title: Screening for substance use disorders in first-episode psychosis: implications for readmission.
abstract: BACKGROUND
  Screening of substance use may prove useful to prevent readmission after the first episode of psychosis. The aim of the present study was to evaluate the influence of drug use on readmission risk in a first-episode psychosis sample, and to determine whether the cannabis/cocaine subscale of the Dartmouth Assessment of Lifestyle Inventory (DALI) is a better predictive instrument than urinary analysis.
  
  
  METHODS
  After admission, first-episode psychotic patients were interviewed for substance use and assessed with the DALI scale. They also underwent blood and urine sampling. Time to readmission was studied as a dependent outcome. The Kaplan-Meier estimator was applied to estimate the survival curves for bivariate analysis. The Cox proportional hazards model for multivariate analysis was assessed in order to control for potential confounders. ROC curve and validity parameters were used to assess validity to detect readmission.
  
  
  RESULTS
  Fifty-eight patients were included. The DALI cannabis/cocaine subscale and urinalysis were associated with increased readmission risk in survival curves, mainly the first five years of follow-up. After controlling for potential confounding variables for readmission, only the DALI cannabis/cocaine subscale remained as a significant risk factor. In terms of validity, the DALI cannabis/cocaine subscale was more sensitive than urinalysis. Alcohol assessments were not related to readmission.
  
  
  CONCLUSIONS
  The findings demonstrated that a quick screening self-report scale for cannabis/cocaine use disorders is superior to urinary analysis for predicting readmission. Future research should consider longitudinal assessments of brief validated screening tests in order to evaluate their benefits in preventing early readmission in first-episode psychosis.
authors.affiliation: Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, Centro de Investigación Biomédica en Red en Salud Mental, 08036 Barcelona, Spain. batalla@clinic.ub.es
authors.forename: Albert
authors.initials: A
authors.lastname: Batalla
authors.forename: Clemente
authors.initials: C
authors.lastname: Garcia-Rizo
authors.forename: Pere
authors.initials: P
authors.lastname: Castellví
authors.forename: Emili
authors.initials: E
authors.lastname: Fernandez-Egea
authors.forename: Murat
authors.initials: M
authors.lastname: Yücel
authors.forename: Eduard
authors.initials: E
authors.lastname: Parellada
authors.forename: Brian
authors.initials: B
authors.lastname: Kirkpatrick
authors.forename: Rocío
authors.initials: R
authors.lastname: Martin-Santos
authors.forename: Miguel
authors.initials: M
authors.lastname: Bernardo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000209:etiology* / Q000517:prevention & control*; D012372:ROC Curve; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000145:classification / Q000150:complications*; D055815:Young Adult