title: Stability of early-phase primary psychotic disorders with concurrent substance use and substance-induced psychosis.
abstract: BACKGROUND
  The stability of the diagnostic distinction between a substance-induced psychosis and a primary psychotic disorder co-occurring with substance use is not established.
  
  
  OBJECTIVE
  To describe DSM-IV diagnostic changes over 1 year and determine the predictive validity of baseline indicators of the substance-induced psychosis v. primary psychosis distinction.
  
  
  METHODS
  We conducted a 1-year follow-up study of 319 psychiatric emergency department admissions with diagnoses of early-phase psychosis and substance use comorbidity.
  
  
  RESULTS
  Of those with a baseline DSM-IV diagnosis of substance-induced psychosis, 25% had a diagnosis of primary psychosis at follow-up. These patients had poorer premorbid functioning, less insight into psychosis and greater family mental illness than patients with a stable diagnosis of substance-induced psychosis. Reclassifying change cases to primary psychoses on follow-up, key baseline predictors of the primary/substance-induced distinction at 1 year also included greater family history of mental illness in the primary psychosis group.
  
  
  CONCLUSIONS
  Further study of substance-induced psychoses should employ neuroscientific and behavioural approaches. Study findings can guide more accurate diagnoses at first treatment.
authors.affiliation: Department of Psychiatry, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, New York 10032, USA. clc3@columbia.edu
authors.forename: Carol L M
authors.initials: CL
authors.lastname: Caton
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Hasin
authors.forename: Patrick E
authors.initials: PE
authors.lastname: Shrout
authors.forename: Robert E
authors.initials: RE
authors.lastname: Drake
authors.forename: Boanerges
authors.initials: B
authors.lastname: Dominguez
authors.forename: Michael B
authors.initials: MB
authors.lastname: First
authors.forename: Sharon
authors.initials: S
authors.lastname: Samet
authors.forename: Bella
authors.initials: B
authors.lastname: Schanzer
mesh_terms: D000328:Adult; D017831:Diagnosis, Dual (Psychiatry); D004637:Emergency Services, Psychiatric / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011237:Predictive Value of Tests; D011605:Psychoses, Substance-Induced / Q000175:diagnosis; D011618:Psychotic Disorders / Q000175:diagnosis*; D019966:Substance-Related Disorders / Q000175:diagnosis*