Substance use disorders among psychotic patients admitted to inpatient psychiatric care

Abstract

Previous epidemiological and clinical studies have shown high rates of substance use disorders in patients with psychotic disorders. There are few studies from the Scandinavian countries. The aim of this study was to investigate the rate of substance use disorders in a group of Norwegian psychotic inpatients from a specific catchment area. Sixty patients, aged 18-40 years, were interviewed through standardized methods: the Addiction Severity Index (EuropASI) and the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I). Urine toxicology screens confirmed patients' self-report of recent substance use. The lifetime rate of substance use disorders was 70% when all psychotic disorders were included and 62.5% when substance-induced psychotic disorders were excluded. Fifty percent of all the patients studied had current substance use disorders. The majority of substance use disorders were dependence disorders. Alcohol, amphetamine and cannabis were the dominant substances. The level of comorbidity found in this study is comparable with that found in American studies, despite lower prevalence of substance use in the Norwegian population. The high rate of substance use disorders in psychotic inpatients has implications for the treatment and the organization of psychiatric care for these patients.

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

“…Our study sample is not representative in a national perspective, but we assume that our findings are representative for other big city hospitals in Norway. In Oslo, high detection rates of amphetamines have also been reported from psychotic inpatients previously (142), whereas psychotic outpatients have high rates of self-reported use (51).…”

“…In many studies, sample sizes were small and biological specimens were often obtained only for a subgroup of included patients (Table A2). All studies were performed in urban settings, but some studies have selected groups of patients, such as men (81) or psychotic patients (142). Studies also exhibit variation in the 24 methods used for substance detection.…”

“…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).…”

“…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). Urine samples were obtained within 2, 24 or 48 hours after admission, if information about this was reported, and blood samples were used in three studies only (87,116,142). At the time of admission, clinical drug intoxication due to cocaine was reported among 50% of the patients in one study (70), and clinical drug influence among one-third of the patients in another (87), but these results were not compared with blood drug findings.…”

“…Studies among inpatients in a sub-acute phase have reported better agreement between urine findings and structured interviews, partly explained by the fact that these patients knew that their reports were compared with urine tests (69,142). …”