ArticleSchizophrenia (Heidelberg, Germany)2026
Predictors of conversion to psychosis and mortality in first-episode substance-induced psychosis: a nationwide register-based study in South Korea.
Article in Schizophrenia (Heidelberg, Germany), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveSubstance-induced psychosis (SIP) is associated with a substantial risk of progression to schizophrenia spectrum disorders (SSD), bipolar disorder (BD), and premature mortality. However, evidence from Asia, particularly South Korea (SK), remains limited.
methodsWe conducted a retrospective, nationwide, population-based cohort study using the Korean National Health Insurance Claims Database (2003-2012) with follow-up through 2017. Individuals aged 18-60 years with a first episode of SIP (FE-SIP) were identified after excluding those with ICD-10 codes for substance use disorders (SUD; F10-F19) and other neuropsychiatric disorders (F00-F09, F20-F29, F30.x, F31.x, F32.3, or F33.3) during a 1-year washout. Incidence was estimated using national census data. Conversion to first-episode psychosis (FEP-SSD or -BD) was examined using cumulative incidence function and Cox regression. Standardized mortality ratios (SMRs) were calculated against the general population and a SUD reference cohort.
resultsA total of 2244 individuals with FE-SIP were identified. The average annual incidence proportion was 0.7 per 100,000, peaking in 2005. Over a median follow-up of 9.3 years, 655 individuals (33.2%) converted to FEP, with cumulative conversion rates of 23.3% at 5 years, and 28.8% at 10 years. Younger age, female sex, disability, longer initial hospitalization, and use of other stimulants were significant predictors of conversion. All-cause mortality was markedly elevated (SMR 33.3 vs general population; SMR 1.49 vs SUD cohort), particularly among young men.
conclusionsDespite a low incidence of FE-SIP in SK, the risks of conversion to FE-SSD/FE-BD and premature mortality are substantial. Findings underscore the need for early detection, psychoeducation, and integrated care tailored to high-risk individuals, especially within the first two years after diagnosis.
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