Substance Abuse in Early Onset Psychotic Disorders

Abstract

ABSTRACT Objectives: To examine patterns of substance use in youths with schizophrenia or other early onset psychotic disorders. Methods: Youths with psychotic disorders (onset before age 18 years) were assessed annually over two years using standardized diagnostic and symptom rating measures, including the Structured Clinical Interview for DSM-IV (SCID). Subjects with psychosis solely due to substance use were excluded. Subjects were between the ages of 6 and 17 years at study entry, with a mean age of 14.8 ± 2.2 years. Results: Thirty-nine percent of the 69 subjects met criteria for schizophrenia. Forty-five percent of the subjects met criteria for substance use disorders (i.e., substance abuse or dependence), and another 7% tried illicit substances without meeting criteria for abuse or dependence. Substance use disorders (SUDs) were not significantly associated with the type of psychotic illness, gender, ethnicity, socioeconomic status, severity of positive or negative symptoms at baseline, or other hypothesized risk factors (e.g., disruptive behavior disorders, familial substance abuse, and maltreatment). Subjects with SUDs had a significantly older age of entry into the study (p < .001). Subjects with co-occurring schizophrenia and SUDs used substances prior to the onset of psychosis and had a significantly older age of onset of psychosis (p < .021). Only 26% of youths with SUDs had received specific chemical dependency treatment. Conclusions: Substance abuse is a very significant and under-treated problem in this sample of youths with early onset psychosis. Efforts to identify specific risk factors and effective intervention strategies are needed.