Sex and substance use in first episode psychosis: Impact on clinical symptoms, psychosocial functioning and cognitive performance

Introduction

Sex differences in first episode of psychosis (FEP) have been widely studied. However, the existence of controversial results may be attributable to not considering relevant factors such as substance use. Cannabis use is associated with an earlier age of onset of psychosis and rates of cannabis use are consistently higher among men. The main objective of this study was to analyze and describe sex differences while considering the presence of substance use and its potential role when predicting age at onset of psychosis.

Material and methods

A cross-sectional study of 223 non-affective FEP patients was performed. Participants were divided into “current substance users”, defined as those who reported having used a substance in the past 30 days, and those who did not as “not current substance users”. Descriptive analyses, general linear modeling and multiple regression modeling were used.

Results

In the current substance group, women were older, with an older age of onset, a better premorbid adjustment and a higher cognitive reserve while presenting less clinical severity, a better functioning and a better verbal memory performance in comparison with men. In males, but not in females, lifetime of cannabis use and accumulative lifetime substance use was associated with age of onset.

Conclusions

Clinical presentation of FEP varies by sex and especially when considering substance use. Our results suggest that early interventions need to be tailored to the different clinical needs of males and females and according to substance consumption in FEP.