Treatment Orders for Early Psychosis Youth Including Treatment for Comorbid Severe Substance Use Disorder (SUD): A Case Series

Poster A5, Monday, October 8, 11:30 am - 1:00 pm, Essex Ballroom

Bastian Bertulies-Esposito1, Clairélaine Ouellet-Plamondon1,2,3, Amal Abdel-Baki1,2,3; 1Université de Montréal, 2Centre hospitalier de l'Université de Montréal, 3Centre de recherche du centre hospitalier de l'Université de Montréal

Introduction: About 60% of patients with first-episode psychosis (FEP) have a comorbid substance use disorder (SUD), persisting in about 2/3 of them. Comorbid SUD is associated with unfavorable outcomes (hospitalizations, psychotic symptoms, unemployment, etc.). Could court treatment orders (CTO) including mandatory inpatient treatment for SUD be a path towards recovery for the minority of FEP patients with severe SUD (having a major impact on their psychotic illness) who do not respond to motivational approaches and harm reduction strategies? Objectives: To study the impact of CTOs that include inpatient treatment for SUD on the evolution of FEP with severe comorbid SUD. Methods: Longitudinal study by chart review of the 20 FEP (out of the 480 FEP of the entire cohort) who were obliged to participate in an inpatient treatment for SUD as well as psychosis treatment. Measures of functioning, mental health service use, aggressiveness and the SUD course were collected before and after the mandatory SUD treatment during the patients’ follow-up (2.3-6.4 years). Results: After the CTO, improvements in quality of life, functional and social outcomes and a reduction, of aggressive episodes, substance use . and acute healthcare services use, were observed for the majority of patients. Conclusion: The use of CTOs which include treatment for severe comorbid SUD in FEP, seems to improve outcome. Further research with sturdier study designs are warranted to deepen understanding of the possible contribution of this approach in the treatment of severe comorbid SUD in FEP , and to investigate its ethical aspects.

Topic Area: Comorbid Conditions

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