Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior at UCLA, University of California Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America.
Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America; Department of Statistics, University of California Riverside, Riverside, CA, United States of America.
J Subst Use Addict Treat. 2023 Aug;151:209033. doi: 10.1016/j.josat.2023.209033. Epub 2023 Apr 1.
Methamphetamine (MA) is increasingly available in the United States and manufactured with increasing potency. Although psychosis is a known harm related to MA use, we know little about the clinical outcomes and prognosis of individuals who use MA and experience psychosis. Some evidence exists that psychosis among people who use methamphetamine leads to a high utilization of emergency and acute inpatient services, but the extent of this use is unclear.
Using an electronic health record (EHR) database, this study assessed acute care visits of individuals receiving diagnostic codes of the following disorders: methamphetamine use disorder with undifferentiated psychosis (MUDp), schizophrenia (MUDs) and no history of psychosis (MUD) in addition to individuals without MUD diagnosis but with diagnoses of either undifferentiated psychosis (Psy) or schizophrenia (Scz) from 2006 to 2019. The study explored potential clinical risk factors associated with rate of acute care visits.
Receiving diagnoses of psychotic disorders and MUD were both associated with high rates of acute care utilization. The incidence rate ratio (IRR) was highest in the MUDp group 6.30 (95% CI: 5.73, 6.93) followed by the MUDs group 4.03 (95% CI: 3.87, 4.20), the Psy group 3.77 (95% CI: 3.45, 4.11), the Scz group 3.11 (95% CI: 2.99, 3.23), and the MUD group 2.17 (95% CI: 2.09, 2.25). Receiving another SUD diagnosis was identified as a risk factor for acute care visits in the MUDp group, and mood and anxiety disorder diagnoses were a risk factor in the MUDs group.
In a general health care system, individuals receiving diagnoses of MUD and co-occurring psychotic disorders were observed to have particularly high rates of acute care service utilization, suggesting a high degree of disease burden and the need for development of targeted treatment interventions with both MUD and psychosis.
甲基苯丙胺（MA）在美国的供应日益增加，且效力也越来越强。虽然精神病是与 MA 使用相关的已知危害，但我们对使用 MA 并出现精神病的个体的临床结局和预后知之甚少。有一些证据表明，使用甲基苯丙胺出现精神病的人会大量使用急诊和急性住院服务，但具体使用量尚不清楚。
本研究使用电子健康记录（EHR）数据库，评估了 2006 年至 2019 年期间，患有以下诊断的个体的急性护理就诊情况：未分化精神病性障碍的甲基苯丙胺使用障碍（MUDp）、精神分裂症（MUDs）且无精神病病史（MUD），以及无 MUD 诊断但患有未分化精神病（Psy）或精神分裂症（Scz）的个体。研究探索了与急性护理就诊率相关的潜在临床危险因素。
诊断为精神病性障碍和 MUD 均与高急性护理利用率相关。MUDp 组的发病率比值比（IRR）最高，为 6.30（95%CI：5.73，6.93），其次是 MUDs 组 4.03（95%CI：3.87，4.20），Psy 组 3.77（95%CI：3.45，4.11），Scz 组 3.11（95%CI：2.99，3.23），MUD 组 2.17（95%CI：2.09，2.25）。在 MUDp 组中，另一个物质使用障碍诊断被确定为急性护理就诊的危险因素，而心境和焦虑障碍诊断则是 MUDs 组的危险因素。
在一般医疗保健系统中，被诊断为 MUD 且伴有共病精神病的个体观察到急性护理服务利用率特别高，这表明他们的疾病负担很重，需要针对 MUD 和精神病开发有针对性的治疗干预措施。
