Project Type(s):
Clinical Research

First-episode substance-induced psychosis (SIP) presents a clinical challenge in which treatment decisions cannot rely on evidence-based guidelines and long-term outcomes are not well understood. Preliminary findings from our retrospective study of psychiatry inpatients at Harborview Medical Center (HMC) suggest that patients with first-episode SIP had similar rehospitalization rates to those with first-episode psychosis (FEP) but were less likely to receive long-acting injectable antipsychotics (LAIs) even though LAIs may reduce the risk of 30- and 180-day rehospitalization. Our study has also revealed inconsistent assessment of key risk factors for rehospitalization—such as family history of psychosis and patterns of cannabis use—that may be limiting informed decision-making, including appropriate LAI use. This project seeks to improve the risk stratification of first-episode SIP by addressing these gaps. Aim 1 will use qualitative interviews with inpatient attending psychiatrists, psychiatry residents, and patients to explore factors influencing the management of first-episode SIP. Aim 2 will evaluate the acceptability and feasibility of implementing a standardized assessment of cannabis use and family history of psychosis on HMC inpatient psychiatry units. This project will lay the groundwork for future clinical interventions that optimize treatment decisions and improve patient outcomes in psychiatric inpatient settings.

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