Lane Scott D, da Costa Sabrina C, Teixeira Antonio L, Reynolds Charles F, Diniz Breno S
Department of Psychiatry and Behavioral Sciences, UTHealth Harris County Psychiatric Center, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Int J Geriatr Psychiatry. 2018 Feb;33(2):e323-e329. doi: 10.1002/gps.4799. Epub 2017 Oct 18.
To examine associations among substance use disorder (SUD) and measures of length of stay (LOS) and non-psychiatric medical comorbidity (MEDCO) in older-adult inpatients with serious mental illness (SMI), hypothesizing SUD would be related to worse clinical outcomes.
A cross-sectional study analyzed medical records from 2010 to 2016 of 7258 inpatients with SMI ≥ age 50, obtained from a 274-bed psychiatric hospital. Descriptive analyses examined prevalence rates for SUD status (+/-), individual drug classes, and total number of SUDs (polysubstance use disorders). Regression models examined the influence of 2 independent variables of interest: (1) SUD status (+/-) and (2) type of SUD (ie, specific drug), controlling for demographic factors and additional (non-SUD) psychiatric disorders. Two dependent (outcome) variables were examined: LOS and MEDCO.
The overall SUD rate was 26%; cocaine was the most common SUD (≈ 10%). SUD status and additional (non-SUD) psychiatric diagnoses were significantly associated with longer LOS (both P < 0.001). For individual SUDs, cocaine, marijuana, opiates, and alcohol were all significantly associated with LOS (all P < 0.01). SUD status, age, sex, admission status, and race were significantly associated with MEDCO (all P < 0.002). For individual SUDs, barbiturates, opiates, and alcohol were all significantly associated with MEDCO (P < 0.01).
The prevalence of SUD in this sample underscores concerns related to treating older adults presenting providers with comorbid SUD and SMI. This combination may increase the burden and complexity of care, warranting further investigation into mechanisms and long-term consequences.
研究患有严重精神疾病（SMI）的老年住院患者中物质使用障碍（SUD）与住院时间（LOS）及非精神科合并症（MEDCO）指标之间的关联，假设物质使用障碍与更差的临床结局相关。
一项横断面研究分析了2010年至2016年期间从一家拥有274张床位的精神病医院获取的7258例年龄≥50岁的患有严重精神疾病的住院患者的病历。描述性分析检查了物质使用障碍状态（阳性/阴性）、各类药物以及物质使用障碍总数（多物质使用障碍）的患病率。回归模型检验了两个感兴趣的自变量的影响：（1）物质使用障碍状态（阳性/阴性）和（2）物质使用障碍类型（即特定药物），同时控制人口统计学因素和其他（非物质使用障碍）精神疾病。研究了两个因（结果）变量：住院时间和非精神科合并症。
总体物质使用障碍率为26%；可卡因是最常见的物质使用障碍（约10%）。物质使用障碍状态和其他（非物质使用障碍）精神科诊断与更长的住院时间显著相关（均P<0.001）。对于个体物质使用障碍，可卡因、大麻、阿片类药物和酒精均与住院时间显著相关（均P<0.01）。物质使用障碍状态、年龄、性别、入院状态和种族与非精神科合并症显著相关（均P<0.002）。对于个体物质使用障碍，巴比妥类药物、阿片类药物和酒精均与非精神科合并症显著相关（P<0.01）。
该样本中物质使用障碍的患病率凸显了治疗同时患有物质使用障碍和严重精神疾病的老年人给医疗服务提供者带来的问题。这种合并情况可能会增加护理的负担和复杂性，有必要进一步研究其机制和长期后果。
