Substance-induced suicidal admissions to an acute psychiatric service: Characteristics and outcomes

Ries, Richard K.; Yuodelis‐Flores, Christine; Comtois, Katherine Anne; Roy‐Byrne, Peter; Russo, Joan

doi:10.1016/j.jsat.2006.12.033

Cited by 26 publications

(11 citation statements)

References 36 publications

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“…Depending on the degree that the psychiatric symptoms could be attributed to drug abuse, they had a LOS that was 1.2 to 3.4 days shorter than those without any drug abuse. Their study did not reveal any difference in the suicidal measures at admission, however, while we found that acutely intoxicated patients were less suicidal by several measures of the SSF-II-R.(27)…”

Section: Discussioncontrasting

confidence: 58%

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How does active substance use at psychiatric admission impact suicide risk and hospital length-of-stay?

Miller

Hitschfeld

Lineberry

et al. 2016

Journal of Addictive Diseases

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Background/Objective Despite their high prevalence, little is known about the effects of substance use disorders (SUD) and active substance use on the suicide risk or length of stay (LOS) of psychiatric inpatients. This study examines the relationship between active substance use at the time of psychiatric hospitalization and changes in suicide risk measures and LOS. Methods Admission and discharge ratings on the Suicide Status Form-II-R, diagnoses, and toxicology data from 2333 unique psychiatric inpatients were examined. Data for patients using alcohol, THC, methamphetamines, cocaine, benzodiazepines, opiates, barbiturates, PCP and multiple substances on admission were compared with data from 1426 admissions without substance use. Results Patients with substance use by toxicology on admission had a 0.9 day shorter LOS compared to toxicology-negative patients. During initial nurse evaluation on the inpatient unit, these patients reported lower suicide measures (i.e. suicidal ideation frequency, overall suicide risk, and wish-to-die). No significant between-group differences were seen at discharge. Patients admitted with a SUD diagnosis had a 1.0 day shorter LOS than those without, while those with a SUD diagnosis and positive toxicology reported the lowest measures of suicidality on admission. These results remained independent of psychiatric diagnosis. Discussion For acute psychiatric inpatients, suicide risk is higher and LOS is longer in patients with SUDs who are NOT acutely intoxicated compared with patients without a SUD. Toxicology-positive patients are less suicidal on admission and improve faster than their toxicology-negative counterparts. This study gives support to the clinical observation that acutely intoxicated patients may stabilize quickly with regard to suicidal urges and need for inpatient care.

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Section: Discussioncontrasting

confidence: 58%

“…(27) These patients have been previously described in a variety of other studies. (28, 29) Just as in our study, these patients showed more rapid improvement in suicidality than those whose admission was not associated with active substance use.…”

Section: Discussionmentioning

confidence: 86%

How does active substance use at psychiatric admission impact suicide risk and hospital length-of-stay?

Miller

Hitschfeld

Lineberry

et al. 2016

Journal of Addictive Diseases

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“…Ries and colleagues reported that self-harm patients who had used substances at the time of injury were discharged sooner than patients whose behaviour was not perceived to be related to substance use [16]. Clinicians believe that AUS related self-harm is linked to lower levels of premeditation (i.e., is more impulsive) and lower levels of suicidal intent [15].…”

Section: Introductionmentioning

confidence: 99%

Substance use and self-harm: a cross-sectional study of the prevalence, correlates and patterns of medical service utilisation among patients admitted to a South African hospital

Breet

Bantjes

Lewis

2018

BMC Health Serv Res

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BackgroundSubstance use is a potentially modifiable risk factor for suicidal behaviour. Little is known about the epidemiology of substance use among self-harm patients in South Africa. This study set out to collect epidemiological data about the prevalence, correlates, and patterns of medical service utilisation among self-harm patients who used substances at the time of self-injury.MethodsData from 238 consecutive self-harm patients treated at an urban hospital in South Africa were analysed using bivariate and multivariate statistics.ResultsApproximately 20% of patients reported substance use at the time of self-harm. When compared to other self-harm patients, higher rates of patients who had used substances: had depressed levels of consciousness on admission; utilised more medical resources and required longer hospital admissions; cited relationship difficulties and financial concerns as reasons for their self-harm; reported a previous episode of self-harm; and intended to die as a result of their injuries. Although the observed differences were not statistically significant (p > 0.05), the proportional differences were congruent with international literature.ConclusionAcute use of substances among self-harm patients warrants more focused research and clinical attention particularly in the context of reducing utilisation of scarce medical resources.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-2963-7) contains supplementary material, which is available to authorized users.

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“…Administrators of the MINI for our study, however, were trained to exclude substance-induced disorders and clinician judgment and oversight was also used at the residential treatment program prior to finalizing the diagnoses. There is evidence that experienced clinician judgment can be useful in making this distinction (Ries et al, 2008). A number of mechanisms have been proposed to account for the comorbidity of substance use and psychiatric disorders, including: 1) pre-existing neurobiological abnormalities may account for both types of disorders which reflect different symptom expressions, 2) neuroadaptation resulting from repeated drug use is associated with biological changes in some psychiatric disorders, and 3) substance use reflects self-medication of symptoms of psychiatric disorders (Herrero et al, 2008; Torrens et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

Demographic and clinical characteristics of current comorbid psychiatric disorders in a randomized clinical trial for adults with stimulant use disorders

Warden

Sanchez

Greer

et al. 2016

Psychiatry Research

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This study aimed to determine if current comorbid psychiatric disorders differ in adults with cocaine use disorder, other stimulant (primarily methamphetamine) use disorder, or both, and identify demographic and clinical characteristics in those with increasing numbers of comorbid disorders. Baseline data from a randomized controlled trial beginning in residential settings (N=302) was used. Mood disorders were present in 33.6%, and anxiety disorders in 29.6%, with no differences among stimulant use disorder groups. Panic disorder was more frequently present with other stimulant use disorder. Those with two or more comorbid psychiatric disorders were more often female, White, had more symptoms of depression, greater propensity and risk for suicidal behavior, lower functioning in psychiatric and family domains, lower quality of life, more symptoms with stimulant abstinence and greater likelihood of marijuana dependence. Those with one or more comorbid disorders had more medical disorder burden, lower cognitive and physical functioning, greater pain, and higher rates of other drug dependence. With current comorbid psychiatric disorders, the morbidity of stimulant use disorders increases. Use of validated assessments near treatment entry, and a treatment plan targeting not only substance use and comorbid psychiatric disorders, but functional impairments, medical disorder burden and pain, may be useful.

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Substance-induced suicidal admissions to an acute psychiatric service: Characteristics and outcomes

Cited by 26 publications

References 36 publications

How does active substance use at psychiatric admission impact suicide risk and hospital length-of-stay?

How does active substance use at psychiatric admission impact suicide risk and hospital length-of-stay?

Substance use and self-harm: a cross-sectional study of the prevalence, correlates and patterns of medical service utilisation among patients admitted to a South African hospital

Demographic and clinical characteristics of current comorbid psychiatric disorders in a randomized clinical trial for adults with stimulant use disorders

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