Diagnosing Psychotic Disorders in the Emergency Department in the Context of Substance Use

Schanzer, M.P.H. Bella M.; First, Michael B.; Dominguez, Boanerges; Hasin, Deborah S.; Caton, Carol L. M.

doi:10.1176/ps.2006.57.10.1468

Cited by 32 publications

(6 citation statements)

References 29 publications

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“…As expected, a number of presentations in this study were intoxicated (Larkin et al 2005, Knott et al 2007) and had substance abuse co-morbidities (Kinner et al 2005, Gray et al 2007, and it is these presentations in particular that ED staff find difficult to manage (Schanzer et al 2006, Breton et al 2007), as they require careful MH status assessment and referral to appropriate follow-up supports. Furthermore, the study found that intoxicated patients were more likely to stay longer than 8 h in the ED before being discharged.…”

Section: Discussionsupporting

confidence: 64%

“…Also, there is a significant prevalence and co-morbidity of substance use and MH problems among ED presentations (Cassar et al 2002, Curran et al 2003, Kinner et al 2005, Gray et al 2007. Management of people with co-morbidities, especially intoxication pose particularly difficulties for ED staff in regard to their diagnosis and management, including their treatment prioritization (Heslop et al 2000, Happell et al 2002, Schanzer et al 2006, Breton et al 2007.…”

Section: Introductionmentioning

confidence: 99%

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The characteristics, management and outcomes of people identified with mental health issues in an emergency department, Melbourne, Australia

Shafiei¹,

Gaynor

Farrell

2010

Journal of Psychiatric and Mental Health Nursing

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Although the number of mental health presentations to emergency departments is increasing as a result of the integration of psychiatric services with general services, few studies have explored the characteristics of mental health patients presenting to emergency departments in Australia. This study investigated the characteristics of, and outcomes in relation to, people presenting with a mental health problem to one large metropolitan emergency department. Data were collected from the emergency department's electronic records system for adult patients aged 18-65 years old with an emergency department discharge diagnosis of a mental health disorder, including substance abuse and psychosocial crisis, for two months. Mental health patients totalled 5.3% (n= 290) of adult presentations to the emergency department. Over half were male; mean age 37.4 years; 49% were allocated triage category 3/urgent; 45% arrived by ambulance; 39% were overdosed/intoxicated and 55% received one or more diagnostic investigations. Patients who were intoxicated, those who arrived after hours, or patients admitted to a mental health ward were more likely to wait longer than 8h. Findings are broadly in line with that reported for other Australian studies, although the present findings suggest that patients had significantly more routine investigations and there were higher rates of presentations for 'intoxication'.

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Section: Discussionsupporting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

The characteristics, management and outcomes of people identified with mental health issues in an emergency department, Melbourne, Australia

Shafiei¹,

Gaynor

Farrell

2010

Journal of Psychiatric and Mental Health Nursing

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“…However, diagnostic studies included in one systematic review typically compare FRS in SZ versus "other psychoses," where the group of "other psychoses" is broadly defined either as affective psychosis (mostly bipolar psychosis) or nonaffective psychosis, and may include a nonspecific, broadly defined "substanceinduced psychosis" group as a smaller subgroup within the "other-psychosis group" [18,[21][22][23][24] . To our knowledge, the prevalence of FRS has not been directly compared in patients with schizophrenia versus MAP in particular (defined more specifically); however, in one study, certain FRS (thought broadcasting and thought withdrawal) have indeed been found to occur significantly more frequently in patients with SZ as compared to those with specifically cocaine-induced and phencyclidine-induced psychoses [25] In turn, clinicians in psychiatric emergency departments may have a tendency to attribute psychotic symptoms to primary psychotic disorders, such as SZ, rather than to concurrent substance use [26] . However, the direction of causality may be more complicated, with each condition reciprocally affecting the other, with deteriorating effects on both conditions [27] .…”

mentioning

confidence: 97%

First-Rank Symptoms in Methamphetamine Psychosis and Schizophrenia

et al. 2016

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Background: Methamphetamine psychosis (MAP) symptomatology has been described as indistinguishable from that of schizophrenia (SZ), yet research comparing these two disorders on specific psychotic symptoms such as schneiderian first-rank symptoms (FRS) is lacking. We aimed to determine and compare the occurrence and associations of FRS in patients diagnosed with MAP and with SZ. Sampling and Method: Data from SCID-I interviews performed on patients with either a diagnosis of SZ or MAP were compared. We calculated the prevalence of different FRS between MAP and SZ patients and used logistic regression to assess the association between FRS and diagnosis. Results: 102 patients were included in the study (MAP = 33, SZ = 69). Thought broadcasting occurred significantly more often in SZ (42%) than in MAP (24.2%) patients (adjusted OR = 3.02; 95% CI: 1.12-8.15; p = 0.028), while auditory hallucinations (voices conversing) were significantly higher in MAP (48.5%) than in SZ (20.3%) patients (adjusted OR = 0.27; 95% CI: 0.10-0.66; p = 0.004). However, there was no significant difference in the occurrence of one or more FRS in MAP and SZ, with most FRS showing overlap. Conclusions: We found that first-rank auditory hallucinations were more prevalent in MAP, whereas first-rank delusions of thought broadcasting were more prevalent in SZ. However, there was a substantial overlap in MAP and SZ for most FRS. This is consistent with the finding that FRS may have limited diagnostic specificity and that there is significant overlap in the symptoms of MAP and SZ. Future research into the neurobiology of delusions and hallucinations needs to take FRS into account.

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“…However, his negative urine toxicology made this less likely. 4 Last, we considered a primary psychiatric disorder. The prevalence of HIV and co-morbid bipolar affective disorder (BAD) or schizophrenia is estimated to be 4-19%.…”

Section: Discussionmentioning

confidence: 99%