Gender differences in psychotic disorders with concurrent substance use.

Objective: We conducted a comparative analysis of gender differences in patients with primary psychotic disorders with concurrent substance use and in those with substance-induced psychoses.

Methods: A total of 385 individuals admitted to psychiatric emergency departments with early-onset psychosis and recent substance use were interviewed at baseline and at six-month intervals for two years. Using a standardized research diagnostic assessment instrument, we classified patients at baseline into primary and substance-induced psychosis groups and analyzed the effects of gender on demographic, family, and clinical characteristics at baseline, the interaction of gender and diagnosis, and gender main effects on illness course, adjustment, and service use over the two-year follow-up period.

Risk factors associated with recurrent homelessness after a first homeless episode.

Alcohol and drug use are commonly associated with the experience of homelessness. In order to better understand this, we explored the prevalence of drug and alcohol use as it related to successful re-housing within a sample of first-time single homeless adults at municipal shelters. From within this sample, we compared the features of recurrent homelessness with those of chronic homelessness and of being stably housed.

Early psychosis and employment.

Background: Employment may be an important factor in helping patients with early psychosis to recover rapidly and to avoid involvement in disability and welfare programs.

Methods: This study followed 351 patients with early psychoses, either primary psychoses or substance-induced psychoses, for two years to examine their patterns of competitive employment in relation to service use, psychosocial outcomes, and disability and welfare payments.

Results: Workers differed from non-workers at baseline and over two years.

Psychological pathways from childhood sexual and physical abuse to HIV/sexually transmitted infection outcomes among homeless women: the role of posttraumatic stress disorder and borderline personality disorder symptoms.

This study examines the psychological factors linking childhood abuse and HIV/sexually transmitted infection outcomes among 190 single homeless women in New York City. Participants were assessed for mental health symptoms, sexually transmitted infections, and exposure to childhood sexual and physical abuse. Findings indicate that the relationship between childhood abuse and HIV/sexually transmitted infection diagnoses during adulthood is mediated by a combination of posttraumatic stress disorder and borderline personality disorder symptoms.

Rates and correlates of HIV and STI infection among homeless women.

We studied the prevalence of biologically confirmed HIV, Chlamydia, and gonorrhea in a randomly selected sample of sheltered homeless women in New York City, and explored their association with demographic, homeless history, and clinical risk factors. 329 women were randomly selected from 28 family and single adult shelters. The estimated prevalence of HIV in the study sample is 0.

Health, access to health care, and health care use among homeless women with a history of intimate partner violence.

Among a sample of sheltered homeless women, we examined health, access to health care, and health care use overall and among the subgroup of participants with and without intimate partner violence (IPV). We recruited homeless women from a random sampling of shelters in New York City, and queried them on health, access to health care and health care use. Using multivariable logistic regression, we determined whether IPV was associated with past-year use of emergency, primary care and outpatient mental health services.

A prospective 2-year study of emergency department patients with early-phase primary psychosis or substance-induced psychosis.

Objective: The authors examined treatment utilization and outcomes over 2 years among patients admitted to emergency departments with early-phase primary or substance-induced psychosis. The main hypothesis was that patients with substance-induced psychosis would have a more benign course of illness than those with primary psychosis

Method: Using a prospective naturalistic cohort study design, the authors compared 217 patients with early-phase primary psychosis plus substance use and 134 patients with early-phase substance-induced psychosis who presented to psychiatric emergency departments at hospitals in Upper Manhattan. Assessments at baseline and at 6, 12, 18, and 24 months included psychiatric diagnoses, service use, and institutional outcomes using the Psychiatric Research Interview for Substance and Mental Disorders; psychiatric symptoms using the Positive and Negative Syndrome Scale; social, vocational, and family functioning using the World Health Organization Psychiatric Disability Assessment Schedule; and life satisfaction using the Quality of Life Interview.

Stability of early-phase primary psychotic disorders with concurrent substance use and substance-induced psychosis.

Background: The stability of the diagnostic distinction between a substance-induced psychosis and a primary psychotic disorder co-occurring with substance use is not established.

Aims: To describe DSM-IV diagnostic changes over 1 year and determine the predictive validity of baseline indicators of the substance-induced psychosis v. primary psychosis distinction.

Homelessness, health status, and health care use.

Objectives: Little is known about the health status of those who are newly homeless. We sought to describe the health status and health care use of new clients of homeless shelters and observe changes in these health indicators over the study period.

Methods: We conducted a longitudinal study of 445 individuals from their entry into the homeless shelter system through the subsequent 18 months.

Diagnosing psychotic disorders in the emergency department in the context of substance use.

Objective: For patients who are actively using a substance and experience psychotic symptoms, determining whether the psychotic symptoms are due to a primary psychotic disorder or are substance induced is challenging, especially in emergency departments, where historical information is limited. This study examined the accuracy and subsequent treatment implications of emergency department diagnoses among substance-using patients who were having their first psychotic episode.

Methods: Emergency department diagnoses for 302 patients were compared with best-estimate longitudinal diagnoses (BELDs) based on research assessments at three time points (baseline, six months, and 12 months).

Predictors of psychosis remission in psychotic disorders that co-occur with substance use.

Objective: To examine rates and predictors of psychosis remission at 1-year follow-up for emergency admissions diagnosed with primary psychotic disorders and substance-induced psychoses.

Method: A total of 319 patients with comorbid psychosis and substance use, representing 83% of the original referred sample, were rediagnosed at 1 year postintake employing a research diagnostic assessment. Remission of psychosis was defined as the absence of positive and negative symptoms for at least 6 months.

Risk factors for long-term homelessness: findings from a longitudinal study of first-time homeless single adults.

Objectives: We examined risk factors for long-term homelessness among newly homeless men and women who were admitted to New York City shelters in 2001 and 2002.

Methods: Interviews were conducted with 377 study participants upon entry into the shelter and at 6-month intervals for 18 months. Standardized assessments of psychiatric diagnosis, symptoms, and coping skills; social and family history; and service use were analyzed.

Differences between early-phase primary psychotic disorders with concurrent substance use and substance-induced psychoses.

Context: The distinction between a substance-induced psychosis and a primary psychotic disorder that co-occurs with the use of alcohol or other drugs is critical for understanding illness course and planning appropriate treatment, yet there has been little study and evaluation of the differences between these 2 diagnostic groups.

Objective: To identify key demographic, family, and clinical differences in substance-induced psychosis and primary psychotic disorders diagnosed according to DSM-IV criteria using a research diagnostic instrument for psychiatric and substance use comorbidity.

Design: Data on demographic, family, and clinical factors were gathered at baseline as part of a 3-year longitudinal study of early-phase psychosis and substance use comorbidity in New York, NY.