Sex as a Predictor of Illness Progression in First Episode Psychosis Patients with Comorbid Substance Use Disorder

Justine Chen, BA

Brigham and Women’s Hospital
Sex as a Predictor of Illness Progression in First Episode Psychosis Patients with Comorbid Substance Use Disorder

Scientific Abstract

Background: Comorbid substance use disorder (SUD) is prevalent among first episode psychosis (FEP) patients with some studies reporting up to a 60% rate of co-occurrence. Previous research has associated higher rates of SUDs and poorer illness outcomes in males, suggesting a possible interaction effect of sex and SUD on outcomes after FEP. This study aimed to examine the effects of SUD on symptom severity in FEP at baseline and follow-up. Further, we investigated interaction effects of sex and SUD as predictors of clinical outcome. We hypothesized that SUD would be common among FEP patients and be associated with greater symptom severity at both timepoints. Additionally, we hypothesized that sex and the presence of SUD at baseline would predict symptom severity at follow-up.

Methods: Participants included 14 healthy controls and 35 FEP participants who had clinical assessments at 2 or more timepoints, approximately 8 months apart. All participants were administered the SCID-5-RV. FEP participants were additionally administered the PANSS. These data were collected as part of a larger longitudinal study.

Results: At baseline, 60% of FEP participants met criteria for lifetime SUD and 40% met criteria for current SUD. At follow-up, rates of lifetime SUD rose to 73% and over 43% met for current SUD. Lifetime SUD was associated with PANSS Positive symptoms at baseline at the trend- level (p=.07) and with PANSS Negative symptoms at follow-up at trend-level (p=.07). As hypothesized, we found a significant sex by SUD interaction at baseline, which predicted more severe PANSS Positive symptoms (t=-2.03, p=.05). However, this interaction did not predict clinical outcomes at follow-up, and there were no main effects of sex or baseline SUD on any follow-up clinical measure.

Conclusions: Consistent with the literature, we found high rates of SUD in FEP, which were associated with more severe symptoms at both assessment points. Males with SUDs exhibited more severe clinical symptoms at baseline, although this interaction did not predict follow-up clinical symptoms. Treating active SUDs may be important for reducing symptoms of psychosis and may be particularly critical in men.

Live Zoom Session – April 21st

research Areas


Justine Chen, BA, Amber R. Carroll, BA, Evdokiya E. Knyazhanskaya, BA, Elizabeth Rizzoni, BA, Michael J. Coleman, MA, Sylvain Bouix, PhD, Nicole Varca, BA, Raquelle Mesholam-Gately, PhD, Martha E. Shenton, PhD, Kathryn Eve Lewandowski, PhD

Principal Investigator

Kathryn Eve Lewandowski, PhD

Affiliated Website