ED Visit for Substance Use With Psychosis Increases Risk for Schizophrenia Diagnosis

Substantial risk of transition still seen with substance use without psychosis

By Lori Solomon HealthDay Reporter

THURSDAY, Oct. 12, 2023 (HealthDay News) — Emergency department visits for substance use are associated with an increased risk for developing a schizophrenia spectrum disorder, according to a brief report published online Sept. 27 in JAMA Psychiatry.

Daniel T. Myran, M.D., M.P.H., from the University of Ottawa in Ontario, Canada, and colleagues assessed the risk for developing schizophrenia spectrum disorder following an emergency department visit caused by substance use with and without psychosis. The analysis included more than 9.8 million individuals (aged 14 to 65 years) with no history of psychotic disorder (January 2008 to March 2022).

The researchers found that 3.4 percent of the 407,737 emergency department visits that were for substance use involved psychosis. Compared with the general population, individuals with substance-induced psychosis had a substantially increased risk for transitioning (age- and sex-adjusted hazard ratio [aHR], 163.2; three-year risk, 18.5 versus 0.1 percent). There was a lower but still elevated risk for transitioning among individuals with an emergency department visit for substance use without psychosis (aHR, 9.8; three-year risk, 1.4 percent). For visits with psychosis, cannabis use was associated with the highest transition risk (aHR, 241.6), which was still elevated in visits without psychosis (aHR, 14.3). A higher risk for transition was seen among those of younger age and male sex.

“Although substance-induced psychoses had a greater relative transition risk, substance use without psychosis was far more prevalent and resulted in a greater absolute number of transitions,” the authors write.

One author disclosed ties to industry.