title: A prospective 2-year study of emergency department patients with early-phase primary psychosis or substance-induced psychosis.
abstract: OBJECTIVE
  The authors examined treatment utilization and outcomes over 2 years among patients admitted to emergency departments with early-phase primary or substance-induced psychosis. The main hypothesis was that patients with substance-induced psychosis would have a more benign course of illness than those with primary psychosis
  
  
  METHODS
  Using a prospective naturalistic cohort study design, the authors compared 217 patients with early-phase primary psychosis plus substance use and 134 patients with early-phase substance-induced psychosis who presented to psychiatric emergency departments at hospitals in Upper Manhattan. Assessments at baseline and at 6, 12, 18, and 24 months included psychiatric diagnoses, service use, and institutional outcomes using the Psychiatric Research Interview for Substance and Mental Disorders; psychiatric symptoms using the Positive and Negative Syndrome Scale; social, vocational, and family functioning using the World Health Organization Psychiatric Disability Assessment Schedule; and life satisfaction using the Quality of Life Interview. Longitudinal analyses were conducted using generalized estimating equations.
  
  
  RESULTS
  Participants with primary psychosis were more likely to receive antipsychotic and mood-stabilizing medications, undergo hospitalizations, and have outpatient psychiatric visits; those with substance-induced psychosis were more likely to receive addiction treatments. Only a minority of each group received minimally adequate treatments. Both groups improved significantly over time on substance dependence, psychotic symptoms, homelessness, and psychosocial outcomes, and few group-by-time interactions emerged.
  
  
  CONCLUSIONS
  Patients presenting to Upper Manhattan emergency departments with either early-phase primary psychosis or substance-induced psychosis improved steadily over 2 years despite minimal use of mental health and substance abuse services.
authors: Dartmouth Medical School and Dartmouth Psychiatric Research Center, Lebanon, NH 03766, USA. robert.e.drake@dartmouth.edu
authors: Robert E
authors: RE
authors: Drake
authors: Carol L M
authors: CL
authors: Caton
authors: Haiyi
authors: H
authors: Xie
authors: Eustace
authors: E
authors: Hsu
authors: Prakash
authors: P
authors: Gorroochurn
authors: Sharon
authors: S
authors: Samet
authors: Deborah S
authors: DS
authors: Hasin
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D015331:Cohort Studies; D015897:Comorbidity; D003419:Crisis Intervention; D017831:Diagnosis, Dual (Psychiatry); D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011605:Psychoses, Substance-Induced / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D011613:Psychotherapy; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D019966:Substance-Related Disorders / Q000188:drug therapy / Q000453:epidemiology; D016896:Treatment Outcome