Substance Use and Psychiatric Disorders in Patients Referred to Consultation-Liaison Psychiatry Within a Regional General Hospital

Murray G Tucker,Harry Hill,Emma Nicholson,Steven Moylan

doi:10.1007/s11469-021-00576-1

Abstract

Little is known about important biopsychosocial differences between patients depending on the number of diagnosed comorbid psychiatric disorders, including the presence or absence of substance use disorder (SUD) comorbidity. This study investigated for differences in psychosocial disadvantage, psychiatric disorders, and health service utilization amongst 194 general hospital patients referred to consultation-liaison psychiatry (CLP) with either no psychiatric diagnosis, single psychiatric diagnosis, multiple (non-SUD) psychiatric diagnoses, or one or more psychiatric diagnoses plus SUD comorbidity. The results revealed that SUDs were the commonest diagnostic category (34%). The SUD comorbidity group had the highest rates of disadvantaged housing, were prescribed the most psychoactive medications, and 20% prematurely self-discharged against medical advice. Increased SUDs were associated with reduced length of stay, men, younger age, increased investigations, and reduced private health insurance subscription. Patients with SUD comorbidity versus multiple psychiatric diagnoses had reduced odds of adjustment disorder, somatic symptom disorder, and insomnia disorder. Post-traumatic stress disorder was the strongest predictor of multiple SUDs, followed by cluster B personality disorders. In conclusion, SUDs have become a leading clinical focus for CLP. The presence or absence of SUDs amongst patients with multiple disorders has important implications for engagement in treatment, patterns of comorbidity, and prescribing practices.

Highlights

Substance use disorder (SUD) related hospital presentations have become a leading health problem
This study investigated for differences in psychosocial disadvantage, psychiatric disorders, and health service amongst 194 general hospital patients referred to consultation-liaison psychiatry (CLP) with no psychiatric diagnosis, single psychiatric diagnosis, multiple psychiatric diagnoses, or psychiatric diagnosis plus substance use disorder (SUD) comorbidity
The aim of the current study was to examine for differences in demographics, physical health, psychiatric variables, and health service utilization based on the number of diagnosed psychiatric disorders and the presence or absence of SUD comorbidity in a cohort of general hospital inpatients referred to CLP

Summary

Introduction

Substance use disorder (SUD) related hospital presentations have become a leading health problem. The frequencies of SUDs were 1.5–12% (Clarke & Smith, 1995; Diefenbacher & Strain, 2002; Holmes et al, 2011; Krautgartner, Alexandrowicz, Benda, & Wancata, 2006; Loewenstein & Sharfstein, 1983; McKegney, McMahon, & King, 1983; Smith et al, 1993) These low rates of SUDs appear inconsistent with the changing landscape of CLP practice towards a more contemporary emphasis on SUDs, which was the leading diagnostic category in two recent studies (Desai, Shah, Shah, Sharma, & Zankat, 2016; Lyne et al, 2010). Multiple substance use may be linked with particular psychopathology, personality disorders, and trauma (Donald, Arunogiri, & Lubman, 2019; Khantzian, 1997; Lubman, Hall, Pennay, & Rao, 2011; Mills, Teesson, Ross, & Peters, 2006; Nesse & Berridge, 1997; Pagura et al, 2010)

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