Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 7;49(5):1269-1280.
doi: 10.1093/schbul/sbad013.

Differences in Patterns of Stimulant Use and Their Impact on First-Episode Psychosis Incidence: An Analysis of the EUGEI Study

Elisa Rodríguez-Toscano  1   2   3 , Clara Alloza  3   4 , David Fraguas  1   3   4 , Manuel Durán-Cutilla  3 , Laura Roldán  2 , Teresa Sánchez-Gutiérrez  5 , Gonzalo López-Montoya  3   5 , Mara Parellada  3   4 , Carmen Moreno  3   4 , Charlotte Gayer-Anderson  6 , Hannah E Jongsma  7   8 , Marta Di Forti  9 , Diego Quattrone  9 , Eva Velthorst  10   11   12 , Lieuwe de Haan  12 , Jean-Paul Selten  13   14 , Andrei Szöke  15   16   17 , Pierre-Michel Llorca  18 , Andrea Tortelli  19 , Julio Bobes  20 , Miguel Bernardo  21 , Julio Sanjuán  22 , José Luis Santos  23 , Manuel Arrojo  24 , Ilaria Tarricone  25 , Domenico Berardi  26 , Mirella Ruggeri  27 , Antonio Lasalvia  27   28 , Laura Ferraro  29 , Caterina La Cascia  29 , Daniele La Barbera  29 , Paulo Rossi Menezes  30 , Cristina Marta Del-Ben  31 ; EU-GEI WP2 Group; Bart P Rutten  14 , Jim van Os  14   32   33 , Peter B Jones  8   34 , Robin M Murray  33 , James B Kirkbride  7 , Craig Morgan  6 , Covadonga M Díaz-Caneja  3   4 , Celso Arango  3   4
Collaborators, Affiliations

Differences in Patterns of Stimulant Use and Their Impact on First-Episode Psychosis Incidence: An Analysis of the EUGEI Study

Elisa Rodríguez-Toscano et al. Schizophr Bull. .

Abstract

Background: Use of illegal stimulants is associated with an increased risk of psychotic disorder. However, the impact of stimulant use on odds of first-episode psychosis (FEP) remains unclear. Here, we aimed to describe the patterns of stimulant use and examine their impact on odds of FEP.

Methods: We included patients with FEP aged 18-64 years who attended psychiatric services at 17 sites across 5 European countries and Brazil, and recruited controls representative of each local population (FEP = 1130; controls = 1497). Patterns of stimulant use were described. We computed fully adjusted logistic regression models (controlling for age, sex, ethnicity, cannabis use, and education level) to estimate their association with odds of FEP. Assuming causality, we calculated the population-attributable fractions for stimulant use associated with the odds for FEP.

Findings: Prevalence of lifetime and recent stimulant use in the FEP sample were 14.50% and 7.88% and in controls 10.80% and 3.8%, respectively. Recent and lifetime stimulant use was associated with increased odds of FEP compared with abstainers [fully adjusted odds ratio 1.74,95% confidence interval (CI) 1.20-2.54, P = .004 and 1.62, 95% CI 1.25-2.09, P < .001, respectively]. According to PAFs, a substantial number of FEP cases (3.35% [95% CI 1.31-4.78] for recent use and 7.61% [95% CI 3.68-10.54] for lifetime use) could have been prevented if stimulants were no longer available and the odds of FEP and PAFs for lifetime and recent stimulant use varied across countries.

Interpretation: Illegal stimulant use has a significant and clinically relevant influence on FEP incidence, with varying impacts across countries.

Keywords: amphetamines; first episode psychosis; methamphetamine; population attributable fractions; stimulant use.

PubMed Disclaimer

Conflict of interest statement

Dr. Fraguas has been a consultant and/or has received fees from Angelini, Casen-Recardati, Janssen, Lundbeck, and Otsuka. He has also received grant support from Instituto de Salud Carlos III (Spanish Ministry of Science and Innovation) and from Fundación Alicia Koplowitz. Dr. Díaz-Caneja has received honoraria from Exeltis and Angelini. Dr. Arango has been a consultant to or has received honoraria or grants from Acadia, Angelini, Boehringer, Gedeon Richter, Janssen Cilag, Lundbeck, Minerva, Otsuka, Pfizer, Roche, Sage, Servier, Shire, Schering Plough, Sumitomo Dainippon Pharma, Sunovion and Takeda. Dr. Bernardo has been a consultant for, received grant/research support and honoraria from, and been on the speakers/advisory board of ABBiotics, Adamed, Angelini, Casen Recordati, Janssen-Cilag, Menarini, Rovi, and Takeda. Dr. Murray has received honoraria from Janssen, Sunovian, Otsuka, and Lundbeck. Dr. Moreno has received honoraria as a consultant and/or advisor and/or for lectures from Angelini, Esteve, Exeltis Janssen, Lundbeck, Neuraxpharm, Nuvelution, Otsuka, Pfizer, Servier, and Sunovion outside the submitted work. The other authors have no conflicts of interest to declare. Dr. Jones has received an honorarium from MSD.

Figures

Fig. 1.
Fig. 1.
Raw and fully adjusted ORs of first-episode psychosis for lifetime patterns of stimulant use and the combined measure of cocaine and/or stimulant use for the whole sample. Raw ORs are adjusted for age, sex, and ethnicity, whereas fully adjusted ORs were additionally adjusted for recent and lifetime cannabis use and education level. Error bars represent 95% of CIs. The reference group for both raw and fully adjusted ORs is abstainers (recent or lifetime, accordingly). Asterisks represent significant ORs (P < .05). CI, confidence interval; OR, odds ratio.
Fig. 2.
Fig. 2.
Fully adjusted ORs and PAFs of psychotic disorder for recent or lifetime use for the whole sample and across countries. In bold, PAFs are shown in percentages. Error bars represent 95% of CIs. CI, confidence interval; OR, odds ratio; PAF, population attributable fraction. *P < .05.
See this image and copyright information in PMC

References

    1. UNODC, United Nations Office on Drugs and Crime. Core team: Beate Hammond (coordination), Juan Carlos Araneda, Conor Crean, Jakub Gregor, Alice Hamilton, Raggie Johansen, Kristina Kuttnig, Sabrina Levissianos, Shawn Kelley, Tun Nay Soe. Global Amphetamine-Type Stimulant Assessment: Amphetamine and Ecstasy. New York, NY: United Nations Publication; 2011.
    1. UNODC, United Nations Office on Drugs and Crime. World Drug Report. New York, NY: United Nations Publication; 2009.
    1. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Schizophrenia Bulletin 2021: Prevalence of Drug Use. 2021.
    1. Brunette MF, Mueser KT, Babbin S, et al. . Demographic and clinical correlates of substance use disorders in first episode psychosis. Schizophr Res. 2018;19.:4–12. doi: 10.1016/j.schres.2017.06.039. - DOI - PubMed
    1. Barnes TRE, Mutsatsa SH, Hutton SB, Watt HC, Joyce EM.. Comorbid substance use and age at onset of schizophrenia. Br J Psychiatry J Ment Sci. 2006;18.:237–242. doi: 10.1192/bjp.bp.104.007237. - DOI - PubMed

Publication types

Substances