Acta Psychiatrica Scandinavica最新文献

{"title":"Clinical Implications of Autistic Features in Patients With a First Episode of Psychosis.","authors":"Miquel Bioque, Anaid Pérez-Ramos, Vicent Llorca-Bofí, Rafael Penadés, M Florencia Forte, Clemente García-Rizo, Silvia Amoretti, Laura Pina-Camacho, Mara Parellada, Manuel J Cuesta, Laura Martinez-Sadurní, Elena de la Serna, Olga Puig, Gisela Mezquida","doi":"10.1111/acps.70079","DOIUrl":"10.1111/acps.70079","url":null,"abstract":"<p><strong>Introduction: </strong>Schizophrenia and autism share neurobiological mechanisms and overlapping clinical features, often resulting in the emergence of autistic traits in early stages of psychosis. The PANSS Autism Severity Score (PAUSS) provides a rapid measure of autistic features within the standard PANSS assessment. We aimed to determine the prevalence of autistic features in first-episode psychosis (FEP), characterise their clinical, cognitive, and functional profile, and examine their impact on 2-year outcomes.</p><p><strong>Methods: </strong>A total of 328 FEP patients were included from the PEPs multicentre cohort, followed for 2 years. Autistic features were rated using PAUSS (cut-off ≥ 30), yielding autistic (n = 38) and non-autistic (n = 290) groups. Sociodemographic, clinical, cognitive, and functional variables were analysed. Longitudinal analyses examined symptomatic remission rates and trajectories of psychopathology and functioning using logistic regression and mixed-model ANOVA.</p><p><strong>Results: </strong>The autistic group represented 11.6% of the sample. At baseline, they exhibited lower birth weight, greater medication side effects, higher general psychopathology and depressive severity, and poorer global functioning. Cognitively, they showed significant deficits in working memory, social cognition, and cognitive reserve compared to the non-autistic group. Over 2 years, this group was 3.6 times less likely to achieve symptomatic remission and consistently exhibited higher symptom severity and lower functioning across all follow-ups.</p><p><strong>Conclusions: </strong>Autistic features in FEP identify a subgroup with a possible distinct profile of neurodevelopmental markers, greater cognitive and functional impairments, and poorer clinical outcomes. Early identification may guide more personalised interventions, although further research is needed to refine PAUSS specificity and develop targeted, tailored treatments.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":"636-648"},"PeriodicalIF":5.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147281232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychiatric History and Postpartum Depression: The Mediating Role of Obstetric Complications.","authors":"Mette-Marie Zacher Kjeldsen, Katrine Holde, Line Bager, Veerle Bergink, Emely Ek Blæhr, Janne Tidselbak Larsen, Kathrine Bang Madsen, Merete Lund Mægbæk, Liselotte Vogdrup Petersen, Trine Munk-Olsen","doi":"10.1111/acps.70105","DOIUrl":"https://doi.org/10.1111/acps.70105","url":null,"abstract":"<p><strong>Introduction: </strong>Psychiatric history is the strongest risk factor for postpartum depression (PPD). Obstetric complications, more prevalent among women with a psychiatric history, are also independent risk factors. However, the mechanisms linking these factors to PPD remain unclear. We examined whether obstetric complications mediate the association between psychiatric history and PPD.</p><p><strong>Methods: </strong>This cohort study utilized Danish nationwide Edinburgh Postnatal Depression Scale (EPDS) screenings (2015-2021) linked with register data. Psychiatric history was defined as psychiatric diagnoses (ICD-10: F00-99) or filled psychotropic prescriptions (ATC: N05A, N05BE01, N06A, N06BA) from 1995 until conception. Complications were defined as a composite measure of complications occurring between conception and delivery. PPD symptoms were defined as a positive EPDS score (≥ 11), and PPD diagnosis was defined as a depression diagnosis (ICD-10: F32-33) or antidepressant prescription fill (ATC: N06A indicated for depression).</p><p><strong>Results: </strong>Of 170,218 mothers (163,326 in analyses), 23.9% had a psychiatric history. These mothers had higher levels of PPD symptoms (13.4% vs. 6.1%), PPD diagnosis (7.0% vs. 0.4%), and complications (34.1% vs. 28.5%) compared to those without. (A) Psychiatric history (PPD symptoms: OR = 2.32 [95% CI, 2.22; 2.41]; PPD diagnosis: OR = 5.09 [95% CI, 4.48; 5.79]) and complications (PPD symptoms: OR = 1.16 [95% CI, 1.11; 1.21]; PPD diagnosis: OR = 1.18 [95% CI, 1.04; 1.34]) were independently associated with PPD. (B) Psychiatric history did not modify the association between complications and PPD (PPD symptoms: OR = 1.20 [95% CI, 1.14; 1.26] vs. 1.09 [95% CI, 1.02; 1.17]; PPD diagnosis: OR = 1.22 [95% CI, 1.00; 1.49] vs. 1.15 [95% CI, 0.97; 1.36]). (C) Complications mediated only a small fraction of the association between psychiatric history and PPD (proportion mediated: PPD symptoms = 0.68% [95% CI, 0.50%; 1.00%], PPD diagnosis = 0.42% [95% CI, 0.14%; 0.79%]).</p><p><strong>Conclusions: </strong>Psychiatric history and complications are independently associated with PPD, but complications explain only a negligible portion. These findings suggest that the link between psychiatric vulnerability and PPD is primarily driven by direct mechanisms rather than mediation through complications.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147830767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Theory of Mind Assessment in Adults With ADHD: Four Methodological Concerns.","authors":"Berkan Şahin","doi":"10.1111/acps.70104","DOIUrl":"https://doi.org/10.1111/acps.70104","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Attention Deficit Hyperactivity Disorder Medication Among Danish Children and Adolescents From 2010 to 2023.","authors":"Maria Højgaard Stoltz-Andersen, Martin Thomsen Ernst, Søren Dalsgaard, Lotte Rasmussen, Rikke Wesselhoeft","doi":"10.1111/acps.70103","DOIUrl":"https://doi.org/10.1111/acps.70103","url":null,"abstract":"<p><strong>Introduction: </strong>Pharmacological treatment is an important component in the multimodal management of attention deficit hyperactivity disorder (ADHD), but contemporary trends in ADHD medication use among boys and girls in Denmark have not been fully characterized. This study aimed to provide an updated and detailed description of ADHD medication use among Danish children and adolescents during 2010-2023.</p><p><strong>Methods: </strong>We analyzed filled prescriptions for ADHD medication in youths aged 5-17 years in Denmark (2010-2023), calculating incidence rates, prevalence proportions, male/female ratios, treatment persistence, age at initiation, and prescriber setting. Analyses were stratified by sex and age.</p><p><strong>Results: </strong>The incidence rates of ADHD medication use followed a u-shaped pattern for boys, declining from 0.59 per 100 person-years in 2010 to 0.34 in 2014, before rising to 1.0 in 2023. Among girls, incidence rates increased continuously from 0.20 per 100 person-years in 2010 to 0.67 per 100 person-years in 2023. Prevalence proportions were stable until 2018, where an increase was observed for both sexes, reaching 3.4% for boys and 1.8% for girls in 2023. The male/female incidence and prevalence ratios decreased consistently from 2010 to 2023. ADHD medication was initiated at a median age of 13 years for girls and 11 years for boys. The share of index prescriptions from child and adolescent psychiatry increased, reaching 87% in 2023. Most 5-9-year-olds (65%) and almost half of 10-13-year-olds (45%) were covered by an ADHD medication prescription 5 years after treatment initiation, as opposed to 29% of 14-17-year-olds.</p><p><strong>Conclusion: </strong>ADHD medication use in Denmark increased from 2010 to 2023, particularly among girls, where the prevalence tripled compared to a 1.5-fold increase in boys. This likely reflects greater awareness of ADHD in girls, although their 2-year treatment delay compared to boys warrants clinical attention.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147727848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Benzodiazepines on Catatonia: A Systematic Review and Meta-Analysis.","authors":"L Bot, B Schotsman, E Oostra, A W Hoogendoorn, B W C Storosum, C H M Planting, H M Heller, J J B van der Vlugt, J G van Mill, L J C A Smarius, M S Oudijn, M S van Noorden, S M M Lange, Y D van der Werf, E van Exel","doi":"10.1111/acps.70102","DOIUrl":"https://doi.org/10.1111/acps.70102","url":null,"abstract":"<p><strong>Introduction: </strong>Catatonia is a complex psychomotor syndrome associated with various psychiatric and somatic underlying disorders. Current treatment protocols include benzodiazepines and electroconvulsive therapy (ECT). Despite their widespread use, systematic evidence regarding efficacy and optimal benzodiazepine dosage remains limited. This systematic review and meta-analysis aims to evaluate the effectiveness of benzodiazepines in treating catatonia.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, Embase, APA PsychInfo, and Cochrane central identified studies reporting benzodiazepine treatment outcomes in catatonia. Screening and data extraction were done by two independent researchers. A targeted meta-analysis was performed on cases and studies that provided clear documentation of the Bush Francis Catatonia Rating Scale (BFCRS) scores before and after treatment, along with well-defined dosage regimens. Finally, the relationship between dosage and BFCRS improvement was explored.</p><p><strong>Results: </strong>Of 1336 screened articles, 53 met inclusion criteria. Most were case series using lorazepam (a benzodiazepine) to treat catatonia, with dosages ranging from 2 to 60 mg/day with a median dose of 8 mg/day. The overall remission rate was 55%; overall response was 77%. Treatment duration varied, but predominantly did not exceed 1 week. Our targeted analysis showed an overall effect of -11.88 points on the BFCRS when a benzodiazepine was used in the treatment of catatonia with a Cohen's d = -3.15. In a meta regression, no significant dose-response relationship was found.</p><p><strong>Conclusion: </strong>Benzodiazepines are highly effective for treating catatonia, but optimal dosing remains unclear. The absence of a clear dose-effect relationship highlights the need for individualized treatment strategies and well-designed controlled studies to establish stronger evidence-based treatment guidelines.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147727794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood Alcohol Concentration in Finnish Suicide Deaths and Associated Risk Factors, 2016-2024.","authors":"Tristan Pokornyi, Marjut Grainger, Timo Partonen","doi":"10.1111/acps.70100","DOIUrl":"https://doi.org/10.1111/acps.70100","url":null,"abstract":"<p><strong>Aims: </strong>There is limited research examining the relationship between blood alcohol concentration (BAC) and other risk factors among suicide deaths in Finland. Our study aimed to investigate the relationship of an elevated (more than zero) blood alcohol concentration with medical history, including sociodemographic characteristics and disease diagnoses.</p><p><strong>Methods: </strong>Data was collected from suicide deaths in Finland from 2016 to 2024 and verified by official cause-of-death investigations, which included forensic autopsy, toxicology results, and other key information from death certificates and national healthcare registries. A condition recorded in both the death certificate (autopsy) and healthcare register was considered as confirmed diagnosis. BAC, as expressed as a percentage, was grouped into three categories: nil (BAC = 0.000), low-to-medium (BAC = 0.010%-0.099%), and high (BAC = 0.100%-0.500%). Descriptive statistics, correlation, and stepwise logistic regression to estimate odds ratios (ORs) for BAC categories were undertaken.</p><p><strong>Results: </strong>The number of suicide deaths from 2016 to 2024 in Finland was n = 6892, with 5183 men (75.2%) and 1709 women (24.8%). BAC reports were available for n = 6835. Independent factors associated with a low-to-medium or high BAC at death were alcohol use (ORs: 41.80-275.27), longer than 1 day since last healthcare visit (ORs: 1.54-2.53), previous suicide attempt(s) (ORs: 1.42-1.65), and female gender (only for high BAC, OR: 1.30). There were reduced odds for schizophrenia spectrum diagnosis (OR: 0.17), bipolar disorder (OR: 0.29), age groups 10-19 (ORs: 0.30-0.65), 80 and over (ORs: 0.15-0.39), and 70-79 years (only for high BAC, OR: 0.43).</p><p><strong>Conclusion: </strong>Our findings show that individuals with documented habitual alcohol use, female gender, previous suicide attempts, and less frequent healthcare visits had higher odds of intoxication at suicide. Meanwhile, being aged under 20, over 70, or diagnosed with schizophrenia or bipolar disorders reduced the odds. The results highlight the need for proactive healthcare engagement and integrated alcohol-use interventions in suicide prevention strategies.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum Depression: Overlap Between Symptom-Based and Register-Based Measures.","authors":"Sofie Egsgaard, Mette Bliddal, Mette-Marie Zacher Kjeldsen, Xiaoqin Liu, Kathrine Bang Madsen, Merete Lund Mægbæk, Trine Munk-Olsen","doi":"10.1111/acps.70090","DOIUrl":"https://doi.org/10.1111/acps.70090","url":null,"abstract":"<p><strong>Introduction: </strong>Postpartum depression (PPD) can be measured in various ways, including questionnaire-based symptom scores or through administrative health databases. We examined the overlap between symptom-based and register-based PPD definitions and assessed the consistency in exposure-outcome associations.</p><p><strong>Methods: </strong>We linked Danish nationwide health registers to PPD screening records (Edinburgh Postnatal Depression Scale, EPDS) at 2 months postpartum from women screened between January 1, 2015, and December 31, 2021. We defined symptom-based PPD as an EPDS ≥ 11, and register-based PPD as an antidepressant prescription or hospital depression diagnosis within 1 year postpartum. We estimated the overlap between women with register-based and symptom-based PPD, as well as between continuous EPDS scores and register-based treatment indicators. We evaluated consistency between the two definitions using logistic regression analyses for socioeconomic, obstetric, demographic- and health-related exposures from which we obtained odds ratios (ORs) for each PPD definition and calculated ratio of odds ratios (ROR).</p><p><strong>Results: </strong>Among 157,193 mothers (132,593 unique), 11,193 (7.1%) had symptom-based PPD and 2409 (1.5%) had register-based PPD. Of those with symptom-based PPD, 8.8% also had register-based PPD, while 40.8% of those with register-based PPD had symptom-based PPD. We observed a higher overlap with higher EPDS scores. Consistency was highest for obstetric variables but varying for demographic- and health-related exposures (ROR register-based vs. symptom-based 1.84 [95% CI 1.67-2.03] for psychiatric history and 0.75 [95% CI 0.68-0.83] for primiparity).</p><p><strong>Conclusion: </strong>We observed substantial differences and limited overlap between symptom-based and register-based PPD. Register-based measures capture hospital-based diagnoses and pharmacological treatment only, but not all treatment within the healthcare system, and differences may reflect a combination of severity, symptom transience, misclassification, and timing of measurement. Consistency in exposure-outcome associations varied, particularly for certain exposures. Our findings underline the importance of considering both the nature and implications of PPD definitions in epidemiological research.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No Effect of Low-Dose Aspirin Versus Placebo as Add-On Treatment in Bipolar Disorder-Results From a Randomised Controlled Trial (the A-Bipolar RCT).","authors":"Sharaz Ahmed, Shubha Bagri, Nishtha Chawla","doi":"10.1111/acps.70099","DOIUrl":"https://doi.org/10.1111/acps.70099","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lithium, Electroconvulsive Therapy and Cognition: A Systematic Review and Meta-Analysis.","authors":"Liese Van den Eynde, Akihiro Takamiya, Kristof Vansteelandt, Jasmien Obbels, Nathalie Denayer, Shauni Verspecht, Kaat Hebbrecht, Pascal Sienaert","doi":"10.1111/acps.70095","DOIUrl":"10.1111/acps.70095","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to synthesize the evidence on confusional states and neurocognitive changes associated with the concurrent use of lithium and electroconvulsive therapy (ECT).</p><p><strong>Methods: </strong>We conducted a systematic search of PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, CINAHL, PsycArticles, and clinical trials registries up to September 2025. Eligible studies compared the incidence of confusional states or changes in neurocognitive test scores in patients receiving lithium and ECT (Li-ECT) and those receiving ECT without lithium. We performed separate meta-analyses and calculated odds ratios (OR) with 95% confidence intervals (CI) for dichotomous outcomes and standardized mean differences (SMD) for continuous outcomes. Additionally, case reports describing cognitive effects of Li-ECT were synthesized.</p><p><strong>Results: </strong>Sixteen studies were included: 11 studies (n = 66,156) assessed confusional states and five (n = 341) evaluated neurocognitive changes. The Restricted Maximum-Likelihood meta-analysis showed no significant association between lithium use and confusional states (OR 2.09; 95% CI: 0.94-4.66; p = 0.07), whereas a Paule-Mandel sensitivity analysis suggested a significant association (OR 2.38; 95% CI: 1.20-4.74; p = 0.01). No significant differences were observed in changes in global cognitive functioning, autobiographical memory or verbal fluency test scores ([SMD = 0.25; 95% CI: -0.98-1.49; p = 0.69], [SMD = 0.27; 95% CI: -1.37; 1.9; p = 0.75], [SMD = -0.89; 95% CI: -3.18; 1.39; p = 0.44]).</p><p><strong>Conclusion: </strong>Current evidence does not show a significant increase in cognitive side effects associated with lithium use during ECT. However, methodological limitations, sensitivity to meta-analytic assumptions and clinical heterogeneity preclude definitive conclusions. Large prospective studies using standardized cognitive assessments are needed to confirm the tolerability of concurrent lithium and ECT use. While our findings support the cautious continuation of lithium during ECT, individualized clinical decision-making remains crucial to maximize efficacy and minimize cognitive burden.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Clinical Trajectories Across Cannabis-Related and Nonsubstance-Related Psychoses.","authors":"Antti Mustonen, Solja Niemelä, Alexander Denissoff, Antti Tanskanen, Ellenor Mittendorfer-Rutz, Markku Lähteenvuo, Jari Tiihonen, Heidi Taipale","doi":"10.1111/acps.70097","DOIUrl":"10.1111/acps.70097","url":null,"abstract":"<p><strong>Background: </strong>Research indicates that first-episode psychosis (FEP) with cannabis use disorder (CUD) carries a substantial disease burden, but more granular clinical trajectories of cannabis-related psychoses remain unclear. This study examines the clinical trajectories of first clinically diagnosed FEP&CUD and cannabis-induced psychosis (CIP) in comparison with FEP without substance use disorder (SUD).</p><p><strong>Methods: </strong>From the linkage of nationwide administrative and medical registers of Sweden (2006-2021), we identified 1772 individuals (84.1% men) with incident CIP, 1360 individuals (84.3% men) with FEP&CUD and matched individuals with FEP but without SUD and followed them up until 2023. We compared annual prevalence of psychiatric diagnoses before and after cohort entry, medication use, days in inpatient care, and the risks of hospitalization for psychosis and death.</p><p><strong>Results: </strong>Mean age at first diagnosis was 26.6 years (SD 8.3) for incident CIP and 26.9 years (SD 8.4) for FEP&CUD and FEP without SUD. Individuals in the FEP without SUD cohort were more likely to have a record of schizophrenia diagnosis compared to the FEP&CUD and CIP cohorts during the first (14.41%, 6.25%, 2.37%) and second year (10.88%, 7.13%, 3.27%) after cohort entry. However, FEP&CUD and CIP cohorts had a more pronounced burden of inpatient treatment as well as elevated risks of hospitalization for psychosis (aHR = 1.66; 95% CI 1.49-1.86 and aHR = 1.47; 1.32-1.64) and death (aHR = 2.02; 1.44-2.82 and aHR = 1.80; 1.30-2.50) compared to individuals with FEP without SUD.</p><p><strong>Conclusions: </strong>Cannabis-related psychoses, that is, FEP&CUD and CIP, were associated with poor outcomes, including high risk of hospitalization for psychosis and increased mortality, underscoring the need for targeted interventions. Moreover, the overlapping clinical trajectories suggest that cannabis-related psychoses may not represent clinically distinct entities but instead lie on a continuum.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}