title: Comorbid substance abuse in first-episode schizophrenia: effects on cognition and psychopathology in the EUFEST study.
abstract: Studies and meta-analyses investigating the influence of substance use disorder (SUD) (substance abuse or dependence) on psychopathology and neurocognitive function in schizophrenia patients have revealed controversial results. Most studies did only have small samples and did not focus exclusively on first-episode schizophrenia patients.
  
  
  METHODS
  In a post-hoc analysis of the European First Episode Schizophrenia Trial (EUFEST) psychopathology and cognitive performances of patients with (FE-SUD, N=119, consisting of N=88 patients with persisting SUD at baseline and N=31 patients with previous SUD) and without SUD (FE-non-SUD, N=204) were compared at baseline and 6 months follow-up. Neurocognitive assessment included the Rey Auditory Verbal Learning Test (RAVLT); Trail Making Tests A and B (TMT), Purdue Pegboard and Digit-Symbol Coding.
  
  
  RESULTS
  In total 31.1% of patients reported SUD, and 22.2% of patients used cannabis. There were no significant differences between patients with and without SUD concerning PANSS scores, extrapyramidal motor symptoms or neurocognitive measures except better performance in psychomotor speed (TMT-A, p=0.033, Cohen's d=0.26) in patients with SUD at 6 months follow-up. Interestingly, SUD patients with ongoing substance use at follow-up showed elevated positive symptoms (PANSS positive score, p=0.008, Cohen's d=0.84) compared to those who abstained. PANSS scores at baseline were increased in patients with an onset of SUD before the age of 16 years. In addition we found a correlation between longer duration of cannabis use and higher cognitive performance as well as reduced symptom improvement and more extrapyramidal motor symptoms in patients with higher frequency of cannabis consumption.
  
  
  CONCLUSIONS
  FE-SUD and FE-non-SUD show similar psychopathology and neuropsychological performances at baseline and during the first 6 months of antipsychotic treatment.
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Centre, Georg-August-University, Göttingen, Germany; Centre of Mental Health, Darmstadt-Dieburg Clinics, Groß-Umstadt, Germany. Electronic address: t.wobrock@kreiskliniken-dadi.de.
authors.forename: T
authors.initials: T
authors.lastname: Wobrock
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Falkai
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Schneider-Axmann
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hasan
authors.affiliation: Department of Psychiatry, University of Naples SUN, Naples, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Galderisi
authors.affiliation: Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Davidson
authors.affiliation: Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, The Netherlands.
authors.forename: R S
authors.initials: RS
authors.lastname: Kahn
authors.affiliation: Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, The Netherlands.
authors.forename: E M
authors.initials: EM
authors.lastname: Derks
authors.affiliation: Department of Epidemiology (unit HTA), University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Boter
authors.affiliation: Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: J K
authors.initials: JK
authors.lastname: Rybakowski
authors.affiliation: Department of Psychiatry, University Hospital Hradec Kralove, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Libiger
authors.affiliation: Department of Adult Psychiatry, Centre Hospitalier Universitaire, Centre Esquirol, Caen, France.
authors.forename: S
authors.initials: S
authors.lastname: Dollfus
authors.affiliation: Institute of Psychiatry and Mental Health, San Carlos Clinical University Hospital of Madrid, Spain.
authors.forename: J J
authors.initials: JJ
authors.lastname: López-Ibor
authors.affiliation: University Psychiatric Centre, Katholieke Universiteit Leuven, Campus St. Jozef Kortenberg, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Peuskens
authors.affiliation: Department of Psychiatry, University Hospital of Neurology and Psychiatry, St. Naum, Sofia, Bulgaria.
authors.forename: L G
authors.initials: LG
authors.lastname: Hranov
authors.affiliation: Department of Psychiatry and Psychotherapy, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Gaebel
authors.affiliation: Department of Psychiatry, Department of Biological Psychiatry, Medical University of Innsbruck, Austria.
authors.forename: W W
authors.initials: WW
authors.lastname: Fleischhacker
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D014150:Antipsychotic Agents / Q000627:therapeutic use; D000987:Antisocial Personality Disorder / Q000209:etiology*; D002746:Chlorpromazine / Q000627:therapeutic use; D003072:Cognition Disorders / Q000209:etiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D012559:Schizophrenia / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology*; D012565:Schizophrenic Psychology; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology / Q000523:psychology; D014706:Verbal Learning; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D002746:Chlorpromazine