Stimulant use disorders in people with psychosis: a meta-analysis of rate and factors affecting variation

Sara, Grant E., Large, Matthew M., Matheson, Sandra L., Burgess, Philip M., Malhi, Gin S., Whiteford, Harvey A. and Hall, Wayne D. (2015) Stimulant use disorders in people with psychosis: a meta-analysis of rate and factors affecting variation. Australian and New Zealand Journal of Psychiatry, 49 2: 106-117. doi:10.1177/0004867414561526


Author Sara, Grant E.
Large, Matthew M.
Matheson, Sandra L.
Burgess, Philip M.
Malhi, Gin S.
Whiteford, Harvey A.
Hall, Wayne D.
Title Stimulant use disorders in people with psychosis: a meta-analysis of rate and factors affecting variation
Journal name Australian and New Zealand Journal of Psychiatry   Check publisher's open access policy
ISSN 1440-1614
1440-1614
Publication date 2015-02-22
Year available 2014
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1177/0004867414561526
Open Access Status Not yet assessed
Volume 49
Issue 2
Start page 106
End page 117
Total pages 12
Place of publication London, United Kingdom
Publisher Sage Publications
Language eng
Subject 2738 Psychiatry and Mental health
Abstract Objective: Stimulant abuse and dependence often complicate the care of people with psychotic disorders. This study systematically reviews the prevalence estimates reported for stimulant abuse and dependence in people with psychotic disorders, and examines personal, clinical, regional and methodological factors which explain variation in these rates.
Formatted abstract
Objective: Stimulant abuse and dependence often complicate the care of people with psychotic disorders. This study systematically reviews the prevalence estimates reported for stimulant abuse and dependence in people with psychotic disorders, and examines personal, clinical, regional and methodological factors which explain variation in these rates.

Methods: PsychINFO, EMBASE and MEDLINE (1946–2013) were searched systematically for studies reporting on stimulant drug use disorders in representative samples of people with psychotic disorders. Random effects models estimated the pooled rate of a stimulant use disorder, defined to include stimulant abuse and stimulant dependence. Study characteristics associated with heterogeneity in rates of stimulant use disorder were examined by subgroup analyses for categorical variables, by meta-regression for continuous independent variables and by multiple meta-regression.

Results: Sixty-four studies provided 68 estimates of lifetime or recent stimulant use disorders in 22,500 people with psychosis. The pooled rate of stimulant use disorder was 8.9% (95% CI 7.4%, 10.5%). Higher rates of stimulant use disorders were reported in studies of affective psychosis, studies from inpatient settings, studies from the USA and Australia, and studies with higher rates of cannabis disorder; in multiple meta-regression analysis these factors explained 68% of between-study variance. Rates of stimulant use disorder were stable over time, and unrelated to age, sex, stage of psychosis, type of stimulant drug or study methodology factors.

Conclusions: Reported rates of stimulant use disorder in people with psychosis are much higher than in the general population but vary widely and are associated with regional, service setting and clinical differences between studies. It is likely that stimulants contribute to the overall burden of psychosis, and that social and environmental factors combine with drug and illness-related factors to influence stimulant use in psychosis.
Keyword Affective psychosis
Amphetamine
Cocaine
Ecstasy
Schizophrenia
Systematic review
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online ahead of print 17 December 2014.

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2015 Collection
Centre for Youth Substance Abuse Research Publications
School of Public Health Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 12 times in Thomson Reuters Web of Science Article | Citations
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