Substance use at admission to an acute psychiatric department

Abstract

Substance use is prevalent in patients with psychiatric disorders and may cause severe symptoms in addition to complicating the diagnosis of psychiatric disorders. The aims of the study were to find the prevalence in use of alcohol, drugs, benzodiazepines, hypnotics, opiates and stimulants, and to find the prevalence of substance use disorders at admission to an acute psychiatric department receiving all admissions from a catchment area. Patients were interviewed about use of medications and intoxicating substances during the last week before admission in 227 consecutive admissions. Urine samples were analysed with the liquid chromatography with mass spectrometry (LC-MS) method. Use of substances was determined from reported use and findings in urine samples. Diagnoses were set at discharge according to ICD-10 research criteria. In 81.9% of the admissions, the patient had used alcohol, drugs, benzodiazepines, hypnotics, opiates or stimulants prior to admission. More men used alcohol, cannabis and stimulants, whereas more women used benzodiazepines. In 31.7% of the admissions, 49.5% of men and 16.4% of women, the patients had a substance use disorder (ICD-10, F10-19). Patients with substance use disorders had a shorter stay in hospital than other patients, and patients with no psychiatric disorder other than substance use disorders had a median length of stay of 2 days. Most patients had used psychoactive substances before admission to the acute psychiatric department, and half of the men had a substance use disorder.

Drugs of abuse among acute psychiatric and medical admissions: laboratory based identification of prevalence and drug influence

“…Our findings confirm the shortcomings of on-site urine testing in a clinical setting (30,191) and demonstrate the additional information obtained by comprehensive laboratory screening (90,191) (Table 9). …”

“…With this exception, the study was conducted in accordance with the declaration of Helsinki (167). Other recent studies have also been performed without informed consent of the patients (80,90), and some previous studies performed drug analyses under the guise of other somatic tests (143,148). We experienced in the main project that informed consent very well can be obtained, within a few days after admission, and we recommend future studies to do so.…”

“…In studies from psychiatric acute care settings, physicians have been asked to judge if the patient had been taking any substances recently (76,90). Clinical assessment of recent drug intake is a challenging task, and when compared with laboratory drug findings, these studies report significant discrepancies.…”

“…Only four previous studies have used gas or liquid chromatography-mass spectroscopy (81,90,117,142), of which two included immunological screening (81,117). Many studies lacked detailed information on recent substance intake and polydrug use, and substance specific detection rates were reported in about half of the studies (Table A2).…”

Patterns of psychiatric diagnoses in inpatient and outpatient psychiatric settings in Saudi Arabia

“…Compared with our findings, an Indian study conducted in a tertiary care center showed that alcohol-use disorders account for 29% of substance-use disorders 35 . In Norway, approximately onethird of the admissions in an acute psychiatric ward had a substanceuse disorder 36,37 . This discrepancy may be explained by the fact that patients with substance-use disorders in SA are, according to national policy, admitted to separate addiction facilities.…”