Skip to main content
    • Aa
    • Aa
  • Access
  • Open access
  • Cited by 24
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Koike, Shinsuke Satomura, Yoshihiro Kawasaki, Shingo Nishimura, Yukika Takano, Yosuke Iwashiro, Norichika Kinoshita, Akihide Nagai, Tatsuya Natsubori, Tatsunobu Tada, Mariko Ichikawa, Eriko Takizawa, Ryu and Kasai, Kiyoto 2016. Association between rostral prefrontal cortical activity and functional outcome in first-episode psychosis: a longitudinal functional near-infrared spectroscopy study. Schizophrenia Research, Vol. 170, Issue. 2-3, p. 304.

    Patel, Rashmi Wilson, Robin Jackson, Richard Ball, Michael Shetty, Hitesh Broadbent, Matthew Stewart, Robert McGuire, Philip and Bhattacharyya, Sagnik 2016. Association of cannabis use with hospital admission and antipsychotic treatment failure in first episode psychosis: an observational study. BMJ Open, Vol. 6, Issue. 3, p. e009888.

    Schoeler, Tabea Monk, Anna Sami, Musa B Klamerus, Ewa Foglia, Enrico Brown, Ruth Camuri, Giulia Altamura, A Carlo Murray, Robin and Bhattacharyya, Sagnik 2016. Continued versus discontinued cannabis use in patients with psychosis: a systematic review and meta-analysis. The Lancet Psychiatry, Vol. 3, Issue. 3, p. 215.

    Seddon, Jennifer L. Birchwood, Max Copello, Alex Everard, Linda Jones, Peter B. Fowler, David Amos, Tim Freemantle, Nick Sharma, Vimal Marshall, Max and Singh, Swaran P. 2016. Cannabis Use Is Associated With Increased Psychotic Symptoms and Poorer Psychosocial Functioning in First-Episode Psychosis: A Report From the UK National EDEN Study. Schizophrenia Bulletin, Vol. 42, Issue. 3, p. 619.

    Gurillo, Pedro Jauhar, Sameer Murray, Robin M and MacCabe, James H 2015. Does tobacco use cause psychosis? Systematic review and meta-analysis. The Lancet Psychiatry, Vol. 2, Issue. 8, p. 718.

    Tantirangsee, Nopporn and Assanangkornchai, Sawitri 2015. Prevalence, patterns, associated factors and severity of substance use among psychotic patients in southern Thailand. Asian Journal of Psychiatry, Vol. 13, p. 30.

    Tantirangsee, Nopporn Assanangkornchai, Sawitri and Marsden, John 2015. Effects of a Brief Intervention for Substance Use on Tobacco Smoking and Family Relationship Functioning in Schizophrenia and Related Psychoses: A Randomised Controlled Trial. Journal of Substance Abuse Treatment, Vol. 51, p. 30.

    Bahorik, Amber L. Cornelius, Jack R. Bangalore, Srihari S. Newhill, Christina E. Keshavan, Matcheri S. and Eack, Shaun M. 2014. Brief report: The impact of alcohol and cannabis misuse on cognition among individuals with schizophrenia. Schizophrenia Research: Cognition, Vol. 1, Issue. 3, p. 160.

    Chakraborty, Rudraprosad Chatterjee, Arunima and Chaudhury, Suprakash 2014. Impact of Substance Use Disorder on Presentation and Short-Term Course of Schizophrenia. Psychiatry Journal, Vol. 2014, p. 1.

    Lange, Elisabeth Heffermehl Nesvåg, Ragnar Ringen, Petter Andreas Hartberg, Cecilie Bhandari Haukvik, Unn Kristin Andreassen, Ole Andreas Melle, Ingrid and Agartz, Ingrid 2014. One year follow-up of alcohol and illicit substance use in first-episode psychosis: Does gender matter?. Comprehensive Psychiatry, Vol. 55, Issue. 2, p. 274.

    Favrod, Jérôme Manetti, Silvia Gibellini Rexhaj, Shyhrete Balemi, Sara Crespi Conus, Philippe and Bonsack, Charles 2013. Effet des groupes motivationnels pour les personnes atteintes de psychose qui consomment du cannabis. L'Évolution Psychiatrique, Vol. 78, Issue. 1, p. 97.

    Keski-Rahkonen, Anna Raevuori, Anu Bulik, Cynthia M. Hoek, Hans W. Sihvola, Elina Kaprio, Jaakko and Rissanen, Aila 2013. Depression and Drive for Thinness are Associated with Persistent Bulimia Nervosa in the Community. European Eating Disorders Review, Vol. 21, Issue. 2, p. 121.

    Koike, Shinsuke Takano, Yosuke Iwashiro, Norichika Satomura, Yoshihiro Suga, Motomu Nagai, Tatsuya Natsubori, Tatsunobu Tada, Mariko Nishimura, Yukika Yamasaki, Syudo Takizawa, Ryu Yahata, Noriaki Araki, Tsuyoshi Yamasue, Hidenori and Kasai, Kiyoto 2013. A multimodal approach to investigate biomarkers for psychosis in a clinical setting: The integrative neuroimaging studies in schizophrenia targeting for early intervention and prevention (IN-STEP) project. Schizophrenia Research, Vol. 143, Issue. 1, p. 116.

    Peritogiannis, Vaios Tatsioni, Athina Menti, Nefeli Grammeniati, Aikaterini Fotopoulou, Vassiliki and Mavreas, Venetsanos 2013. Treatment Engagement of Psychotic Patients with a Mobile Mental Health Unit in Rural Areas in Greece: A Five-Year Study. Schizophrenia Research and Treatment, Vol. 2013, p. 1.

    Seddon, Jennifer L. Copello, Alex and Birchwood, Max 2013. Cannabis use and abstention in first-episode psychosis: the participants'view. Mental Health and Substance Use, Vol. 6, Issue. 1, p. 47.

    Cotton, S.M. Lambert, M. Schimmelmann, B.G. Mackinnon, A. Gleeson, J.F.M. Berk, M. Hides, L. Chanen, A. McGorry, P.D. and Conus, P. 2012. Depressive symptoms in first episode schizophrenia spectrum disorder. Schizophrenia Research, Vol. 134, Issue. 1, p. 20.

    Donoghue, K. Mazzoncini, R. Hart, J. Zanelli, J. Morgan, C. Dazzan, P. Morgan, K. D. Murray, R. M. Jones, P. B. and Doody, G. A. 2012. The differential effect of illicit drug use on cognitive function in first-episode psychosis and healthy controls. Acta Psychiatrica Scandinavica, Vol. 125, Issue. 5, p. 400.

    Faridi, Kia Joober, Ridha and Malla, Ashok 2012. Medication adherence mediates the impact of sustained cannabis use on symptom levels in first-episode psychosis. Schizophrenia Research, Vol. 141, Issue. 1, p. 78.

    Leeson, V. C. Harrison, I. Ron, M. A. Barnes, T. R. E. and Joyce, E. M. 2012. The Effect of Cannabis Use and Cognitive Reserve on Age at Onset and Psychosis Outcomes in First-Episode Schizophrenia. Schizophrenia Bulletin, Vol. 38, Issue. 4, p. 873.

    Potvin, Stéphane Stavro, Katherine and Pelletier, Julie 2012. Paradoxical Cognitive Capacities in Dual Diagnosis Schizophrenia: The Quest for Explanatory Factors. Journal of Dual Diagnosis, Vol. 8, Issue. 1, p. 35.


Naturalistic follow-up of co-morbid substance use in schizophrenia: the West London first-episode study

  • I. Harrison (a1), E. M. Joyce (a2), S. H. Mutsatsa (a1), S. B. Hutton (a3), V. Huddy (a1), M. Kapasi (a1) and T. R. E. Barnes (a1)
  • DOI:
  • Published online: 01 May 2007

The impact of co-morbid substance use in first-episode schizophrenia has not been fully explored.


This naturalistic follow-up of a cohort of 152 people with first-episode schizophrenia examined substance use and clinical outcome in terms of symptoms and social and neuropsychological function.


Data were collected on 85 (56%) of the patient cohort after a median period of 14 months. Over the follow-up period, the proportion of smokers rose from 60% at baseline to 64%. While 30% reported lifetime problem drinking of alcohol at baseline, only 15% had problem drinking at follow-up. Furthermore, while at baseline 63% reported lifetime cannabis use and 32% were currently using the drug, by the follow-up assessment the latter figure had fallen to 18.5%. At follow-up, persistent substance users had significantly more severe positive and depressive symptoms and greater overall severity of illness. A report of no lifetime substance use at baseline was associated with greater improvement in spatial working memory (SWM) at follow-up.


Past substance use may impede recovery of SWM performance in people with schizophrenia in the year or so following first presentation to psychiatric services. The prevalence of substance use other than tobacco tends to diminish over this period, in the absence of specific interventions. Persistent substance use in first-episode schizophrenia is associated with more severe positive and depressive symptoms but not negative symptoms, and should be a target for specific treatment intervention.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Naturalistic follow-up of co-morbid substance use in schizophrenia: the West London first-episode study
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Naturalistic follow-up of co-morbid substance use in schizophrenia: the West London first-episode study
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Naturalistic follow-up of co-morbid substance use in schizophrenia: the West London first-episode study
      Available formats
Corresponding author
*Address for correspondence: Professor T. R. E. Barnes, Division of Neuroscience and Mental Health, Imperial College Faculty of Medicine, Charing Cross Campus, St Dunstan's Road, London W6 8RP, UK. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

J Addington , D Addington (2001). Impact of an early psychosis program on substance use. Psychiatric Rehabilitation Journal 25, 6066.

J Addington , V Duchak (1997). Reasons for substance use in schizophrenia. Acta Psychiatrica Scandinavica 96, 329333.

ML Ambrose , SC Bowden , G Whelan (2001). Working memory impairments in alcohol-dependent participants without clinical amnesia. Alcoholism: Clinical and Experimental Research 25, 185191.

TRE Barnes (1989). A scale for rating drug-induced akathisia. British Journal of Psychiatry 154, 486491.

TRE Barnes , SH Mutsatsa , SB Hutton , HC Watt , EM Joyce (2006). Comorbid substance use and age at onset of schizophrenia. British Journal of Psychiatry 188, 237242.

M Birchwood , J Smith , R Cochrane , S Wetton , S Copestake (1990). Social Functioning Scale: the development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. British Journal of Psychiatry 157, 853859.

RI Block , WJ Erwin , MM Ghoneim (2002). Chronic drug use and cognitive impairments. Pharmacology, Biochemistry and Behavior 73, 491504.

B Bühler , M Hambrecht , W Löffler , W an der Heiden , H Häfner (2002). Precipitation and determination of the onset and course of schizophrenia by substance use – a retrospective and prospective study of 232 population-based first illness episodes. Schizophrenia Research 54, 243251.

D Caspari (1999). Cannabis and schizophrenia: results of a follow-up study. European Archives of Psychiatry and Clinical Neuroscience 249, 4549.

RM Condren , J O'Connor , R Browne (2001). Prevalence and patterns of substance misuse in schizophrenia: a catchment area case-control study. Psychiatric Bulletin 25, 1720.

RJ Croft , AJ Mackay , AT Mills , JG Gruzelier (2001). The relative contributions of ecstasy and cannabis to cognitive impairment. Psychopharmacology 153, 373379.

AS David (1990). Insight and psychosis. British Journal of Psychiatry 156, 798808.

RE Drake , H Xie , GJ McHugo , AI Green (2000). The effects of clozapine on alcohol and drug use disorders among patients with schizophrenia. Schizophrenia Bulletin 26, 441449.

PJ Duke , C Pantelis , TRE Barnes (1994). South Westminster Schizophrenia Survey. Alcohol use and its relationship to symptoms, tardive dyskinesia and illness onset. British Journal of Psychiatry 164, 630636.

PJ Duke , C Pantelis , MA McPhillips , TRE Barnes (2001). Comorbid substance misuse among people with schizophrenia in the community: an epidemiological study in central London. British Journal of Psychiatry 179, 501513.

JM Fletcher , JB Page , DJ Francis , K Copeland , MJ Naus , CM Davis , R Morris , D Krauskopf , P Satz (1996). Cognitive correlates of long-term cannabis use in Costa Rican men. Archives of General Psychiatry 53, 10511057.

E Gouzoulis-Mayfrank , J Daumann , F Tuchtenhagen , S Pelz , S Becker , HJ Kunert , B Fimm , H Sass (2000). Impaired cognitive performance in drug free users of recreational ecstasy (MDMA). Journal of Neurology, Neurosurgery and Psychiatry 68, 719725.

A Grech , J Van Os , PB Jones , SW Lewis , RM Murray (2005). Cannabis use and outcome of recent onset psychosis. European Psychiatry 20, 349353.

AI Green , MF Tohen , RM Hamer , SM Strakowski , JA Lieberman , I Glick , WS Clark ; HGDH Research Group (2004). First-episode schizophrenia-related psychosis and substance use disorders: acute response to olanzapine and haloperidol. Schizophrenia Research 66, 125136.

GE Hunt , J Bergen , M Bashir (2002). Medication compliance and comorbid substance abuse in schizophrenia: impact on community survival 4 years after a relapse. Schizophrenia Research 54, 253264.

SB Hutton , BK Puri , LJ Duncan , TW Robbins , TRE Barnes , EM Joyce (1998). Executive function in first-episode schizophrenia. Psychological Medicine 28, 463473.

CC Joyal , P Hallé , D Lapierre , S Hodgins (2003). Drug abuse and/or dependence and better neuropsychological performance in patients with schizophrenia. Schizophrenia Research 63, 297299.

E Joyce , S Hutton , S Mutsatsa , H Gibbins , E Webb , S Paul , T Robbins , TRE Barnes (2002). Executive dysfunction in first-episode schizophrenia and relationship to duration of untreated psychosis: the West London Study. British Journal of Psychiatry 181 (Suppl. 43), 3844.

DJ Kavanagh , G Waghorn , L Jenner , DC Chant , V Carr , M Evans , H Hemnan , A Jablensky , JJ McGrath (2004). Demographic and clinical correlates of comorbid substance use disorders in psychosis: multivariate analyses from an epidemiological sample. Schizophrenia Research 66, 115124.

M Lambert , P Conus , DI Lubman , D Wade , H Yuen , S Moritz , D Naber , PD McGorry , BG Schimmelmann (2005). The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis. Acta Psychiatrica Scandinavica 112, 141148.

PF Liddle , TRE Barnes (1990). Syndromes of chronic schizophrenia. British Journal of Psychiatry 157, 558561.

DH Linszen , PM Dingemans , ME Lenoir (1994). Cannabis abuse and the course of recent-onset schizophrenic disorders. Archives of General Psychiatry 51, 273279.

T Lundqvist (2005). Cognitive consequences of cannabis use: comparison with abuse of stimulants and heroin with regard to attention, memory and executive functions. Pharmacology, Biochemistry and Behavior 81, 319330.

S Magura , SY Kang (1996). Validity of self-reported drug use in high risk populations: a meta-analytical review. Substance Abuse and Misuse 31, 11311153.

GW Martin , DA Wilkinson , BM Kaur (1988). Validation of self-reported cannabis use by urine analysis. Addictive Behaviors 13, 147150.

A McCleery , J Addington , D Addington (2006). Substance misuse and cognitive functioning in early psychosis: a 2 year follow-up. Schizophrenia Research 88, 187191.

SA Montgomery , M Asberg (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382389.

MJ Morgan , L McFie , H Fleetwood , JA Robinson (2002). Ecstasy (MDMA): are the psychological problems associated with its use reversed by prolonged abstinence? Psychopharmacology 159, 294303.

S Mutsatsa , EM Joyce , S Hutton , E Webb , H Gibbins , S Paul , TRE Barnes (2003). Clinical correlates of early medication compliance: West London first episode schizophrenia study. Acta Psychiatrica Scandinavica 108, 439446.

TJ Ornstein , JL Iddon , AM Baldacchino , BJ Sahakian , M London , BJ Everitt , TW Robbins (2000). Profiles of cognitive dysfunction in chronic amphetamine and heroin abusers. Neuropsychopharmacology 23, 113126.

S Potvin , C Briand , A Proteau , RH Bouchard , O Lipp , P Lalonde , L Nicole , A Lesage , E Stip (2005). CANTAB explicit memory is less impaired in addicted schizophrenia patients. Brain and Cognition 59, 3842.

S Potvin , E Stip , JY Roy (2003). Clozapine, quetiapine and olanzapine among addicted schizophrenic patients: towards testable hypotheses. International Clinical Psychopharmacology 18, 121132.

J Rodgers (2000). Cognitive performance amongst recreational users of ‘ecstasy’. Psychopharmacology 151, 1924.

MP Salyers , KT Mueser (2001). Social functioning, psychopathology and medication side effects in relation to substance use and abuse in schizophrenia. Schizophrenia Research 48, 109123.

LJ Santin , S Rubio , A Begega , JL Arias (2000). Effects of chronic alcohol consumption on spatial reference and working memory tasks. Alcohol 20, 149159.

S Sevy , DG Robinson , S Holloway , JM Alvir , MG Woerner , R Bilder , R Goldman , J Lieberman , J Kane (2001). Correlates of substance misuse in patients with first-episode schizophrenia and schizoaffective disorder. Acta Psychiatrica Scandinavica 104, 367374.

CR Spencer , D Castle , PT Michie (2002). Motivations that maintain substance use among individuals with psychotic disorders. Schizophrenia Bulletin 28, 233247.

D Wade , S Harrigan , J Edwards , PM Burgess , G Whelan , PD McGorry (2006). Course of substance misuse and daily tobacco use in first-episode psychosis. Schizophrenia Research 81, 145150.

T Weaver , P Madden , V Charles , G Stimson , A Renton , P Tyrer , TRE Barnes , C Bench , H Middleton , N Wright , S Paterson , W Shanahan , N Seivewright , C Ford on behalf of the Comorbidity of Substance Misuse and Mental Illness Collaborative (COSMIC) study team (2003). Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. British Journal of Psychiatry 183, 304313.

RD Weiss , LM Najavits , SF Greenfield , JA Soto , SR Shaw , D Wynerm (1998). Validity of substance use self-reports in dually diagnosed outpatients. American Journal of Psychiatry 155, 127128.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *