From substance-induced psychosis to schizophrenia: Predictors of treatment response and transition to chronic psychotic illness-A systematic review.
Valerio Ricci, Stefania Chiappini, Giovanni Martinotti et al.
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In 30 seconds
This systematic review examined predictors of treatment response and progression to chronic psychotic illness in substance-induced psychotic disorders (SIPDs). It included 27 studies representing approximately 33,500 patients, with follow-up ranging from 1 month to 15.5 years. Moderate-certainty evidence linked symptom onset within 24–48 h of substance use with favorable response, while prominent negative symptoms and poor premorbid functioning were associated with slower remission or poorer outcomes. The review also identified bimodal response patterns, including rapid remission within 30 days for some patients, and cautioned that several other proposed predictors rest on lower-certainty evidence.
Key findings
- Symptom onset within 24–48 h of substance use predicted favorable treatment response, supported by moderate-certainty evidence.
- Prominent negative symptoms predicted slower remission and higher transition to chronic psychotic disorders, with moderate-certainty evidence.
- Poor premorbid functioning and response patterns involving rapid remission within 30 days versus poorer later outcomes distinguished responders from non-responders.
- Cannabis-induced and methamphetamine-induced psychosis were highlighted as warranting caution because of higher persistence rates and psychiatric comorbidity.
Why it matters
SIPDs can resolve after substance cessation or persist and progress, making prognosis clinically important. The review identifies temporal onset, negative symptoms, and premorbid functioning as the best-supported factors for distinguishing likely outcomes. Recognising these features may help frame monitoring and prognostic discussions, while the varying certainty of evidence argues against treating less-established predictors as definitive.
What to keep in mind
Evidence certainty varied across predictors; findings on neuroimaging were based on small studies, and several proposed factors had low or very low certainty.