Abstract
Acute resident psychiatric facilities in Norway usually get their patients after referral from a medical doctor. Acute psychiatric wards are the only places accepting persons in need of emergency hospitalisation when emergency units in somatic hospitals do not accept the patient. Resident patients at one random chosen day were scrutinized in an acute psychiatric facility with 36 beds serving a catchment area of 165 000. Twenty-five patients were resident in the facility at that particular day. Eight of 25 resident patients (32.0%) in the acute wards were referred for a substance-induced psychosis (SIP). Another patient may also have had a SIP, but the differential diagnostic work was not finished. A main primary diagnosis of substance use was given in the medical reports in only 12.9% of patients during the last year. Given that the chosen day was representative of the year, a majority of patients with substance abuse problems were given other diagnoses. There seems to be a reluctance to declare the primary reason for an acute stay in a third of resident stays. Lack of specialized emergency detoxification facilities may have contributed to the results.
Highlights
Acute treatment of substance abuse is handled differently from country to country
Eight of 25 resident patients (32.0%) in the acute wards were referred for a substance-induced psychosis (SIP)
A random day summary of treatment relevant diagnoses showed that 32.0% of patients in an acute facility had substance-induced psychosis
Summary
Acute treatment of substance abuse is handled differently from country to country. The abusers may be referred to a somatic hospital, taken care of in police custody, by specialized detoxification centres or within the realms of an acute psychiatric hospital. Alcohol-abusing patients, when referred to an acute psychiatric ward for suspected delirium, may develop a Korsakoff syndrome after many years of abuse All such patients must get high-dose parenteral thiamine (100– 200 mg IM/day) wherever they are admitted to reduce the probability of developing a psychosis that may be difficult to treat [6]. Self-injurious behaviour has been shown to have a lifetime prevalence rate of 49% in a group of opiate addicts admitted to community and inpatient treatment programmes [8] Such behaviour may, when viewed through purely psychiatric lenses, be interpreted as a symptom and part of a psychiatric illness, rather than as part of the substance abuse. It would be of interest to study the referrals to an emergency psychiatric ward in a country where emergency detoxification is not offered in specialized facilities
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