Kibitov A, MD, PhD.3
1. Medical center Bechterev, Saint-Petersburg, Russia
2. Saint- Petersburg State University, Saint-Petersburg, Russia
3. Serbsky National Medical Research Center on Psychiatry and Addictions, Moscow, Russia.
Patients with "dual diagnosis" are a special group, in respect of which there is no single theoretical, clinical, therapeutic and organizational approach. The number of psychoses among cannabis and synthetic cannabinoid users is significantly increasing. The issues of comorbidity of mental disorders and cannabis abuse remain insufficiently studied.
Objective: To examine the specific clinical features of cannabis-induced psychotic disorder (CIPD) as compared to primary psychotic disorder with concurrent cannabis abuse (PPD + CA)
Material and methods: 36 (22 males and 14 females) inpatients were examined. 17 patients (12 males and 5 females) with PPD+ CA (ICD F 23.0+ F12.x) aged 25.2 (SD = 8,15) were examined as first group. Average duration of cannabis abuse was 5.85 (SD = 3.25) years. The second group consisted of 19 patients (10 males and 9 females) aged 24.2 (SD = 6.85) with Substance-Induced Psychotic Disorders due to cannabis abuse (ICD F12.5). Average duration of cannabis abuse was -1,75 (SD = 2,1) years. The two compared groups had no significant differences in age and sex.
Clinical, experimental, psychological (ASI-5, PANSS, MADRS, SCL-90, DAI-10) and statistical (Mann–Whitney U test for independent samples) methods were used. The mean values, standard deviations, median and quartiles were considered as statistical characteristics for quantitative indicators.
Results. The patients of the first group lived with their parents more often, were less likely to be married and have a permanent job than the patients of the second group (р<0,05). Family members of the patients of the first group had significantly more psychotic disorders (14%) or suicide attempts (6%) while among family members of patients of the second group alcohol abuse was more frequent (60%) (р<0,05).
Differences between groups in the age of the onset of cannabis abuse have not been found. The duration of systematic use of cannabinoids before the manifestation of psychosis and the daily dose in patients of the first group were higher than in the second group (р<0,005). According to anamnesis data patients with PPD+CA had significantly more remissions than the patients with CIPD (р<0,05).
Patients from the first group scored higher (p< 0,05) on ASI-5 scales "medical status", "mental health", "work and social status" than the patients from second group (which indicated a higher damage in these areas). Such scales as "family and social relations"," legal aspects " were affected more adversely in patients of the second group (р<0,05). Scores on the "drug use" scale (characterizing frequency and quantity of drugs use) showed no significant differences between two groups.
Data on the structure of the psychotic episode revealed that the patients of the second group initially had significantly higher scores on PANSS and most scales of SCL-90, which indicates more significant positive symptomatology compared to the patients of the first group. The rate of reduction of positive symptoms in patients with SIPD was higher than in the first group (р<0,01), and the duration of hospitalization was shorter. The severity of negative symptoms and the level of depression were higher in patients of the first group (р<0,05) and structural thought disorders were diagnosed more frequently (р<0,05). The structure of the psychotic episode in these patients revealed more non-congruent affective psychotic symptoms (р<0,05).
According to one-year follow-up study, in the patients of the second group adherence to the treatment was stricter, they were more likely to be included in rehabilitation programs (50% and 20%), among them there were more people who abstained from using cannabis (60% and 30% (р<0,01). Among the patients of both groups who took part in rehabilitation programs for addicts, relapses of mental disorder were less frequent (16% and 60%; р<0,005).
Discussion. So, possible differential factors specific to PPD + SA which indicate that it might be distinct from SIPD include: a weaker family history of psychotic disorder and suicides; inferior social characteristics, more frequent remissions; fewer positive symptoms and higher negative symptoms; slower reduction of symptomology, worse adherence to rehabilitation. Similar studies show different and even sometimes contradictory results.
Conclusion. There are no strictly defined phenomenological and anamnestic differential diagnostic characteristics PPD + SA and SIPD. Genetic analysis is required to establishing diagnosis.