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Between 20% and 70% of psychiatric patients have a co-occurring substance use disorder and rates of substance abuse among patients with psychotic disorders are especially high. Patients with co-existing psychosis and substance use disorders typically have poorer outcomes than patients diagnosed with either disorder alone. Frequently, treatment services for such dually diagnosed patients are not integrated and organizational barriers may impede the appropriate detection, referral, and treatment of these patients. This article reviews the epidemiology and treatment outcome for patients dually diagnosed with chronic mental illness (usually psychotic disorders) and substance use disorders. The article then presents a description of a dual diagnosis referral and treatment service in a large private, non-profit psychiatric hospital.

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Olanzapine has been shown to be superior to placebo for the treatment of mania. This secondary analysis suggests that olanzapine monotherapy is similarly effective for patients whether or not they previously have failed to respond to another mood stabilizer for mania. A study limitation is that response to lithium or valproate was determined retrospectively.

Nine depressed inpatients completed trials with S-adenosylmethionine. Seven showed improvement or remission of their symptoms. As in European studies, no side effects were seen except the apparent induction of mania in two patients with bipolar disorder.

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