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Substance misuse in the psychiatric emergency service; a descriptive study.

Chaput Y, Lebel MJ, Beaulieu L, Paradis M, Labonté E - Subst Abuse (2014)

Bottom Line: Although many variables significantly differentiated the three groups, few were sufficiently detailed to be used as potential screening tools.Variables related to substance misuse itself were the primary predictors of PSM and, less significantly, CSM.The nursing staff rating, although promising, was obtained in less than 30% of all visits, rendering its practical use difficult to assess.

View Article: PubMed Central - PubMed

Affiliation: Presently in Private Practice (during this study, Department of Psychiatry, McGill University, Montreal, Quebec, Canada).

ABSTRACT
Substance misuse is frequently encountered in the psychiatric emergency service (PES) and may take many forms, ranging from formal DSM-IV diagnoses to less obvious entities such as hazardous consumption. Detecting such patients using traditional screening instruments has proved problematic. We therefore undertook this study to more fully characterize substance misuse in the PES and to determine whether certain variables might help better screen these patients. We used a prospectively acquired database of over 18,000 visits made to four PESs during a 2-year period in the province of Quebec, Canada. One of the variables acquired was a subjective rating by the nursing staff as to whether substance misuse was a contributing factor to the visit (graded as direct, indirect, or not at all). Substance misuse accounted for 21% of all diagnoses and alcohol was the most frequent substance used. Patients were divided into those with primary (PSM), comorbid (CSM) or no substance misuse (NSM). Depressive disorders were the most frequent primary diagnoses in CSM, whereas personality and substance misuse disorders were frequent secondary diagnoses in PSM. Although many variables significantly differentiated the three groups, few were sufficiently detailed to be used as potential screening tools. Those situations that did have sufficient details included those with a previous history of substance misuse, substance misuse within 48 hours of the visit, and visits graded by the nursing staff as being directly and/or indirectly related to substance misuse. Variables related to substance misuse itself were the primary predictors of PSM and, less significantly, CSM. The nursing staff rating, although promising, was obtained in less than 30% of all visits, rendering its practical use difficult to assess.

No MeSH data available.


Related in: MedlinePlus

The secondary diagnoses1 of primary substance misuse and the primary diagnoses of comorbid substance misuse visits.2Notes:1AD (adjustment disorders), PER (personality disorders), DEP (major affective disorders), SCH (schizophrenia/chronic psychotic disorders), ANX (anxiety disorders), SM (substance misuse disorders), Other (all other DSM-IV disorders). 2P < 0.001, Pearson chi2 and likelihood-ratio.
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f2-sart-8-2014-007: The secondary diagnoses1 of primary substance misuse and the primary diagnoses of comorbid substance misuse visits.2Notes:1AD (adjustment disorders), PER (personality disorders), DEP (major affective disorders), SCH (schizophrenia/chronic psychotic disorders), ANX (anxiety disorders), SM (substance misuse disorders), Other (all other DSM-IV disorders). 2P < 0.001, Pearson chi2 and likelihood-ratio.

Mentions: The per substance distribution of the PSM and CSM visits are illustrated in Figure 1. In the majority of cases, alcohol was the substance misused. Combining the alcohol subcategory with “poly-substance misuse” (which typically involved alcohol with another substance), alcohol was responsible for 84% of PSM and 72% of CSM diagnoses. Generally, the greater number of concurrent substance misuse diagnoses, the greater the probability of alcohol being the substance misused. For instance, alcohol was almost twice as likely as all other substances combined (OR 1.7, CI 1.44–2.08, P < 0.001) to be misused when both primary and secondary diagnoses were substance misuse compared to visits with only a secondary substance misuse diagnosis. The comorbid psychiatric diagnoses for PSM visits and the primary psychiatric diagnoses for CSM visits are shown in Figure 2. Outcomes of the consultation process differed significantly between groups inasmuch as PSM visits were less likely to result in a hospitalization (7%) than either NSM (31%) or CSM (25%) visits (RRR 0.60, CI 0.57–0.64, P < 0.001, n = 16,022). In contrast, short-term (24 to 48 hours) observation in a PES holding area following the assessment was spread quite evenly between groups (21%, 28%, and 27% for NSM, CSM, and PSM visits, respectively). Involuntary commitment following the psychiatric assessment was significantly less frequent in PSM visits compared to NSM visits (RRR 0.65, CI 0.55–0.77, P < 0.001, n = 15,323). Discharge recommendations following the psychiatric assessment are shown in Figure 3. Unsurprisingly, referral to a substance misuse treatment center was more frequently observed for PSM, when compared to CSM (or NSM) visits.


Substance misuse in the psychiatric emergency service; a descriptive study.

Chaput Y, Lebel MJ, Beaulieu L, Paradis M, Labonté E - Subst Abuse (2014)

The secondary diagnoses1 of primary substance misuse and the primary diagnoses of comorbid substance misuse visits.2Notes:1AD (adjustment disorders), PER (personality disorders), DEP (major affective disorders), SCH (schizophrenia/chronic psychotic disorders), ANX (anxiety disorders), SM (substance misuse disorders), Other (all other DSM-IV disorders). 2P < 0.001, Pearson chi2 and likelihood-ratio.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3928057&req=5

f2-sart-8-2014-007: The secondary diagnoses1 of primary substance misuse and the primary diagnoses of comorbid substance misuse visits.2Notes:1AD (adjustment disorders), PER (personality disorders), DEP (major affective disorders), SCH (schizophrenia/chronic psychotic disorders), ANX (anxiety disorders), SM (substance misuse disorders), Other (all other DSM-IV disorders). 2P < 0.001, Pearson chi2 and likelihood-ratio.
Mentions: The per substance distribution of the PSM and CSM visits are illustrated in Figure 1. In the majority of cases, alcohol was the substance misused. Combining the alcohol subcategory with “poly-substance misuse” (which typically involved alcohol with another substance), alcohol was responsible for 84% of PSM and 72% of CSM diagnoses. Generally, the greater number of concurrent substance misuse diagnoses, the greater the probability of alcohol being the substance misused. For instance, alcohol was almost twice as likely as all other substances combined (OR 1.7, CI 1.44–2.08, P < 0.001) to be misused when both primary and secondary diagnoses were substance misuse compared to visits with only a secondary substance misuse diagnosis. The comorbid psychiatric diagnoses for PSM visits and the primary psychiatric diagnoses for CSM visits are shown in Figure 2. Outcomes of the consultation process differed significantly between groups inasmuch as PSM visits were less likely to result in a hospitalization (7%) than either NSM (31%) or CSM (25%) visits (RRR 0.60, CI 0.57–0.64, P < 0.001, n = 16,022). In contrast, short-term (24 to 48 hours) observation in a PES holding area following the assessment was spread quite evenly between groups (21%, 28%, and 27% for NSM, CSM, and PSM visits, respectively). Involuntary commitment following the psychiatric assessment was significantly less frequent in PSM visits compared to NSM visits (RRR 0.65, CI 0.55–0.77, P < 0.001, n = 15,323). Discharge recommendations following the psychiatric assessment are shown in Figure 3. Unsurprisingly, referral to a substance misuse treatment center was more frequently observed for PSM, when compared to CSM (or NSM) visits.

Bottom Line: Although many variables significantly differentiated the three groups, few were sufficiently detailed to be used as potential screening tools.Variables related to substance misuse itself were the primary predictors of PSM and, less significantly, CSM.The nursing staff rating, although promising, was obtained in less than 30% of all visits, rendering its practical use difficult to assess.

View Article: PubMed Central - PubMed

Affiliation: Presently in Private Practice (during this study, Department of Psychiatry, McGill University, Montreal, Quebec, Canada).

ABSTRACT
Substance misuse is frequently encountered in the psychiatric emergency service (PES) and may take many forms, ranging from formal DSM-IV diagnoses to less obvious entities such as hazardous consumption. Detecting such patients using traditional screening instruments has proved problematic. We therefore undertook this study to more fully characterize substance misuse in the PES and to determine whether certain variables might help better screen these patients. We used a prospectively acquired database of over 18,000 visits made to four PESs during a 2-year period in the province of Quebec, Canada. One of the variables acquired was a subjective rating by the nursing staff as to whether substance misuse was a contributing factor to the visit (graded as direct, indirect, or not at all). Substance misuse accounted for 21% of all diagnoses and alcohol was the most frequent substance used. Patients were divided into those with primary (PSM), comorbid (CSM) or no substance misuse (NSM). Depressive disorders were the most frequent primary diagnoses in CSM, whereas personality and substance misuse disorders were frequent secondary diagnoses in PSM. Although many variables significantly differentiated the three groups, few were sufficiently detailed to be used as potential screening tools. Those situations that did have sufficient details included those with a previous history of substance misuse, substance misuse within 48 hours of the visit, and visits graded by the nursing staff as being directly and/or indirectly related to substance misuse. Variables related to substance misuse itself were the primary predictors of PSM and, less significantly, CSM. The nursing staff rating, although promising, was obtained in less than 30% of all visits, rendering its practical use difficult to assess.

No MeSH data available.


Related in: MedlinePlus