Ball, Michael

Bhattacharyya, Sagnik

Broadbent, Matthew

Jackson, Richard George

McGuire, Philip

Patel, Rashmi

Shetty, Hitesh

Stewart, Robert James

Wilson, Robin

Background: Cannabis is frequently used by people with first episode psychosis (FEP), though its effect on clinical outcome is less clear. We investigated whether cannabis use may be associated with increased risk of hospitalization and whether antipsychotic treatment failure, as indexed by number of unique antipsychotics prescribed, may mediate this effect in a large dataset of patients with FEP.Methods: Data were obtained from electronic health records of 2,026 people with FEP in the South London and Maudsley NHS Foundation Trust (SLaM) using the Clinical Record Interactive Search tool (CRIS). Cannabis use was identified using natural language processing. Data on subsequent hospital admission and the number of unique antipsychotics prescribed (a marker of treatment failure) were obtained and analyzed using multivariable regression and mediation analyses with age, gender, ethnicity, marital status and diagnosis as covariates.Results: Cannabis use was present in 46.3% of the sample at first presentation and was particularly common in patients who were 16-25, male and single. It was associated with increased frequency of hospital admission (incidence rate ratio 1.50, 95% CI 1.25 to 1.80), increased likelihood of compulsory admission (odds ratio 1.55, 1.16 to 2.08) and greater number of inpatient days (B coefficient 35.1 days, 12.1 to 58.1). Antipsychotic treatment failure mediated increased frequency of hospital admission (natural indirect effect: 1.09, 95% CI 1.01 to 1.18; total effect: 1.50, 1.21 to 1.87), increased likelihood of compulsory admission (NIE: 1.27, 1.03 to 1.58; TE: 1.76, 0.81 to 3.84) and greater number of inpatient days (NIE: 17.9, 2.4 to 33.4; TE: 34.8, 11.6 to 58.1).Discussion: Cannabis use in patients with FEP was associated with increased likelihood and duration of hospital admission. This was linked to the prescription of several different antipsychotic drugs, indicating clinical judgement of antipsychotic treatment failure. This suggests that cannabis use might be associated with worse clinical outcomes in psychosis by contributing towards failure of antipsychotic treatment.<br/

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                       King’s Research Portal  Document VersionPublisher's PDF, also known as Version of recordLink to publication record in King's Research PortalCitation for published version (APA):Patel, R., Wilson, R., Jackson, R. G., Ball, M., Shetty, H., Broadbent, M., Stewart, R. J., McGuire, P., &Bhattacharyya, S. (Accepted/In press). Impact of cannabis use on clinical outcomes and treatment failure in firstepisode psychosis. NPJ SCHIZOPHRENIA, 2, M111. [16008].Citing this paperPlease note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this maydiffer from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination,volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you areagain advised to check the publisher's website for any subsequent corrections.General rightsCopyright and moral rights for the publications made accessible in the Research Portal are retained by the authors and/or other copyrightowners and it is a condition of accessing publications that users recognize and abide by the legal requirements associated with these rights.•Users may download and print one copy of any publication from the Research Portal for the purpose of private study or research.•You may not further distribute the material or use it for any profit-making activity or commercial gain•You may freely distribute the URL identifying the publication in the Research PortalTake down policyIf you believe that this document breaches copyright please contact librarypure@kcl.ac.uk providing details, and we will remove access tothe work immediately and investigate your claim.Download date: 14. Oct. 2023associated with remission status at follow-up. Substance use in theyear after psychosis onset was associated with increased probability ofpoor medication adherence during the follow-up. In particular, theanalysis showed significant main effects of nicotine dependence(OR= 2.18), cannabis use (OR= 2.86), and stimulant use (OR= 2.63) onthe odds of being non adherent to treatment. In contrast, the ORfailed to reach significance for an association between problemdrinking and poor medication adherence.Substance use in the first year after psychosis onset was associatedwith increased probability of non-remission during the one yearfollow-up. In particular, the analysis showed significant main effects ofnicotine dependence (OR= 2.13) and cannabis use (OR= 2.60) onprobability of not achieving remission. In contrast, the ORs failed toreach significance for an association between problem drinking andnon-remission as well as between stimulant use and non-remission.Medication adherence significantly predicted remission during theone year follow-up. In particular, patients with poor medicationadherence showed a six-fold increased probability of non-remission oftheir psychosis when compared with patients with good medicationadherence. When substance use in the one year follow-up period wasadded in to this model, the association between medicationadherence and remission was still significant. Following Baron andKenny’s approach to mediation, criteria were satisfied only for nicotinedependence and cannabis use post onset. In order to test formediation, the associations between nicotine dependence afterpsychosis onset and non-remission as well as between cannabis useand non-remission were adjusted for medication adherence. Whenmedication adherence was added in to the model, even if increased,the ORs failed to reach significance. Sobel tests for mediation showedthat medication adherence was a significant mediator of therelationship between nicotine dependence and remission (z=2.02,P= 0.04) as well as that between cannabis use and remission (z=2.12,P= 0.03).Discussion: In conclusion, medication adherence lies on the causalpathway between nicotine dependence and cannabis on the onehand and non-remission on the other. As cannabis and tobacco areoften consumed together in the same joint and there is accumulatingevidence of a common underlying vulnerability to both substances,further research is needed to definitively disentangle their indepen-dent contribution on patients’ clinical outcome.M110. 36 Month results of a smoking and healthy lifestylesintervention among people with a psychotic disorderAmanda Baker*1, Robyn Richmond2, Frances Kay-Lambkin1, SachaFilia3, David Castle4, Robin Callister1, Jill Williams5, Vanessa Clark1, TerryLewin6, Kerrin Palazzi11University of Newcastle, Australia, 2University of NSW, Australia, 3MonashUniversity, Australia, 4University of Melbourne, Melbourne, Victoria, Australia,5Robert Wood Johnson Medical School, 6Hunter New England Mental Health,AustraliaBackground: People with schizophrenia have a life expectancy 15 yearsless than the general community, and much higher rates of chronicdiseases such as cardiovascular disease, diabetes and obesity. Inresponse to this disproportionately high burden of illness the firstAustralian National Report Card on Mental Health stated “the reducedlife expectancies and poor health of people with the most severemental illnesses…is a national disgrace and it should be a majorpublic health concern”. Telephone interventions for health behaviors(such as smoking, alcohol use, low fruit and vegetable consumptionand high levels of sedentary activity) as well as for psychoticsymptomatology and also smartphone applications have beenevaluated with promising results. This is the first randomizedcontrolled trial to evaluate a cognitive-behavioral interventionaddressing smoking and other health behaviors among people withpsychotic disorders.Methods: Study participants were randomly assigned to receive asingle face to face session consisting of feedback and motivationalinterviewing and nicotine replacement therapy, plus either: (i) a face-to-face intervention targeting multiple health risk behaviors; or (ii) apredominantly telephone delivered intervention involving monitor-ing. Follow-up surveys were completed at 15 weeks (n= 165, 70.2%),12 months (n= 139, 59%), 18 months (n=132, 56.2%), 24 months(n=133, 56.6%), 30 months (n= 129, 54.9%) and 36 months (n= 134,57%). ITT analysis was used for primary outcomes and mixed modelswere used for both primary and secondary modeling, so all studyparticipants were included in analyses.Results: At baseline, participants (N= 235, Age, M= 41.6 years, 59%male) were smoking on average 28.6 (SD= 15.3) CPD. There were nosignificant overall differences between the telephone and face-to-faceconditions in the primary smoking outcome of biochemicallyconfirmed point-prevalence abstinence rates (8% and 11% respec-tively) at 36 months. There were no significant differences betweengroups in most measures of exercise, diet and body measures (totalminutes walking per week, total minutes sitting per week, BMI, waistcircumference, weight, waist-to-hip ratio).Discussion: Face-to-face and telephone-delivered interventions arefeasible and effective among people with severe mental disorders forsmoking. Interventions for multiple health behavior change appearworthy of further research among people with psychotic disorders.M111. Impact of cannabis use on clinical outcomes andtreatment failure in first episode psychosisRashmi Patel*1, Robin Wilson1, Richard Jackson1, Michael Ball1,Hitesh Shetty2, Matthew Broadbent2, Robert Stewart1, Philip McGuire1,Sagnik Bhattacharyya11IoPPN, King's College London, London, UK, 2BRC Nucleus, South London andMaudsley NHS Foundation Trust, Beckenham, UKBackground: Cannabis is frequently used by people with first episodepsychosis (FEP), though its effect on clinical outcome is less clear. Weinvestigated whether cannabis use may be associated with increasedrisk of hospitalization and whether antipsychotic treatment failure, asindexed by number of unique antipsychotics prescribed, may mediatethis effect in a large dataset of patients with FEP.Methods: Data were obtained from electronic health records of 2,026people with FEP in the South London and Maudsley NHS FoundationTrust (SLaM) using the Clinical Record Interactive Search tool (CRIS).Cannabis use was identified using natural language processing. Data onsubsequent hospital admission and the number of unique antipsycho-tics prescribed (a marker of treatment failure) were obtained andanalyzed using multivariable regression and mediation analyses withage, gender, ethnicity, marital status and diagnosis as covariates.Results: Cannabis use was present in 46.3% of the sample at firstpresentation and was particularly common in patients who were16-25, male and single. It was associated with increased frequency ofhospital admission (incidence rate ratio 1.50, 95% CI 1.25 to 1.80),increased likelihood of compulsory admission (odds ratio 1.55, 1.16 to2.08) and greater number of inpatient days (B coefficient 35.1 days,12.1 to 58.1). Antipsychotic treatment failure mediated increasedfrequency of hospital admission (natural indirect effect: 1.09, 95% CI1.01 to 1.18; total effect: 1.50, 1.21 to 1.87), increased likelihood ofcompulsory admission (NIE: 1.27, 1.03 to 1.58; TE: 1.76, 0.81 to 3.84)and greater number of inpatient days (NIE: 17.9, 2.4 to 33.4; TE: 34.8,11.6 to 58.1).Discussion: Cannabis use in patients with FEP was associated withincreased likelihood and duration of hospital admission. This waslinked to the prescription of several different antipsychotic drugs,indicating clinical judgement of antipsychotic treatment failure. Thissuggests that cannabis use might be associated with worse clinicaloutcomes in psychosis by contributing towards failure of antipsycho-tic treatment.M112. Better social but worse academic premorbid adjustmentin cannabis-users psychotic patients across EuropeLaura Ferraro1, Capuccio Veronica1, Caterina La Cascia1, Lucia Sideli1,Alice Mulè1, Fabio Seminerio*1, Crocettarachele Sartorio1, GiadaTripoli1, Robin Murray2, Daniele La Barbera1, Marta Di Forti21University of Palermo, 2Institute of Psychiatry, King's CollegeBackground: Several studies report that patients with psychosis whoused cannabis have a better cognitive performance than those whoAbstracts40npj Schizophrenia (2016) 16008 © 2016 Schizophrenia International Research Society/Nature Publishing Group

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Impact of cannabis use on clinical outcomes and treatment failure in first episode psychosis

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Impact of cannabis use on clinical outcomes and treatment failure in first episode psychosis

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