Substance-induced psychosis or psychosis with substance use?

Background

Substance use disorder (SUD) is a well-recognized comorbidity in schizophrenia spectrum disorders, and rates of substance use are significantly higher among patients with first-episode psychosis (FEP) than in the general population (1). When a patient presenting with FEP has co-occurring substance use, such as cannabis or stimulant use, it can be extremely difficult to distinguish by clinical presentation whether the psychosis is substance-induced (SIP) or a primary psychosis, where substance use is only temporally connected (2). We do know, however, that patients presenting with FEP diagnosed as a SIP have high conversion rates into the schizophrenia spectrum in the following years (3).

Current knowledge on the efficacy of antipsychotic treatment among persons with FEP and comorbid SUD is scarce, and we know even less about treatment of FEP-SIP. Real-world treatment outcomes of patients with psychotic disorders and SUD have been examined in nationwide register-based studies (4). A recent study found evidence to support the use of clozapine, LAI formulations of second-generation antipsychotics other than olanzapine, or oral aripiprazole to prevent hospitalization in FEP and co-occurring cannabis use disorder (CUD) (5). There is a need for more research to guide clinicians in their decision making when patients present with FEP and co-occurring substance use.

Objectives

This interactive, hands-on skills-building workshop will include three case vignettes concerning differential diagnostics, course and treatment of psychosis with co-occurring substance use. Participants will discuss the cases in small groups (15 min per case) after which there will be a general discussion led by the facilitators (10 min), as well as brief fact sheets concerning the most recent literature relevant to each case. To close, the participants will have the chance to bring forth own cases and experiences relevant to the topic (15 min).