Duration of Untreated Disorder and Cannabis Use: An Observational Study on a Cohort of Young Italian Patients Experiencing Psychotic Experiences and Dissociative Symptoms
Abstract
:1. Introduction
1.1. Psychosis and Duration of Untreated Psychosis (DUP)
1.2. Cannabis Use and First Episode Psychosis (FEP)
2. Materials and Methods
2.1. Participants
- -
- a group with a DUP < 1 year, considered as short DUP;
- -
- a group with a DUP ≥ 1 year, considered as long DUP.
- -
- a group comprising patients with persistent use of cannabis in quantities equal to or greater than 15 joints per week who met the DSM-5 diagnostic criteria for CUD (CUD+ group);
- -
- a group comprising patients without a prior history of CUD (CUD− group).
2.2. Measurements
- -
- PANSS [43] is based on two established psychiatric rating systems and is a 30-item questionnaire conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology. It thus constitutes 3 subscales (i.e., positive, negative, and psychopathology) measuring positive and negative syndromes and general severity of illness [43];
- -
- The GAF scale [44] is a single measure of overall psychosocial impairment caused by mental factors, constituting Axis V of the DSM, third and fourth versions. It is a clinician-rated scale for evaluating the level of psychological, social, and occupational functioning on a continuum from 0 to 100 [45];
- -
- The DES-II [46] is a self-report questionnaire that measures dissociative experiences, such as derealization, depersonalization, absorption, and amnesia. The DES-II has been prevalently used as a screening tool in patients suffering from psychotic disorders or schizophrenia to evaluate the dissociative experience [47]. The DES [48] comprises 28 items based on the assumption of a ‘dissociative continuum’ ranging from a mild alteration to severe dissociation. Subjects are asked to select their choices for topics, such as experiences of amnesia, absorption, depersonalization, and derealization. Cronbach’s alpha for this instrument in the present sample was 0.812, suggesting a good internal consistency.
2.3. Statistical Analysis
3. Results
3.1. Demographical and Clinical Characteristics of the Sample
3.2. Cannabis Use and Duration of Untreated Psychosis
3.3. Psychometric Scores
3.4. Psychometric Scores and Cannabis Use
4. Discussion
- -
- the greater negative symptomatology represented by patients with DUP ≥ 1 year and CUD−, which could be explained by a greater intensity and persistence of positive symptoms in CUD+ patients, therefore masking the negative ones, being a longer DUP determining the intensity and persistence of negative symptoms [56];
- -
- the major dissociative symptomatology presented by CUD+ patients both in the case of short and long DUP. The presence of a high level of dissociative symptoms in FEP and in general in psychosis is consistent with the current literature and recently investigated by our group, that showed how dissociation is a typical feature of schizophrenia spectrum disorder associated with CUD [19,57]. This form of psychosis associated with substance use represents a modern clinical presentation of schizophrenia spectrum disorder, also frequently observed in adolescents and young adults, as recently reported [19,58].
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | DUP < 1 Year (N = 31) | DUP ≥ 1 Year (N = 31) | Statistics | p |
---|---|---|---|---|
Age in years (SD) | 21.6 (3.5) | 22.4 (4.4) | −0.862 | 0.392 a |
Gender, female, n (%) | 14 (45.2) | 16 (51.6) | 0.58 | 0.611 b |
Current cannabis use disorder, n (%) | 16 (51.6) | 16 (51.6) | 0.000 | 1.000 b |
Marital status, n (%) | 2.200 | 0.333 b | ||
Not married | 24 (77.4) | 21 (67.7) | ||
Married | 6 (19.4) | 10 (32.3) | ||
Divorced | 1 (3.2) | 0 (0) | ||
Educational level, n (%) | 0.404 | 0.817 b | ||
Student | 11 (35.5) | 11 (35.5) | ||
Worker | 10 (32.3) | 12 (38.7) | ||
Unemployed | 10 (32.3) | 8 (25.8) | ||
Care setting, inpatients, n (%) | 26 (83.9) | 26 (83.9) | 0.000 | 1.000 b |
Suicide attempts, n (%) | 5 (16.1) | 4 (12.9) | 1.000 c | |
Other substances sporadic use, n (%) | 20 (64.5) | 16 (51.6) | 1.060 | 0.303 b |
Smoking, n (%) | 16 (51.6) | 20 (64.5) | 1.060 | 0.303 b |
Variables | CUD+ (N = 32) | CUD− (N = 30) | Statistics | p |
---|---|---|---|---|
DUP in weeks (SD) | 77.4 (77) | 81.7 (77.7) | 0.115 | 0.909 |
Total Patients N = 62 | DUP < 1 Year (N = 31) | DUP ≥ 1 Year (N = 31) | T | p | Effect Size (D) |
---|---|---|---|---|---|
PANSS—positive | |||||
T0 | 27.45 ± 4.01 | 31.16 ± 5.39 | −3.075 | 0.003 | 0.78 |
T1 | 25.10 ± 4.55 | 29.10 ± 4.92 | −3.323 | 0.002 | 0.84 |
T2 | 23.03 ± 4.76 | 28.16 ± 5.42 | −3.959 | <0.001 | 1.01 |
PANSS—negative | |||||
T0 | 21.52 ± 3.41 | 26.74 ± 4.43 | −5.204 | <0.001 | 1.32 |
T1 | 20.13 ± 2.99 | 25.03 ± 4.29 | −5.220 | <0.001 | 1.33 |
T2 | 18.97 ± 2.73 | 24.52 ± 4.07 | −6.311 | <0.001 | 1.60 |
PANSS—general | |||||
T0 | 59.19 ± 9.75 | 58.10 ± 5.90 | 0.536 | 0.594 | 0.14 |
T1 | 54.16 ± 9.67 | 55.68 ± 6.92 | −0.710 | 0.481 | 0.18 |
T2 | 50.23 ± 10.14 | 53.77 ± 6.33 | −1.653 | 0.104 | 0.42 |
PANSS—total | |||||
T0 | 108.16 ± 11.51 | 116.00 ± 8.36 | −3.069 | 0.003 | 0.78 |
T1 | 99.39 ± 11.21 | 109.81 ± 9.74 | −3.908 | <0.001 | 0.99 |
T2 | 92.23 ± 11.78 | 106.45 ± 8.94 | −5.354 | <0.001 | 1.36 |
GAF | |||||
T0 | 48.61 ± 4.88 | 48.32 ± 5.87 | 0.212 | 0.833 | 0.05 |
T1 | 52.68 ± 4.32 | 50.45 ± 5.31 | 1.810 | 0.075 | 0.46 |
T2 | 58.61 ± 4.11 | 54.68 ± 3.28 | 4.165 | <0.001 | 1.06 |
DES | |||||
T0 | 29.65 ± 6.05 | 34.29 ± 7.56 | −2.671 | 0.010 | 0.68 |
T1 | 26.19 ± 6.63 | 33.06 ± 7.82 | −3.733 | <0.001 | 0.95 |
T2 | 25.16 ± 6.77 | 30.16 ± 8.60 | −2.544 | 0.014 | 0.65 |
DUP in Weeks | |
---|---|
PANSS—positive | |
T0 | 0.137 (0.287) |
T1 | 0.152 (0.239) |
T2 | 0.218 (0.089) |
PANSS—negative | |
T0 | 0.381 (0.002) |
T1 | 0.375 (0.003) |
T2 | 0.469 (<0.001) |
PANSS—general | |
T0 | −0.041 (0.749) |
T1 | 0.059 (0.649) |
T2 | 0.103 (0.427) |
PANSS—total | |
T0 | 0.202 (0.116) |
T1 | 0.251 (0.049) |
T2 | 0.333 (0.008) |
GAF | |
T0 | 0.013 (0.921) |
T1 | −0.146 (0.258) |
T2 | −0.284 (0.025) |
DES | |
T0 | 0.157 (0.224) |
T1 | 0.221 (0.084) |
T2 | 0.035 (0.788) |
DUP < 1 year | CUD− (n = 15) | CUD+ (n = 16) | t | p | |
PANSS—positive | |||||
T0 | 26.00 ± 2.36 | 28.81 ± 4.78 | −2.097 | 0.048 | |
T1 | 22.93 ± 3.75 | 27.13 ± 4.38 | −2.853 | 0.008 | |
T2 | 20.13 ± 3.74 | 25.75 ± 3.99 | −4.036 | 0.000 | |
PANSS—negative | |||||
T0 | 20.40 ± 3.09 | 22.56 ± 3.44 | −1.836 | 0.077 | |
T1 | 19.20 ± 2.37 | 21.00 ± 3.31 | −1.732 | 0.094 | |
T2 | 18.53 ± 2.59 | 19.38 ± 2.87 | −0.855 | 0.399 | |
PANSS—general | |||||
T0 | 58.27 ± 8.44 | 60.06 ± 11.04 | −0.506 | 0.617 | |
T1 | 53.93 ± 8.75 | 54.38 ± 10.75 | −0.125 | 0.901 | |
T2 | 49.60 ± 10.53 | 50.81 ± 10.06 | −0.328 | 0.745 | |
PANSS—total | |||||
T0 | 104.67 ± 8.45 | 111.44 ± 13.21 | −1.687 | 0.102 | |
T1 | 96.07 ± 9.00 | 102.50 ± 12.42 | −1.642 | 0.111 | |
T2 | 88.27 ± 11.57 | 95.94 ± 11.06 | −1.887 | 0.069 | |
GAF | |||||
T0 | 50.67 ± 4.61 | 46.69 ± 4.44 | 2.449 | 0.021 | |
T1 | 54.40 ± 4.21 | 51.06 ± 3.89 | 2.296 | 0.029 | |
T2 | 59.80 ± 3.57 | 57.50 ± 4.38 | 1.596 | 0.121 | |
DES | |||||
T0 | 25.53 ± 2.20 | 33.50 ± 6.00 | −4.967 | 0.000 | |
T1 | 21.07 ± 3.08 | 31.00 ± 5.29 | −6.330 | 0.000 | |
T2 | 19.73 ± 3.04 | 30.25 ± 5.09 | −6.924 | 0.000 | |
DUP ≥ 1 year | CUD− (n = 15) | CUD+ (n = 16) | t | p | |
PANSS—positive | |||||
T0 | 29.87 ± 5.30 | 32.38 ± 5.35 | −1.310 | 0.201 | |
T1 | 27.47 ± 4.26 | 30.63 ± 5.14 | −1.857 | 0.074 | |
T2 | 26.27 ± 5.08 | 29.94 ± 5.27 | −1.972 | 0.058 | |
PANSS—negative | |||||
T0 | 28.93 ± 3.65 | 24.69 ± 4.19 | 2.998 | 0.006 | |
T1 | 27.07 ± 4.08 | 23.13 ± 3.65 | 2.839 | 0.008 | |
T2 | 26.07 ± 3.77 | 23.06 ± 3.89 | 2.181 | 0.037 | |
PANSS—general | |||||
T0 | 58.07 ± 6.24 | 58.13 ± 5.76 | −0.027 | 0.979 | |
T1 | 53.47 ± 5.74 | 57.75 ± 7.45 | −1.784 | 0.085 | |
T2 | 51.93 ± 5.76 | 55.50 ± 6.52 | −1.609 | 0.118 | |
PANSS—total | |||||
T0 | 116.87 ± 8.92 | 115.19 ± 8.00 | 0.552 | 0.585 | |
T1 | 108.00 ± 8.15 | 111.50 ± 11.02 | −1.000 | 0.326 | |
T2 | 104.27 ± 7.60 | 108.50 ± 9.84 | −1.334 | 0.193 | |
GAF | |||||
T0 | 49.33 ± 5.19 | 47.38 ± 6.46 | 0.926 | 0.362 | |
T1 | 52.33 ± 4.91 | 48.69 ± 5.20 | 2.004 | 0.054 | |
T2 | 56.27 ± 3.24 | 53.19 ± 2.61 | 2.922 | 0.007 | |
DES | |||||
T0 | 29.80 ± 5.19 | 38.50 ± 7.08 | −3.881 | 0.001 | |
T1 | 28.53 ± 5.21 | 37.31 ± 7.56 | −3.740 | 0.001 | |
T2 | 24.73 ± 4.76 | 35.25 ± 8.35 | −4.270 | 0.000 |
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Ricci, V.; Martinotti, G.; Ceci, F.; Chiappini, S.; Di Carlo, F.; Burkauskas, J.; Susini, O.; Luciani, D.; Quattrone, D.; De Berardis, D.; et al. Duration of Untreated Disorder and Cannabis Use: An Observational Study on a Cohort of Young Italian Patients Experiencing Psychotic Experiences and Dissociative Symptoms. Int. J. Environ. Res. Public Health 2021, 18, 12632. https://doi.org/10.3390/ijerph182312632
Ricci V, Martinotti G, Ceci F, Chiappini S, Di Carlo F, Burkauskas J, Susini O, Luciani D, Quattrone D, De Berardis D, et al. Duration of Untreated Disorder and Cannabis Use: An Observational Study on a Cohort of Young Italian Patients Experiencing Psychotic Experiences and Dissociative Symptoms. International Journal of Environmental Research and Public Health. 2021; 18(23):12632. https://doi.org/10.3390/ijerph182312632
Chicago/Turabian StyleRicci, Valerio, Giovanni Martinotti, Franca Ceci, Stefania Chiappini, Francesco Di Carlo, Julius Burkauskas, Ottavia Susini, Debora Luciani, Diego Quattrone, Domenico De Berardis, and et al. 2021. "Duration of Untreated Disorder and Cannabis Use: An Observational Study on a Cohort of Young Italian Patients Experiencing Psychotic Experiences and Dissociative Symptoms" International Journal of Environmental Research and Public Health 18, no. 23: 12632. https://doi.org/10.3390/ijerph182312632