Dynamics of Diagnosis in Patients with a First Psychotic Episode Induced by the Use of Psychoactive Substances // Динамика на диагнозата при пациенти с първи психотичен епизод след употреба на психоактивни вещества

The first psychotic episode marks a critical moment in the development of chronic psychotic disorders and carries substantial diagnostic and prognostic significance. In recent decades, a steady increase in the number of registered psychotic disorders induced by psychoactive substance use has been documented. The dynamics of diagnosis in these patients are a relevant yet insufficiently researched issue, thereby requiring investigation. The thesis aims to track the variability (dynamics) of diagnosis in patients with a first psychotic episode after psychoactive substance use within a two-year period. The study is designed as a longitudinal, prospective study, including a total sample of 81 patients aged 18 to 65 years, divided into two groups: the study group of 41 individuals with a diagnosis of first psychotic episode after psychoactive substance use and the control group of 40 individuals. To achieve the objectives, sociodemographic and clinical characteristics, severity of psychotic symptomatology, frequency of hospitalisations, level of functional recovery, and dynamics of initial diagnosis were studied. Applied research methods included clinical psychiatric examination, standardised assessment instruments (PANSS, GAF scales, and DAST 10 questionnaire), clinical laboratory tests, and combined urine tests for psychoactive substances. Data were processed with modern statistical methods, ensuring reliability and statistical significance of the obtained results. The analysis of results and conclusions confirms that psychoactive substance use is a substantial modifying factor in the development and course of psychotic disorders and exerts unfavourable influence on psychosis severity, number of hospitalisations, degree of recovery, and the quality of life. In patients in the study group, slower and partial improvement is observed, as well as a tendency toward chronification of psychosis, mainly with transition to diagnosis in the schizophrenia spectrum. Decrease in positive symptomatology remains the leading prognostic marker for early remission, while negative and cognitive impairments determine poorer long-term prognosis and social maladaptation. The study demonstrates the applicability of standardised psychometric instruments (PANSS, GAF, and DAST-10) in Bulgarian clinical practice and outlines the need for inclusion of neuropsychological assessments in future studies. The main limitations in the course of the study were the relatively small sample size (n ≈ 80) and an insufficiently prolonged follow-up period.

Grantor dc:publisher

Medical University of Varna

Year dc:date

2026

Authors dc:creator

• Avramov, Danko
• Аврамов, Данко

• psychotic episode
• psychotic disorder
• substances
• Психиатрия и медицинска психология / Psychiatry and Medical Psychology

Repository record dc:identifier

http://repository.mu-varna.bg/handle/nls/4377

OAI identifier oai:identifier

oai:repository.mu-varna.bg:nls/4377