Underdiagnosis of Psychoactive-Substance-lnduced Organic Mental Disorders in Emergency Psychiatry

Abstract

The tendency of emergency psychiatrists to make alcohol- and drug-related diagnoses was examined before and after the addition of a standardized psychoactive substance use questionnaire. The addition of the questionnaire resulted in a significant increase in the number of psychoactive-substance-induced organic mental disorder (substance-induced disorder) diagnoses. The questionnaire selectively increased the recognition of nonalcoholic substance-induced disorders while not significantly increasing the diagnoses of alcohol-induced disorders when alcohol was used alone. This suggests that nonalcoholic substance-induced disorders are underdiagnosed in emergency psychiatry. With the increase in the diagnoses of substance-induced disorders, there was a significant decrease in the frequency of psychotic disorder diagnoses and a significant increase in the frequency of adjustment disorder diagnoses. The clinical impact of underdiagnosing and misdiagnosing substance-induced disorders is discussed. Overall, the findings suggest that an increased awareness of substance use history, by the use of a standardized questionnaire, is an effective means of increasing the diagnostic yield of substance-induced disorders in the psychiatric emergency room. Follow-up studies using urine drug screening are recommended.

Drug withdrawal, cocaine and sedative use disorders increase the need for mechanical ventilation in medical patients

“…Single-center studies report DUD prevalences of 10-18%, substantially higher rates than the 1.9% rate we found [21,22]. Indeed, studies have found that alcohol and other drug use disorders are typically under-diagnosed, even by mental health professionals [23][24][25]. These data support the notion that physicians markedly under-diagnose DUD.…”

Psychiatric Emergency Services: A Review of the Literature and a Proposed Research Agenda

“…The results suggest the potential benefits of early detection and intervention strategies; however, no research was found to validate this. Several researchers have examined the prevalence of substance abuse amongst psychiatric emergency service users (34)(35)(36)(37)(38). It is evident that substance abuse is prevalent amongst persons receiving psychiatric emergency services; however, nothing is known about appropriate management strategies and their influence on outcomes for this population.…”

Evaluation of a Urine On-Site Drugs of Abuse Screening Test in Patients Admitted to a Psychiatric Emergency Unit

“…1Y7,9 In psychiatric emergency settings, the diagnosis of a substance use disorder can be difficult to establish. 10,11 Substanceinduced syndromes may resemble other psychiatric disorders, 8 and self-reporting is often unreliable. 12 Consequently, substance use disorders are often underdiagnosed.…”