Alcohol-related Mental Disorders Research Articles

Systematic analysis of withdrawal-related seizure in alcohol-related mental disorders

Systematic analysis of withdrawal-related seizure in alcohol-related mental disorders

Homelessness among inpatients diagnosed with alcohol-related mental disorders: an epidemiological study

Homelessness among inpatients diagnosed with alcohol-related mental disorders: an epidemiological study

Patient experiences of alcohol specialist nurse interventions in a general hospital, and onwards care pathways.

To provide insight into patient experiences of a general hospital-based alcohol specialist nurse intervention during alcohol detoxification, experiences of alcohol specialist nurse hospital-based follow-up appointments (Pathway A) as well as the experiences of patients who did not have access to this additional help post detoxification (Pathway B). A longitudinal qualitative study. A thematic analysis of semi-structured interviews (2016-2017) with 24 patient participants (N=12 in each pathway; purposive selection) 1-4weeks post-detoxification and at 3 and 6months, to identify patient experiences of these interventions. Participants gave accounts of how 'empathic' and 'straight talking' interactions with alcohol specialist nurses during detoxification helped them to 'open up' and orient towards change. After detoxification follow-up, outpatient appointments in the hospital setting were seen as supporting change in early recovery and engagement with a wider range of services. Those with no access to nurse follow-up described experiencing a 'void' in available help. Participants in both groups described barriers to engagement with community alcohol services, peer groups and access to help for mild-moderate mental health problems. Patient accounts indicate alcohol specialist nurse interventions during and after unplanned detoxification in a hospital setting can help orient patients towards change and support early recovery. Providing alcohol specialist nurse interventions in general hospitals offers one route to initiating recovery in alcohol-dependent patients. This has potential to improve the lives of those affected and to reduce related demands on hospital services, but further research is needed.

Epidemiological Trends of End-organ Damage with Alcohol Consumption: Liver, Pancreas and Neuropsychiatric Disorders

Introduction: Alcohol use disorder was estimated to affect 16.3 million adults, and accounted for $249.0 billion in healthcare costs and is known to be the 4th leading cause of preventable death in United States. Alcohol consumption is associated with development of liver disease, pancreatitis, and alcohol induced mental disorders. However, little is known of the differences in rates of prevalence and hospitalization, and whether there is an overlap between these disorders in chronic alcoholics. Our hypothesis is that alcohol related end-organ damage is dependent on individual susceptibility of different pathways to alcohol exposure. The aim of this study was to evaluate the rates of alcohol related pancreatitis, liver diseases and neuropsychatric disorders. Methods: The National Inpatient Sample (NIS) database for year 2011 was queried for ICD-9 discharge diagnosis of alcoholic liver disease (ALD), alcoholic acute- or chronic -pancreatitis (ALP), and alcohol related mental disorders (ALMS) including withdrawal, psychosis and delirium. Patients were grouped into seven groups ALD only, ALP only, ALMS only, ALD+ALP, ALD+ALM, ALP+ALM, and ALD+ALP+ALM. Demographic characters, length of stay, hospitalization charges and death were noted for all the groups. Venn diagram was used to demonstrate the degree of overlap between the study groups. Univariable analysis was performed using logistic regression among the groups, and a p value of < 0.01 was considered significant. Results: A total of 158, 407 admissions were retrieved, with a mean age of 51 ± 12.6 years, 72.8% males, and 68% white. Figure 1 demonstrates the Venn diagram between the study groups which shows minimal overlap between the 3 groups of < 16% in the entire cohort. Table 1 demonstrates the demographic and clinical outcome in various study groups. Patients with ALD only were significantly older than other groups, and were associated with higher hospitalization charges and increased LOS. Patients with ALD only had a higher rate of mortality at 7% compared to an average of 3% in other groups.Figure 1Table 1: Demographic and Clinical Outcome in Alcoholic Related- Pancreatitis, Alcohol Liver Disease and Mental DisordersConclusion: There is a significant difference in the rates and mortality of alcoholic pancreatitis, alcoholic liver disease, and alcohol related mental disorders. There is little overlap between the prevalence of these three disorders, and further studies are needed to investigate the different pathways of end-organ damage in alcoholic consumption.

STUDY THE CLINICAL FEATURES AND RELATED FACTORS AND THERAPEUTIC RESULTS ALCOHOL- INDUCED PSYCHOTIC DISORDERS WITH DELUSION, HALLUCINATION.

Background: Alcohol-related mental disorders have become more popular in recent years. Alcohol-induced psychotic disorders (APD) with delusions, hallucinations are accounted for the highest percentage. Studying the clinical features and related factors and therapeutic results to enhance the therapeutic quality. Methodology: Retrospective, longitudinal study combined with description and analysis on 45 patients at Danang psychiatric hospital from 03/2013 to 07/2014. Results All patients are male, age from 30-49 are common, low educational level, alcoholic family history, many of them are peasants and poor. Average alcohol-consumption time is from 11-15 years, with average amount of 500-1000 ml/day, mainly rice wine. The rate of APD with delusions and hallucinations is highest (44.4%), high rate of delusion of persecution (66.7%), and followed by delusion of jealousy and delusion of being followed. Most common hallucinations are auditory (92.9%), mainly with menace content (61.5%). Visual and tactile hallucinations are also pretty high. Patient's behaviour is influenced by delusions and hallucinations. AUDIT results show all patients are alcohol addicts. Blood tests have no significant changes. Hepatic enzymes rise dramatically. Good response to haloperidol with average dose around 6-9mg/day, symptoms disapear after 4-6 days. The longer alcohol consumption time needs the longer delay for recovery. Clear corelation between the AUDIT reasults and recovery delay. Conclusion: APD has polymorphic symptomatology. Good response to antipsychotic medications. Key words: AUDIT (Alcohol Use Disorders Identification Test)

Psychiatric Discharges in Community Hospitals With and Without Psychiatric Units: How Many and for Whom?

Psychiatric Discharges in Community Hospitals With and Without Psychiatric Units: How Many and for Whom?

Psychiatric Discharges in Community Hospitals With and Without Psychiatric Units: How Many and for Whom?

This study sought to describe the extent to which community hospitals, in a sample of states, are caring for patients with psychiatric disorders in medical-surgical beds (scatter beds) and to compare the characteristics of patients treated in scatter beds with those of patients treated in psychiatric units in community hospitals. Information on hospital discharges in 12 states for patients with a principal psychiatric diagnosis was gathered from the Healthcare Cost and Utilization Project State Inpatient Databases. Discharges of patients who were treated in community hospital psychiatric units (N=370,984) were compared with those of patients who were treated in scatter beds (N=26,969). Overall, only 6.8% of discharges were from scatter beds. The rate of total psychiatric discharges per 10,000 total state population ranged from a high of 62.3 in one study state to a low of 9.6 in another. The average rate of scatter bed discharges per 10,000 state population ranged from 1.6 to 5.8, whereas the average rate of psychiatric unit discharges ranged from 7.4 to 58.9. A comparison of discharges of patients treated in scatter beds with discharges of patients treated in psychiatric units indicated that patients in scatter beds were more likely to have somatic conditions and were half as likely to have an accompanying substance use disorder. Discharge codes indicated that almost 40% of patients from scatter beds had a diagnosis of schizophrenia, episodic mood disorder, or depression; about two-thirds were admitted from emergency rooms; and about one-fifth were transferred to another facility. More research is needed to determine the optimal supply of psychiatric unit beds across regions and whether and how scatter beds should be used to address the lack of psychiatric beds.

Utility Assessment in Patients with Mental Disorders

Preference-based health-state values, also referred to as utility scores, are considered an important measure of outcome in the evaluation of healthcare. A common approach to elicit utility scores is the use of the time trade-off (TTO) method; however, the data on TTO utility scores in patients with mental disorders are scarce. To analyse the TTO method in patients with mental disorders in terms of discriminative ability, validity and the refusal to trade life time (zero trade). In patients with affective (n = 172), schizophrenia spectrum (n = 166) and alcohol-related (n = 160) mental disorders, TTO utilities were administered through a standardized interview. Measures of quality of life (QOL) EQ-5D, WHOQOL-BREF, subjective (SCL-90R) and objective (CGI-S) psychopathology, and functioning (GAF, GARF, SOFAS, HoNOS) provided comparison. Discriminative ability was analysed by assessing frequency distributions of TTO utilities. Validity was analysed by assessing the correlation of TTO utilities with all other scores. The association of a patient's QOL, sociodemographic and disease-related variables with zero trade was analysed by logistic regression. Of patients with affective/schizophrenic/alcohol-related mental disorders, 153/143/145 (89/86/91%), respectively, completed the TTO elicitation; 29/43/28% of the respondents were zero traders. The mean TTO utility was 0.66/0.75/0.61 and the median was 0.85/0.95/0.75. TTO utility scores discriminated well among more impaired mental health states, but discrimination was limited among less impaired health states. In patients with affective and alcohol-related mental disorders, TTO utility scores were significantly correlated (mostly moderate: 0.3 < r < 0.5) with all other scores. However, in schizophrenic patients, TTO utility scores were only a little correlated with other subjective measures and not correlated with objective measures. QOL was significantly associated with zero trade; the influence of the other variables on zero trade was negligible. TTO utility scores in patients with affective or alcohol-related mental disorders were reasonably valid, but discriminative ability was compromised by a ceiling effect due to zero trade. In schizophrenic patients, validity of TTO utility scores was not demonstrated.

Admission to acute care hospitals for adolescent substance abuse: a national descriptive analysis

BackgroundUse of alcohol and illicit drugs by adolescents remains a problem in the U.S. Case identification and early treatment can occur within a broad variety of healthcare and non-healthcare settings, including acute care hospitals. The objective of this study is to describe the extent and nature of adolescent admissions to the acute inpatient setting for substance abuse (SA). We use the Agency for Healthcare Research and Quality (AHRQ) 2000 Healthcare Cost and Utilization Project Kids Inpatient Database (HCUP-KID) which includes over 2.5 million admissions for youth age 20 and under to 2,784 hospitals in 27 states in the year 2000. Specifically, this analysis estimates national number of admissions, mean total charges, and mean lengths of stay for adolescents between the ages of 12 and 17 admitted to an acute care hospital for the following diagnostic categories from the AHRQ's Clinical Classifications Software categories: "alcohol-related mental disorders" and "substance-related mental disorders". Frequency and percentage of total admissions were calculated for demographic variables of age, gender and income and for hospital characteristic variables of urban/rural designation and children's hospital designation.ResultsSA admissions represented 1.25 percent of adolescent admissions to acute care hospitals. Nearly 90 percent of the admission occurred in non-Children's hospitals. Most were for drug dependence (38%) or non-dependent use of alcohol or drugs (35%). Costs were highest for drug dependence admissions. Nearly half of admissions had comorbid mental health diagnoses. Higher rates of admission were seen in boys, in older adolescents, and in "self-pay" patients. Alcohol and drug rehabilitation/detoxification, alone or in combination with psychological and psychiatric evaluation and therapy, was documented for 38 percent of admissions. Over 50 percent of cases had no documentation of treatment specific to substance use behavior.ConclusionGeneral acute care hospitals have a significant and important opportunity to recognize, treat, and refer adolescents with substance abuse problems. These results suggest that inpatient facilities should develop and implement policies and processes to ensure that adolescent substance abusers admitted to their institutions receive appropriate care during the admission and appropriate referral to community care resources.

From the Feds

From the Feds