Background and Hypothesis There is a paucity of research on treatment outcomes of patients with psychosis and cannabis use disorder (CUD). We aimed to compare the effectiveness of antipsychotics in reducing the risk of hospitalization in patients with first-episode psychosis (FEP) and co-occurring CUD. Study Design We utilized a nationwide Swedish cohort of patients with longitudinal register data from the year 2006 to 2021. Participants were patients with FEP and co-occurring CUD (n = 1820, 84.73% men, mean age 26.80 years, SD 8.25 years). The main outcome was hospitalization due to psychotic relapse. Hospitalization due to any psychiatric disorder or substance use disorder (SUD) were examined as secondary outcomes. Within-individual Cox regression models were used to study these associations. Study Results Use of any antipsychotic was associated with a 33% risk reduction of psychotic relapse (aHR = 0.67; 95% CI 0.60–0.75). Clozapine (0.43; 0.29–0.64), long-acting injectable (LAI) formulations of risperidone (0.40; 0.22–0.71), aripiprazole (0.42; 0.27–0.65), and paliperidone (0.46; 0.30–0.69) were associated with the lowest risk of relapse. The association between the LAI formulation of olanzapine and hospitalization due to psychosis was statistically non-significant (0.61; 0.35–1.05). Clozapine was associated with an 86% risk reduction of hospitalization due to SUD (0.14; 0.05–0.44). Of oral non-clozapine antipsychotics, aripiprazole was associated with the lowest risk of hospitalization due to psychotic relapse (0.61; 0.45–0.83). Conclusions These findings support the use of clozapine, LAI formulations of second-generation antipsychotics other than olanzapine, or oral aripiprazole to prevent hospitalization in FEP and co-occurring CUD.

中文翻译：

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首发非情感性精神病和大麻使用障碍中抗精神病药物的使用和精神病住院治疗：瑞典全国队列研究

背景和假设 关于精神病和大麻使用障碍 (CUD) 患者的治疗结果的研究很少。我们的目的是比较抗精神病药物在降低首发精神病 (FEP) 和并发 CUD 患者住院风险方面的有效性。研究设计我们利用了瑞典全国患者队列，该队列具有 2006 年至 2021 年的纵向登记数据。参与者是 FEP 和并发 CUD 的患者（n = 1820，84.73% 为男性，平均年龄 26.80 岁，SD 8.25 岁）。主要结果是因精神病复发而住院。因任何精神疾病或物质使用障碍（SUD）而住院的情况被作为次要结果进行检查。使用个体内 Cox 回归模型来研究这些关联。研究结果 使用任何抗精神病药物均可使精神病复发风险降低 33%（aHR = 0.67；95% CI 0.60-0.75）。氯氮平 (0.43; 0.29–0.64)、利培酮长效注射剂 (LAI) (0.40; 0.22–0.71)、阿立哌唑 (0.42; 0.27–0.65) 和帕潘立酮 (0.46; 0.30–0.69) 与最低复发的风险。奥氮平 LAI 制剂与精神病住院之间的相关性在统计学上不显着（0.61；0.35-1.05）。氯氮平与 SUD 导致的住院风险降低 86% 相关（0.14；0.05-0.44）。在口服非氯氮平抗精神病药物中，阿立哌唑因精神病复发而住院的风险最低（0.61；0.45-0.83）。结论 这些发现支持使用氯氮平、奥氮平以外的第二代抗精神病药 LAI 制剂或口服阿立哌唑来预防 FEP 和并发 CUD 住院。