{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:15:04Z","timestamp":1790777704297,"version":"4.1.0"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"<jats:sec id=\"ab-ybr230006-4\"><jats:title>Importance<\/jats:title><jats:p>Episodes of substance-induced psychosis are associated with increased risk of developing a schizophrenia spectrum disorder. However, there are limited data on the transition risk for substance use without psychosis.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ybr230006-5\"><jats:title>Objectives<\/jats:title><jats:p>To quantify the risk of transition to schizophrenia spectrum disorder following an incident emergency department (ED) visit for (1) substance-induced psychosis and (2) substance use without psychosis and to explore factors associated with transition.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ybr230006-6\"><jats:title>Design, Settings, and Participants<\/jats:title><jats:p>A population-based retrospective cohort study (January 2008 to March 2022) of all individuals, aged 14 to 65 years, in Ontario, Canada, with no history of a psychotic disorder. Individuals with incident ED visits for substance use with and without psychosis were compared with members of the general population.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ybr230006-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Transition to schizophrenia spectrum disorder using a chart-validated algorithm. Associations between ED visits for substance use and subsequent transition were estimated using cause-specific hazard models.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ybr230006-8\"><jats:title>Results<\/jats:title><jats:p>The study included 9\u202f844\u202f497 individuals, aged 14 to 65 years (mean [SD] age, 40.2 [14.7] years; 50.2% female) without a history of psychosis. There were 407\u202f737 individuals with an incident ED visit for substance use, of which 13\u202f784 (3.4%) ED visits were for substance-induced psychosis. Individuals with substance-induced psychosis were at a 163-fold (age- and sex-adjusted hazard ratio [aHR], 163.2; 95% CI, 156.1-170.5) increased risk of transitioning, relative to the general population (3-year risk, 18.5% vs 0.1%). Individuals with an ED visit for substance use without psychosis had a lower relative risk of transitioning (aHR, 9.8; 95% CI, 9.5-10.2; 3-year risk, 1.4%), but incurred more than 3 times the absolute number of transitions (9969 vs 3029). Cannabis use had the highest transition risk among visits with psychosis (aHR, 241.6; 95% CI, 225.5-258.9) and the third-highest risk among visits without psychosis (aHR, 14.3; 95% CI, 13.5-15.2). Younger age and male sex were associated with a higher risk of transition, and the risk of male sex was greater in younger compared with older individuals, particularly for cannabis use.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ybr230006-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The findings of this cohort study suggest that ED visits for substance use were associated with an increased risk of developing a schizophrenia spectrum disorder. Although substance-induced psychoses had a greater relative transition risk, substance use without psychosis was far more prevalent and resulted in a greater absolute number of transitions. Several factors were associated with higher transition risk, with implications for counseling and early intervention.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2023.3582","type":"journal-article","created":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T11:34:42Z","timestamp":1695814482000},"page":"1169","source":"Crossref","is-referenced-by-count":46,"title":["Transition to Schizophrenia Spectrum Disorder Following Emergency Department Visits Due to Substance Use With and Without Psychosis"],"prefix":"10.1001","volume":"80","author":[{"given":"Daniel T.","family":"Myran","sequence":"first","affiliation":[{"name":"Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"},{"name":"Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada"},{"name":"ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"},{"name":"Bruy\u00e8re Research Institute, Ottawa, Ontario, 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University of Ottawa, Ottawa, Ontario, Canada"},{"name":"Department of Child and Adolescent Psychiatry, Charit\u00e9 Universit\u00e4tsmedizin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly K.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada"},{"name":"Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada"},{"name":"ICES Western, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jess G.","family":"Fiedorowicz","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"},{"name":"Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada"},{"name":"Department of Mental Health, The Ottawa Hospital, Ottawa, 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