Latt Noeline, Jurd Stephen, Tennant Christopher, Lewis John, Macken Lewis, Joseph Anthony, Grochulski Alan, Long Lidia
Herbert Street Drug and Alcohol Clinic, Royal North Shore Hospital, Australia.
Australas Psychiatry. 2011 Aug;19(4):354-9. doi: 10.3109/10398562.2011.579971. Epub 2011 Aug 18.
The aim of this study was to determine the incidence of alcohol and other substance use in patients presenting to an emergency department with acute psychiatric illnesses and to clarify the role of urine drug screens.
This was an unblinded prospective (observational) cohort study incorporating retrospective review of patient medical records, history of alcohol and substance use, results of urine drug screens and blood alcohol concentrations.
Of 196 acute psychotic patients, 104 were diagnosed with schizophrenia and 92 with "other psychosis". Results of urine drug screens were consistent with self-reported use of substances and only identified an additional 5% of substance users. Cannabis was the commonest illicit substance used by both groups of patients, followed by psychostimulants, mainly amphetamines. Younger males were more likely to use psychostimulants and to present with violence.
Patients with co-existing mental health problems and substance use present a major problem for our emergency departments. Cannabis was the most common substance used. Youth, male gender and psychostimulant use are associated with violent presentations. A comprehensive history of alcohol and substance use is important to implement appropriate dual diagnosis treatment. Urine drug screening is recommended for patients who do not admit to substance use.
本研究旨在确定因急性精神疾病前往急诊科就诊的患者中酒精和其他物质使用的发生率，并阐明尿液药物筛查的作用。
这是一项非盲前瞻性（观察性）队列研究，纳入了对患者病历、酒精和物质使用史、尿液药物筛查结果及血液酒精浓度的回顾性分析。
在196例急性精神病患者中，104例被诊断为精神分裂症，92例被诊断为“其他精神病”。尿液药物筛查结果与自我报告的物质使用情况一致，仅额外识别出5%的物质使用者。大麻是两组患者最常使用的非法物质，其次是精神兴奋剂，主要是苯丙胺。年轻男性更有可能使用精神兴奋剂并伴有暴力行为。
同时存在心理健康问题和物质使用问题的患者给我们的急诊科带来了重大问题。大麻是最常使用的物质。青年、男性以及精神兴奋剂的使用与暴力行为相关。全面的酒精和物质使用史对于实施适当的双重诊断治疗很重要。对于不承认使用物质的患者，建议进行尿液药物筛查。
