F55. CLINICAL OUTCOMES ASSOCIATED WITH ILLICIT SUBSTANCE USE IN FIRST EPISODE PSYCHOSIS (FEP): A TEXT MINING STUDY OF ELECTRONIC HEALTH RECORDS

ObjectiveTo determine whether gender differences in symptom presentation at first episode psychosis (FEP) remain even when controlling for substance use, age and ethnicity, using natural language processing applied to electronic health records (EHRs).Design, setting and participantsData were extracted from EHRs of 3350 people (62% male patients) who had presented to the South London and Maudsley NHS Trust with a FEP between 1 April 2007 and 31 March 2017. Logistic regression was used to examine gender differences in the presentation of positive, negative, depressive, mania and disorganisation symptoms.Exposure(s) (for observational studies)Gender (male vs female).Main outcome(s) and measure(s)Presence of positive, negative, depressive, mania and disorganisation symptoms at initial clinical presentation.ResultsEight symptoms were significantly more prevalent in men (poverty of thought, negative symptoms, social withdrawal, poverty of speech, aggression, grandiosity, paranoia and agitation). Conversely, tearfulness, low energy, reduced appetite, low mood, pressured speech, mood instability, flight of ideas, guilt, mutism, insomnia, poor concentration, tangentiality and elation were more prevalent in women than men. Negative symptoms were more common among men (OR 1.85, 95% CI 1.33 to 2.62) and depressive and manic symptoms more common among women (OR 0.30, 95% CI 0.26 to 0.35). After adjustment for illicit substance use, the strength of associations between gender and negative, manic and depression symptoms increased, whereas gender differences in aggression, agitation, paranoia and grandiosity became insignificant.ConclusionsThere are clear gender differences in the clinical presentation of FEP. Our findings suggest that gender can have a substantial influence on the nature of clinical presentation in people with psychosis, and that this is only partly explained by exposure to illicit substance use.

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Illicit substance use and its correlates in first episode psychosis

Acta Psychiatrica Scandinavica ◽

10.1111/j.1600-0447.2009.01483.x ◽

2010 ◽

Vol 121 (5) ◽

pp. 351-358 ◽

Cited By ~ 40

Author(s):

R. Mazzoncini ◽

K. Donoghue ◽

J. Hart ◽

C. Morgan ◽

G. A. Doody ◽

...

Keyword(s):

Substance Use ◽

First Episode Psychosis ◽

First Episode ◽

Illicit Substance ◽

Illicit Substance Use ◽

Episode Psychosis

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Reductions in cannabis and other illicit substance use between treatment entry and early recovery in patients with first-episode psychosis

Early Intervention in Psychiatry ◽

10.1111/j.1751-7893.2007.00035.x ◽

2007 ◽

Vol 1 (3) ◽

pp. 259-266 ◽

Cited By ~ 16

Author(s):

Mark Hinton ◽

Jane Edwards ◽

Kathryn Elkins ◽

Susy M. Harrigan ◽

Kerri Donovan ◽

...

Keyword(s):

Substance Use ◽

First Episode Psychosis ◽

First Episode ◽

Early Recovery ◽

Illicit Substance ◽

Illicit Substance Use ◽

Episode Psychosis ◽

Treatment Entry

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Barriers and Facilitators That Influence Providers’ Ability to Educate, Monitor, and Treat Substance Use in First-Episode Psychosis Programs Using the Theoretical Domains Framework

Qualitative Health Research ◽

10.1177/1049732321993443 ◽

2021 ◽

pp. 104973232199344

Author(s):

Oladunni Oluwoye ◽

Elizabeth Fraser

Keyword(s):

Substance Use ◽

Behavior Change ◽

Theoretical Domains Framework ◽

First Episode Psychosis ◽

Barriers And Facilitators ◽

First Episode ◽

Evidence Based ◽

Behavior Change Techniques ◽

Episode Psychosis ◽

And Behavior

In this qualitative study, we explore providers’ experiences with addressing substance use among individuals with first-episode psychosis (FEP) enrolled in coordinated specialty care (CSC) programs. Three focus groups were conducted with 24 providers from CSC programs for FEP in Washington. Questions were focused on barriers and facilitators to addressing substance use using the Theoretical Domains Framework (TDF) as a guide. Thematic analysis was used to code all transcripts. Identified TDF domains were then mapped onto the COM-B (Capability, Opportunity, Motivation, Behavior) intervention functions and behavior change techniques. Seven theoretical domains were identified as the most relevant to addressing substance use: “Knowledge,” “Skills,” “Environmental Context and Resources,” “Social Influences,” “Social and Professional Role and Identity,” “Beliefs about Capabilities,” and “Reinforcement.” The use of the TDF provides a framework to explore barriers and facilitators for targeting substance use and suggestions for behavior change techniques when considering implementation of evidence-based strategies to enhance CSC models.

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