title: The impact of substance use at psychosis onset on First Episode Psychosis course: results from a 1 year follow-up study in Bologna.
abstract: OBJECTIVE
  Substance abuse is a well established risk factor for First-Episode Psychosis (FEP), but its influence on FEP course is less clear. Starting from our baseline observation that substance users were younger than non-users at the psychosis onset, we hypothesized that substance use at baseline could be an independent risk factor for a worse clinical course.
  
  
  METHODS
  An incidence cohort of patients with FEP collected in an 8year period (2002-2009) at the Bologna West Community Mental Health Centers (CMHCs) was assessed at baseline and at 12month follow-up. Drop-out, hospitalizations and service utilization were used as clinical outcomes.
  
  
  RESULTS
  Most of the patients were still in contact with CMHC at 12month follow up. Substance users had a significantly higher rate of hospitalizations during the follow-up after adjusting for age, gender and other potential confounders (OR 5.84, 95% CI 2.44-13.97, p≤0.001).
  
  
  CONCLUSIONS
  This study adds to previous evidence showing the independent effect of substance use on FEP course. The identification of a "potentially modifiable" environmental predictor of the course of the illness such as substance use at psychosis onset allows us to envisage the possibility of ameliorating the course of the illness by managing this factor.
authors: Department of Medical and Surgical Science, Section of Psychiatry, Bologna University, Italy; Bologna West Mental Health Department, Ausl Bologna, Italy; Department of Psychosis Studies, Institute of Psychiatry, King's College London, United Kingdom. Electronic address: ilaria.tarricone@unibo.it.
authors: Ilaria
authors: I
authors: Tarricone
authors: Department of Psychosis Studies, Institute of Psychiatry, King's College London, United Kingdom.
authors: Jane
authors: J
authors: Boydell
authors: Department of Medical and Surgical Science, Section of Psychiatry, Bologna University, Italy.
authors: Serena
authors: S
authors: Panigada
authors: Department of Medical and Surgical Science, Section of Psychiatry, Bologna University, Italy.
authors: Fabio
authors: F
authors: Allegri
authors: Department of Medical and Surgical Science, Section of Psychiatry, Bologna University, Italy.
authors: Thomas
authors: T
authors: Marcacci
authors: Bologna West Mental Health Department, Ausl Bologna, Italy.
authors: Maria Gabriella
authors: MG
authors: Minenna
authors: Department of Medical and Surgical Science, Section of Psychiatry, Bologna University, Italy.
authors: Arnisa
authors: A
authors: Kokona
authors: Department of Medical and Surgical Science, Section of Psychiatry, Bologna University, Italy.
authors: Federico
authors: F
authors: Triolo
authors: Department of Medical and Surgical Science, Section of Psychiatry, Bologna University, Italy.
authors: Viviana
authors: V
authors: Storbini
authors: Bologna West Mental Health Department, Ausl Bologna, Italy.
authors: Rossella
authors: R
authors: Michetti
authors: Department of Psychosis Studies, Institute of Psychiatry, King's College London, United Kingdom.
authors: Craig
authors: C
authors: Morgan
authors: Department of Psychosis Studies, Institute of Psychiatry, King's College London, United Kingdom.
authors: Marta
authors: M
authors: Di Forti
authors: Department of Psychosis Studies, Institute of Psychiatry, King's College London, United Kingdom.
authors: Robin M
authors: RM
authors: Murray
authors: Department of Medical and Surgical Science, Section of Psychiatry, Bologna University, Italy; Bologna West Mental Health Department, Ausl Bologna, Italy.
authors: Domenico
authors: D
authors: Berardi
mesh_terms: D000328:Adult; D017668:Age of Onset; D000704:Analysis of Variance; D015331:Cohort Studies; D003155:Community Mental Health Centers; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011618:Psychotic Disorders / Q000453:epidemiology*; D018709:Statistics, Nonparametric; D019966:Substance-Related Disorders / Q000453:epidemiology*; D055815:Young Adult
keywords: First episode psychosis; Psychosis course; Substance use