Substance Misuse in the Psychiatric Emergency Service; A Descriptive Study

Abstract

Substance misuse is frequently encountered in the psychiatric emergency service (PES) and may take many forms, ranging from formal DSM-IV diagnoses to less obvious entities such as hazardous consumption. Detecting such patients using traditional screening instruments has proved problematic. We therefore undertook this study to more fully characterize substance misuse in the PES and to determine whether certain variables might help better screen these patients. We used a prospectively acquired database of over 18,000 visits made to four PESs during a 2-year period in the province of Quebec, Canada. One of the variables acquired was a subjective rating by the nursing staff as to whether substance misuse was a contributing factor to the visit (graded as direct, indirect, or not at all). Substance misuse accounted for 21% of all diagnoses and alcohol was the most frequent substance used. Patients were divided into those with primary (PSM), comorbid (CSM) or no substance misuse (NSM). Depressive disorders were the most frequent primary diagnoses in CSM, whereas personality and substance misuse disorders were frequent secondary diagnoses in PSM. Although many variables significantly differentiated the three groups, few were sufficiently detailed to be used as potential screening tools. Those situations that did have sufficient details included those with a previous history of substance misuse, substance misuse within 48 hours of the visit, and visits graded by the nursing staff as being directly and/or indirectly related to substance misuse. Variables related to substance misuse itself were the primary predictors of PSM and, less significantly, CSM. The nursing staff rating, although promising, was obtained in less than 30% of all visits, rendering its practical use difficult to assess.

Do adolescents and young adults accessing the Emergency Room with substance use receive poor therapeutic indications at discharge? An observational retrospective study

“…In particular, although 40.2% of these patients reported a history of alcohol abuse, 26.3% reported a pattern of lifetime polyabuse followed by cannabinoids use (19.6%). Even though alcohol is considered to be the substance that is most largely related to ER accesses, 32,35,36 the high prevalence of polyabuse in our sample can be explained by the high frequency of positive history of abuse of different substances. Moreover, adolescents and young adults might show a higher frequency of polyabuse in relation to their desire to try new experiences and to the wider offer of substances to which they are exposed to 37 .…”

“…D’Onofrio and co‐workers in 2016 suggested that first accesses to the ER could be the only occasion of contact with healthcare services in patients with alcohol abuse 43 . In a subsequent study, Chaput and colleagues reported a first psychiatric diagnosis prevalence of 16.5% in a 2‐year ER access cohort linked to substance abuse 32 . Therefore, we may suppose that substances are mainly used by a population that does not correspond to a specific category of psychiatric patients.…”

“…43 In a subsequent study, Chaput and colleagues reported a first psychiatric diagnosis prevalence of 16.5% in a 2-year ER access cohort linked to substance abuse. 32 Therefore, we may suppose that substances are mainly used by a population that does not correspond to a specific category of psychiatric patients. Indeed, in our sample, only a minority of patients was already known to psychiatric facilities.…”

The frequency of alcohol induced disorders in patients treated at the Daily

“…Recentna istraživanja pokazuju da tijekom prve godine liječenja 65% (2/3) bolesnika odlazi iz Kluba liječenih alkoholičara (KLA) te da je vrijeme od 3 do 6 mjeseci najkritičnije za napuštanje KLA i rada u njemu [28,29,30,31,32].…”

Incidence of dementia in Facility for older people in Dubrovnik - inclusion factor

“…Klubovi liječenih alkoholičara sinonim su za rehabilitaciju u alkoholičara. Recentna istraživanja pokazuju da tijekom prve godine liječenja 65% (2/3) bolesnika odlazi iz Kluba liječenih alkoholičara (KLA) te da je vrijeme od 3 do 6 mjeseci najkritičnije za napuštanje KLA i rada u njemu [28,29,30,31,32].…”