Substance use, medication adherence and outcome one year following a first episode of psychosis

Marco Colizzi, Elena Carra, Sara Fraietta, John Lally, Diego Quattrone, Stefania Bonaccorso, Valeria Mondelli, Olesya Ajnakina, Paola Dazzan, Antonella Trotta, Lucia Sideli, Anna Kolliakou, Fiona Gaughran, Mizanur Khondoker, Anthony S. David, Robin M. Murray, James H. MacCabe, Marta Di Forti

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58 Citations (Scopus)


Both substance use and poor medication adherence are associated with poor outcome in psychosis. To clarify the contributions of substance use and poor medication adherence to poor outcome in the year following a first episode of psychosis, 205 patients were evaluated for use of tobacco, alcohol, cannabis and stimulants at their psychosis onset, and in a 1-year follow-up. Data on medication adherence and symptom remission were also collected. Patients had high rates of overall substance use before (37-65%) and after psychosis onset (45-66%). 44% showed poor medication adherence and 55% did not reach remission from psychosis. Nicotine dependence and cannabis use after psychosis onset significantly predicted both poor medication adherence and non remission, and poor medication adherence mediated the effects of these substances on non-remission. In conclusion, medication adherence lies on the causal pathway between nicotine dependence and cannabis on the one hand and non-remission on the other. (C) 2015 Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)311-317
Number of pages7
JournalSchizophrenia Research
Issue number2-3
Early online date21 Dec 2015
Publication statusPublished - Feb 2016


  • First episode psychosis
  • Substance use
  • Cannabis use
  • Nicotine dependence
  • Medication adherence
  • Remission

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