Alcohol and Substance Use by Patients with Psychosis Presenting to an Emergency Department: Changing Patterns

Latt, Noeline; Jurd, Stephen; Tennant, Christopher; Lewis, John H.; Macken, Lewis; Joseph, Anthony; Grochulski, Alan; Long, Lidia

doi:10.3109/10398562.2011.579971

Cited by 27 publications

(33 citation statements)

References 12 publications

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“…Table 4, which records specific drugs and their patterns of use in the sample, cannabis once again featured as the most commonly used drug among adolescents with dual diagnosis. This is similar to results from a study by Latt et al, 33 which also found cannabis to be the commonest illicit drug abused by patients with psychosis (schizophrenia and other psychotic disorders) presenting acutely to the emergency department. An important finding is the statistically significant relationship between cannabis as a debut drug and ongoing cannabis use.…”

Section: Substance Historysupporting

confidence: 90%

A retrospective chart review of the clinical and psychosocial profile of psychotic adolescents with co-morbid substance use disorders presenting to acute adolescent psychiatric services at Tygerberg Hospital

et al. 2012

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Background. A large number of adolescents meet criteria for ‘dual diagnosis’ (a psychiatric disorder plus co-morbid substance use disorder (SUD), which prolongs treatment response and complicates intervention strategies. The current service model in Cape Town divides the care of such patients into psychiatric treatment and a separate substance use intervention. Child and adolescent mental health services face the challenge of high rates of readmission of adolescents into psychiatric facilities before utilisation of community-based substance abuse services.Objective. There is a scarcity of available treatment guidelines for dual-diagnosis adolescents, and a lack of systematically documented epidemiological and clinical data in South African adolescent populations.Method. A retrospective chart review of adolescent psychiatric admissions to the Tygerberg Adolescent Psychiatric Unit during 2010 was conducted. Relevant epidemiological, clinical and demographic data for those presenting with a dual diagnosis (specifically psychotic disorders and SUD) was recorded. Results. Results suggest a high prevalence of SUD among adolescents presenting with a first-episode psychosis. Statistically significant correlations with lower levels of education were found in those with ongoing substance abuse (specifically cannabis and methamphetamine), and a significant relationship between choice of debut drug and ongoing drug use was also demonstrated. Risk factors for SUD (psychosocial adversities, childhood trauma, family and community exposure to substances, early debut drug ages), risky sexual behaviours, and clinical psychiatric profiles of adolescents with dual diagnosis are described.Conclusions. This cohort had an enhanced risk as a result of genetic vulnerability and environmental availability of substances, and the findings emphasise the differences in presentation, choice of drugs of abuse and psychosocial difficulties of adolescents with a dual diagnosis presenting to a psychiatric facility. We aim to influence role-players to provide more integrated services, and highlight the need for future prospective studies in this adolescent group to assist in improving outcomes.

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Section: Substance Historysupporting

confidence: 90%

A retrospective chart review of the clinical and psychosocial profile of psychotic adolescents with co-morbid substance use disorders presenting to acute adolescent psychiatric services at Tygerberg Hospital

et al. 2012

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“…Psychiatric diagnoses were grouped into broad categories (affective disorders, schizophrenia and other psychosis, personality disorders, anxiety disorders, and others), and we did not discriminate between bipolar and unipolar affective disorders. We did not include data about laboratory tests objectively detecting drugs; nonetheless, it has been suggested that a urine drug screening can only identify a small additional rate (5%) of substance users [52]. Although it would have been interesting to assess details about reason for "acute" inpatient psychiatric admission, in this study, we focused specifically on a "snapshot" of comorbidity in a psychiatric ward over a 10-year period.…”

Section: Limitationsmentioning

confidence: 99%

“…Based on the literature and their clinical experience, they hypothesized an increase of the proportion of DD among all first psychiatric hospitalizations during the study period due to the increasing prevalence of substance-related disorders in the general population, an increased vulnerability to DD on behalf of specific population groups (e.g., new immigrants) [68][69][70], and, lastly, higher DD rates in involuntarily hospitalized patients because they may be more likely to show episodes of suicidal and violent behavior [52] compared to voluntarily admitted patients. Over the study period, DD with drugs decreased from 1996 to 2010, whereas DD with alcohol and DD with both drugs and alcohol increased.…”

Section: Epidemiology and Clinical Features Of Dd Patientsmentioning

confidence: 99%

“…They are more likely to suffer from comorbid medical conditions; as described above, they may experience more difficulties in family relationships and troubles maintaining a stable job and financial situation; moreover, they may have legal problems related to the behavioral consequences of substance use and/or to the illegal attempts to obtain the substance. Compared to schizophrenia patients who do not use alcohol and drugs, patients with DD tend to have an earlier age of onset, more frequent and sometimes longer periods of hospitalization, more severe depressive and psychotic symptoms, more episodes of suicidal and violent behavior, more legal and financial problems, and higher mortality risk [50][51][52][53][54][55][56]. Likewise, bipolar patients with DD have 6.4-fold risk for violent crime compared with bipolar patients without comorbidity [57,58].…”

Section: Epidemiology and Clinical Features Of Dd Patientsmentioning

confidence: 99%

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Dual Diagnosis Patients First Admitted to a Psychiatric Ward for Acute Psychiatric Patients: 2-Year Period 2003–2004 versus 2013–2014

Gramaglia¹,

Lombardi²,

Rossi³

et al. 2016

Recent Advances in Drug Addiction Research and Clinical Applications

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Dual diagnosis (DD) is the coexistence of severe mental illness (SMI) and substance use disorder (SUD). The increase of DD observed in recent years has important implications for mental health services organization. The aim of this study is to assess the prevalence and features of DD over a decade, comparing the periods 2003-2004 and 2013-2014. We performed a retrospective study retrieving sociodemographic and clinical data from the medical records of patients at their first admission to the Psychiatric Ward of University Hospital "Maggiore della Carità" in Novara, Italy. Patients with SMI and comorbid SUD (SMI-SUD) and patients with SMI without comorbidity (SMI) were compared in the two periods, 2003-2004 versus 2013-2014. SMI-SUD patients in both 2-year periods were more likely to be male, younger, unemployed, living with parents (or alone, for the 2013-2014 period) rather than with a family of their own, and single (or divorced, in 2003-2004). The 2003-2004 patients were more frequently diagnosed with a personality disorder, whereas the 2013-2014 patients had mixed diagnoses. We have found differences in the possible predictors of substance abuse in the two periods as well: in both periods, male gender was associated with an increased risk of DD, whereas age >61 years was associated with decreased risk. Only in the first period (2003)(2004) was having a university degree associated with a decreased risk of DD, whereas the diagnosis of a personality disorder was associated with an increased risk of DD; on the contrary, in the second period (2013)(2014), living in a protective environment was associated with a decreased risk of DD. The identification of changes in the prevalence of first admission DD patients and their clinical and sociodemographic features may help to highlight an evolving pattern of substance use and to identify possible risk factors that may be the target of prevention and treatment approaches.

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“…The substances used most frequently by persons with SMI are alcohol, followed by cannabis and stimulants; sedatives and hallucinogens are used less frequently [5,11,12]. Amphetamine use is greater in persons with psychotic disorders compared with the general population [13,14]. Studies have shown that both cannabis [15,16] and, to a greater extent, amphetamines [17,18] can provoke psychosis.…”

Section: Introductionmentioning

confidence: 99%

Searching for Sobriety: How Persons with Severe Mental Illness Experience Abstaining from Substance Use

Pettersen

Ruud²,

Ravndal³

et al. 2014

J Addict Res Ther

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Individuals diagnosed with severe mental illness (SMI) are more vulnerable to substances than are other people. Many people with SMI tend to attain full remission of their substance use, but others relapse frequently. There is more research on the reasons for substance use than on the reasons for abstaining among these individuals. Information from the latter may contribute to a better understanding of how individuals with SMI experience abstaining from substance use. Objective: The aim of this explorative study was to examine experiences of abstaining from substances of persons diagnosed with SMI. We examined both the reasons given and the requirements and strategies used when abstaining. Methods:A qualitative study with semi-structured interviews was conducted, and a descriptive and explorative design was applied. This study included a purposeful sample of 11 patients with SMI and substance use being treated by assertive community treatment teams. Results:The main reasons for quitting substance use were social relationships and meaningful activities. The stated requirements and strategies used in the search for sobriety were detachment towards people and places, positive thinking, controlling feelings and emotions, and fear of dependency. Conclusion:Our results are consistent with those from other qualitative studies on the importance of social relationships and meaningful activities as expressed reasons for abstaining. The strategy of actively avoiding a former adverse milieu to reach sobriety is consistent with findings from one similar study. The strategies of fear of adverse consequences, positive thinking, and controlling feelings and emotions found in the present study have not been reported by other qualitative studies.

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Alcohol and Substance Use by Patients with Psychosis Presenting to an Emergency Department: Changing Patterns

Cited by 27 publications

References 12 publications

A retrospective chart review of the clinical and psychosocial profile of psychotic adolescents with co-morbid substance use disorders presenting to acute adolescent psychiatric services at Tygerberg Hospital

A retrospective chart review of the clinical and psychosocial profile of psychotic adolescents with co-morbid substance use disorders presenting to acute adolescent psychiatric services at Tygerberg Hospital

Dual Diagnosis Patients First Admitted to a Psychiatric Ward for Acute Psychiatric Patients: 2-Year Period 2003–2004 versus 2013–2014

Searching for Sobriety: How Persons with Severe Mental Illness Experience Abstaining from Substance Use

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