Margolis Anatoly, Rosca Paola, Kurs Rena, Sznitman Sharon R, Grinshpoon Alexander
a Department for the Treatment of Substance Abuse , Ministry of Health , Jerusalem , Israel.
b Faculty of Medicine, Hebrew University , Jerusalem , Israel.
J Dual Diagn. 2016 Jul-Dec;12(3-4):218-226. doi: 10.1080/15504263.2016.1252075. Epub 2016 Oct 25.
This study investigates the proportion of drug users among patients with mental disorders who attended the emergency department of one major psychiatric hospital in Northern Israel, the most frequent psychiatric diagnoses associated with drug use, and the impact of confirmed drug use on hospital admission. We hypothesized that the proportion of individuals with positive urine drug test results presenting at the psychiatric emergency department during the study period would be 20% to 30%.
An unselected cohort of 2,019 adult patients who visited the emergency department of Sha'ar Menashe Mental Health Center, a university-affiliated government facility, was evaluated and underwent routine urine drug testing between April 2012 and February 2014. Clinical, demographic, and urine drug test data were collected from medical records and statistically analyzed, comparing diagnostic evaluation at admission and after discharge from either the emergency department or the hospital. Univariate and logistic regression analyses were used to identify the possible variables associated with drug use in this sample.
Urine drug test results showed that 194 of the 2,019 subjects (9.6%) had used a psychoactive substance before attending the emergency department. Among patients with positive urine drug test results, the majority (77.8%) used cannabis, 25.8% used opiates, 24.7% used ecstasy, and 5.2% used cocaine. Differences in the prevalence of positive urine drug test results between admitted and nonadmitted patients did not reach a statistically significant level. The frequency of positive urine drug test results across lifetime International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) diagnoses was 27.2% for substance-related disorders, 4.8% for psychotic disorders, 4.2% for mood disorders, 11.0% for personality disorders, and 11.5% for nonpsychotic disorders. Both univariate and logistic regression analyses revealed that younger age (18-40), male sex, fewer years of education, single marital status, and ICD-10 diagnosis of substance-related, personality, and nonpsychotic disorders were indicators of higher likelihood of positive urine drug test findings.
Results suggest that routine urine toxicology screening is not necessary in the psychiatric emergency department as an adjunct to a thorough psychiatric clinical examination. However, urine drug tests should be performed when the clinical evaluation cannot determine whether the mental disorder is the result of illicit drug use or clearly non-drug-related.
本研究调查了以色列北部一家大型精神病医院急诊科就诊的精神障碍患者中吸毒者的比例、与吸毒相关的最常见精神科诊断，以及确诊吸毒对住院的影响。我们假设在研究期间到精神科急诊科就诊且尿液药物检测结果呈阳性的个体比例为20%至30%。
对2019名成年患者组成的非选择性队列进行评估，这些患者前往隶属于大学的政府机构沙尔·梅纳什心理健康中心急诊科就诊，并在2012年4月至2014年2月期间接受常规尿液药物检测。从病历中收集临床、人口统计学和尿液药物检测数据，并进行统计分析，比较入院时以及从急诊科或医院出院后的诊断评估情况。采用单因素和逻辑回归分析来确定该样本中与吸毒相关的可能变量。
尿液药物检测结果显示，2019名受试者中有194人（9.6%）在前往急诊科之前使用过精神活性物质。在尿液药物检测结果呈阳性的患者中，大多数（77.8%）使用大麻，25.8%使用阿片类药物，24.7%使用摇头丸，5.2%使用可卡因。入院患者和未入院患者尿液药物检测结果阳性率的差异未达到统计学显著水平。在终生国际疾病分类第十次修订本（ICD - 10）诊断中，物质相关障碍患者尿液药物检测结果阳性率为27.2%，精神障碍患者为4.8%，情绪障碍患者为4.2%，人格障碍患者为11.0%，非精神障碍患者为11.5%。单因素和逻辑回归分析均显示，年龄较小（18 - 40岁）、男性、受教育年限较少、单身婚姻状况以及ICD - 10诊断为物质相关、人格和非精神障碍是尿液药物检测结果呈阳性可能性较高的指标。
结果表明，在精神科急诊科，作为全面精神科临床检查的辅助手段，常规尿液毒理学筛查并非必要。然而，当临床评估无法确定精神障碍是非法药物使用的结果还是明显与药物无关时，应进行尿液药物检测。
