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First-Episode Psychosis and Co-Occurring Substance Use Disorders

First-Episode Psychosis and Co-Occurring Substance Use Disorders

1. Although psychosis can be experienced at any age, symptoms most commonly begin between the ages of:

A. 8 and 12

B. 12 and 24

C. 19 and 26

D. 16 and 30


2. First-episode psychosis is generally regarded as up to _____ after the onset of psychotic symptoms.

A. 6 months

B. 2 years

C. 5 years

D. 10 years


3. All of the following are symptoms of psychosis, except:

A. Aggression

B. Delusions

C. Hallucinations

D. Memory problems


4. All of the following may include psychosis as a severe secondary symptom, except for:

A. Major depression

B. Bipolar disorder

C. Delusional disorder

D. Major depression, bipolar disorder, and delusional disorder all may include psychosis as a severe secondary symptom


5. The longer symptoms go untreated, the greater the risk of additional challenges, such as hospitalization or legal problems.

A. True

B. False


6. Young people in the United States typically experience symptoms of psychosis for more than 3 years before receiving treatment.

A. True

B. False


7. Which of the following refers to patterns of drinking or drug use that confer higher risk for negative consequences?

A. Substance misuse

B. Experimentation with substances

C. Recreational substance use

D. All drinking and drug use confer higher risk for negative consequences


8. Substance misuse is defined as continued and frequent substance use despite experiencing a range of negative consequences, including using the substance in larger amounts over time, unsuccessful attempts to cut down or stop using, spending a lot of time engaged in substance use or recovering from its effects, and giving up important social, occupational, or recreational activities because of substance use.

A. True

B. False


9. Use of _____ is associated with cardiometabolic problems among young adults with first episode psychosis.

A. Alcohol

B. Tobacco

C. Opioids

D. Cannabis


10. Most young adults with first-episode psychosis have tried or used cannabis, alcohol, or tobacco at some point in their lives.

A. True

B. False


11. Research shows that experiencing first-episode psychosis together with a substance use disorder is associated with all of the following, except:

A. A greater number of hospitalizations

B. More likely to go to jail or prison

C. Higher rates of dropout from treatment

D. Greater risk of homelessness


12. One study found that young people who continued to use cannabis after a first episode of psychosis were more likely to have relapses of psychosis, even if they were reliably taking antipsychotic medications.

A. True

B. False


13. Interest in reducing substance use may wax and wane over time and may be more related to:

A. The threat of punishment

B. A desire to make a change

C. Both the threat of punishment and a desire to make a change are equally related to reducing substance use

D. Neither the threat of punishment nor a desire to make a change are related to reducing substance use


14. For individuals with psychotic disorders, treatment of substance misuse or substance use disorders by separate, unconnected clinicians is most effective.

A. True

B. False


15. Making diagnosis more difficult is the fact that the effects of alcohol and all of the following drugs can mimic symptoms of psychotic illness, except for:

A. Stimulants

B. Cannabis

C. Hallucinogens

D. Opioids


Effectiveness of Treatment for Substance Use Disorders Among Persons with First-Episode Psychosis

16. Generalized treatment for first-episode psychosis usually includes all of the following, except:

A. Low doses of antipsychotic medications

B. Specialized interventions for substance misuse / disorders

C. Psycho-education about psychosis and recovery

D. Employment and educational supports


17. Many young adults reported that all of the following values increased in importance over time and were key reasons for reducing or stopping substance use, except for:

A. Health

B. Income

C. Family

D. Spirituality


18. The fact that benefits of brief motivational enhancement and skills training have been found to decrease over time suggests that people may need boosters or ongoing support for reducing substance use.

A. True

B. False


19. Numerous trials found that cognitive behavioral therapy plus motivational interviewing was significantly more effective than a comparison treatment in terms of reducing substance use among individuals with first-episode psychosis.

A. True

B. False


20. Which of the following was found to be superior to other antipsychotics in terms of reducing substance use?

A. Clozapine

B. Risperidone

C. Olanzapine

D. Quetiapine


21. Which of the following was shown to be more effective for reducing cravings?

A. Clozapine

B. Risperidone

C. Olanzapine

D. Quetiapine


22. Those who do not reduce their substance use in response to generalized first-episode psychosis treatment should be offered targeted substance use interventions.

A. True

B. False


23. Treatment focused on addressing problems associated with substance use may be most appropriate for those not ready to reduce or stop substance use.

A. True

B. False


24. Which intervention encourages individuals to anticipate challenges to short-term achievement and long-term maintenance of substance use change and teaches problem-solving skills to address these challenges?

A. Harm reduction approach

B. Coping skills training

C. Relapse prevention planning and problem-solving

D. Motivational enhancement


Evidence-Based Programs for Implementing Integrated Treatment of Substance Use Disorders and First-Episode Psychosis

25. To specifically address substance misuse, EDAPT uses the Substance Abuse Management Module group, which does all of the following, except:

A. Provides psychoeducation on the role substances play in exacerbating symptoms and decreasing functioning.

B. Guides group members in problem solving around substance use.

C. Teaches coping skills from a variety of theoretical orientations to support abstinence or harm reduction.

D. Acts as a transitional program, with the goal of providing the education and resources the person needs to be successful in the long-term.


26. The critical feature of the PIER approach is:

A. Community outreach by a clinical team to school professionals, general practitioners, pediatricians, and other key groups to educate and inform about the early signs of mental illness.

B. As a transitional program, with the goal of providing the education and resources the person needs to be successful in the long-term.

C. Teaching coping skills from a variety of theoretical orientations to support abstinence or harm reduction.

D. Addressing problems associated with substance use for those not ready to reduce or stop substance use.


27. The PIER model assumes that substance misuse among people with a psychotic disorder is largely the result of their environment.

A. True

B. False


28. Substance use treatment within PIER is based on motivational interviewing and cognitive behavioral approaches and follows a harm reduction model.

A. True

B. False


Guidance for Implementing Evidence-Based Practices

29. What is the first task to create a program culture that supports treatment for substance misuse / disorders within first-episode psychosis services?

A. Coordinate first-episode psychosis and specialty substance use disorder services to ensure integrated treatment across programs.

B. Build connections and referral relationships with community treatment programs based on program participants’ needs and culture.

C. Communicate the clear treatment need, and identify substance misuse / disorders as a treatment priority.

D. Integrate a harm reduction approach that promotes both reduction of substance use and abstinence as treatment goals.


30. All clinicians in first-episode psychosis treatment programs should have basic training in all of the following skills, except:

A. Using a brief set of measures to assess quantity and frequency of use.

B. Providing feedback and recommendations in a person-centered and nonjudgemental way.

C. Engaging individuals in recovery-oriented discussions about the impacts of continued substance misuse / disorders on progress towards goals.

D. Performing diagnostic interviewing so that the program has a clear understanding of current and lifetime substance use disorders across substances.


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