Substance use and first-episode psychosis in the Eastern Cape

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In keeping with national and international literature, research from Walter Sisulu University showed a high prevalence of substance use in South African patients with first-episode psychosis.

In the first study of its kind in the Eastern Cape, a young Port Elizabeth doctor found strong links between mental illness and high levels of “lifetime substance abuse” in patients admitted to the acute mental health unit at the city’s Dora Nginza Hospital, according to a Daily Maverick report. Before the study, carried out with the support of a grant by the Discovery Foundation, there were no other studies to inform policymakers on the links between substance abuse and mental illness in the province.

The report says the research, by Dr Yanga Thungana, a psychiatrist at the acute mental health care unit at Dora Nginza Hospital in Port Elizabeth, supported by two professors from the Walter Sisulu University, Zukiswa Zingela and Stephan van Wyk, is the first in a series to build a case for a better treatment model for the province. “We are going to do a few further studies to enable us to present the Health Department with solid evidence for policy change,” Thungana said.

In his study, he looked at data of 12 months of admissions for patients who presented with first onset psychotic episodes. Of the 117 patients that formed part of his study, 86 were men and 31 women. They were aged between 18 and 60, and 95 out of 117 had a history of long-term active or previous substance abuse and 116 had a documented history of substance abuse. This percentage was higher than in other studies done in South Africa, and Thungana said it was one of the things they would study further.

“Our study showed a very high prevalence of substance use (81.9%) in inpatients presenting with a first episode of psychosis and who were admitted to the Dora Nginza Mental Health Unit.”

He is quoted in the report as saying that more than 80% of patients admitted had a history of substance abuse. “This result is higher than published data on substance use rates (30%-75%). This could be because of a combination of factors. Firstly, this could be sampling bias because of the inclusion of patients with both current and lifetime history of substance use. Secondly, this could be because of the perceived rising prevalence of substance use in the area. A study conducted in KwaZulu-Natal in patients with psychotic disorders showed that only 10% had no lifetime history of substance use. Most were brought to the hospital by their families, with a large number needing help from the police,” he said.

He said 66% of the patients in the study were unemployed. Thungana said they found a strong link between unemployment and substance abuse. “It is difficult to say which come first. People with mental illness tend not to be employed, but even if they are employed their functioning is impaired, so they also have a large chance to lose their jobs,” he said.

First-episode psychosis and substance use in Nelson Mandela Bay: Findings from an acute mental health unit

Authors
Yanga Thungana, Zukiswa Zingela and Stephan van Wyk
.

Abstract
Background: Use of psychoactive substances is a common finding in studies on first-episode psychosis (FEP), and this has prognostic implications. We know very little about psychoactive substance use (SU) among patients with FEP in the Eastern Cape province (EC) of South Africa (SA).
Aim: The study seeks to determine SU prevalence and associated features among inpatients with non-affective FEP in an acute mental health unit (MHU) in Nelson Mandela Bay, EC.
Setting: Researchers conducted a retrospective clinical file review of a 12-month admission cohort of patients with FEP, without a concurrent mood episode, to the Dora Nginza Hospital MHU. Information collected included SU history, psychiatric diagnoses, and demographics. Data were then subjected to statistical analysis.

Methods: Researchers conducted a retrospective clinical file review of a 12-month admission cohort of patients with FEP, without a concurrent mood episode, to the Dora Nginza Hospital MHU. Information collected included SU history, psychiatric diagnoses and demographics. Data were then subjected to statistical analysis.
Results: A total of 117 patients (86 [73.5%] males; 31 [26.5%] females) aged 18–60 years (mean 29 years) met the inclusion criteria. After controlling for missing information, 95 of 117 (81.2%) patients had a history of active or previous SU, 82 of 90 (91.1%) were single and 61 of 92 (66.3%) were unemployed. A significant association was found between SU and unemployment (p < 0.001), as well as male sex (p < 0.001). The most common substances used were cannabis (59.8%), followed by alcohol (57.3%) and stimulants (46.4%).

Conclusion: In keeping with national and international literature, the results of this study showed a high prevalence of substance use in South African patients with first-episode psychosis. The high prevalence of lifetime substance use in this cohort compared to previous studies in South Africa requires further investigation and highlights the urgent need for dual diagnosis services in the Eastern Cape province.

Strong link found between substance abuse and psychosis

South African Journal of Psychiatry abstract


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