History Of Substance Misuse Research Articles

Suicide attempts among Greenlandic forensic psychiatric patients – prevalence and determinants

ABSTRACT This nationwide cross-sectional study of the lifetime prevalence and determinants of suicide attempts includes 90% of Greenlandic forensic psychiatric patients. Retrospective data were collected from electronic patient files, court documents, and forensic psychiatric assessments using a coding form from a similar study. We used unpaired t-tests and chi2 or Fisher’s exact test. The lifetime prevalence of suicide attempts was 36% (n = 32), and no difference in prevalence was found between male and female patients (p = 0.95). Patients having attempted suicide had a higher rate of physical abuse in childhood (p = 0.04), family history of substance misuse (p = 0.007), and criminal convictions among family members (p = 0.03) than patients who had never attempted suicide. Women primarily used self-poisoning in their latest suicide attempts (67%), whereas men more often used sharp objects or a firearm (42%). Over a third of Greenlandic forensic patients have attempted suicide at some point in their life, and patients with traumatic childhood experiences are at higher risk of suicidal behaviour. It is not possible to conclude whether the lifetime prevalence of suicide attempts among Greenlandic forensic patients is comparable to that of other high-risk groups in other Arctic regions due to methodological differences among the very few other comparable studies.

793 COLLATERAL HISTORY IN PATIENTS WITH CONFUSION

Abstract Introduction The aims of the project were to intervene early on admission, by taking a collateral history for patients with confusion; to improve the quality and detail of collateral history being taken to better establish certain clinically important specks of information. These include triggers for delirium, the patient’s baseline cognition, any patterns in the change of a patient’s cognition to help determine if a patient was displaying aspects of a certain type of dementia prior to admission, baseline mobility and housing situation, baseline continence, history of substance misuse and alcohol etc. Ultimately, this project aims to identify next of kin from which collateral history can be obtained, but also to establish a firm communication platform to facilitate future discussions on behalf of patients undergoing delirium. This will ultimately, improve care but also making sure family members are involved early on in admission, exploring their ideas, concerns, and expectations. Methods We created a collateral history template booklet that was introduced to a geriatric ward. Specific parameters were set and measured, pre-intervention and post-intervention. A second round of post-intervention data collection was performed with an improved collateral history sheet outlook. We measured the outcome of 22 collateral histories for each round. Results We found that in both rounds, post intervention, there was an improved outcome compared to pre-intervention in almost all the parameters that were measured. For example, in 100% of the collateral histories there was documentation of the patient’s baseline concentrations and attention, issues with orientation, issues with expressive and receptive dysphasia and the main concerns of the next of kin, any problems with executive functioning and the baseline functional status of the patients. Conclusion The collateral history, both improved the overall quality and the quantity of the information gathered in patients with confusion and, contributed to a structured management.

Mental health-related quality of life by sex and sexual identity among U.S. adults with alcohol and tobacco use disorder

IntroductionAlcohol use disorder (AUD) and tobacco use disorder (TUD) are more severe among some sexual minority subgroups. It is less understood whether mental health indicators also differ by sexual identity among those with more severe forms of AUD and TUD. We examined differences in mental health-related QoL by sex-specific sexual identity subgroup among those meeting criteria for moderate-to-severe AUD or moderate-to-severe TUD. MethodsWe analyzed data from the National Epidemiologic Study of Alcohol and Related Conditions-III (2012–2013; n = 36,309). Our analyses focused on those meeting criteria for past-year moderate-to-severe AUD (n = 2341) and past-year moderate-to-severe TUD (n = 3675). Using multivariable linear regression, we examined associations of sex-specific sexual identity subgroups with mental health-related QoL, while controlling for (a) sociodemographic characteristics, (b) disorder severity, and (c) risk and protective factors (adverse childhood experiences, parental history of substance misuse, stressful life events, and social support). ResultsAmong those with past-year moderate-to-severe AUD, gay men and heterosexual, bisexual, and gay/lesbian women had significantly lower mental health-related QoL compared to heterosexual men in fully adjusted models. Among those with past-year moderate-to-severe TUD, gay men and heterosexual and gay/lesbian women had significantly lower mental health-related QoL compared to heterosexual women. Bisexual and heterosexual women were not significantly different in fully adjusted models. DiscussionClinicians should consider the variability in mental health-related QoL among those with moderate-to-severe AUD and TUD particularly for women and sexual minorities. Consideration of current and past stressors and the degree of social support may be beneficial when conducting assessments and forming treatment plans.

IMPACT OF FAMILIAL AND ENVIRONMENTAL RISK FACTORS ON AGE OF ONSET OF SCHIZOPHRENIA

ABSTRACT 
 Objectives: 1.To determines impact of familial risk factor i.e. positive family history of schizophrenia on age of onset of schizophrenia.
 2. To determine impact of environmental risk factor i.e. substance misuse on age of onset of schizophrenia.
 Materials and Methods: In this cross sectional analytical study, 430 patients were enrolled from OPD in Sarhad Hospital for Psychiatric Diseases Peshawar through convenience non probability sampling technique. First Data was dichotomized on the basis of positive and negative family history of schizophrenia. Later on data was again dichotomized on the basis of positive and negative history of substance misuse. Frequency and percentage were calculated for categorical variable while mean and standard deviation for continuous variables. Independent-samples T test was used while comparing categorical variable with continuous variable and Chi-square test was used while comparing two categorical variables in between them.
 Results: The mean age of onset of schizophrenia was 22.28 years with early onset in males than females. In those with familial schizophrenia, the mean ages of onset of schizophrenia in males and females were 22.35 and 22.05 years while in those with sporadic cases, the mean age of onset of schizophrenia in males and females were 21.83 and 25.43 years respectively. Moreover non-tobacco substances and cannabinoids were having statistically significant impact on age of onset of schizophrenia.
 Conclusion: There was significant gender difference in age at onset of schizophrenia and substance misuse. Family history of schizophrenia eliminates the gender difference in age at onset of schizophrenia. Moreover non-tobacco substances and cannabinoids misuse can cause early onset of schizophrenia.

Changes in temporal discounting, hedonic hunger, and food addiction during recovery from substance misuse

Substance use disorders (SUDs) and obesity are both chronic, relapsing, remitting disorders that arise from a heightened preference for immediate-focused rewards (i.e., steep temporal discounting). During recovery from SUDs, overweight and obese outcomes are common as individuals may replace drug rewards for food rewards. However, little has been done to investigate the neuropsychological processes underlying food reward and addiction in individuals recovering from SUDs. Using data collected from the International Quit and Recovery Registry and Amazon Mechanical Turk, we aimed to elucidate the factors that influence the attraction to palatable foods in a population in recovery from substance misuse (n = 114) as well as a population with no history of substance misuse (n = 97). We hypothesized that individuals in recovery from substance misuse would have steeper temporal discounting, an increased drive for palatable foods (i.e., hedonic hunger), and greater food addiction symptoms than non-substance users. Contrary to our hypotheses, we found that individuals in recovery from SUDs show improved outcomes in temporal discounting, hedonic hunger, and food addiction symptoms. Moreover, recovery status and temporal discounting significantly predicted these outcomes. Our findings suggest that the enhanced executive control processes needed for successful SUD recovery may transfer to other reward-related processes such as food reward and consumption. Interventions targeted at improving executive function including episodic future thinking, meditation, or exercise, may be excellent ways to support a successful recovery and improve other reward-related processes, including food consumption, to decrease the risk of overweight or obese outcomes during recovery.

Landlord Perceptions on Homelessness in Northern Utah

Homeless programs often rely on landlord engagement for successful implementation. However, there is very little research that examines landlord perspectives related to homelessness. Better understanding landlords’ opinions and attitudes regarding those experiencing homelessness can inform program development and policy in the efforts to prevent and mitigate homelessness in the U.S. A 49-question survey was created and administered by social work faculty and students to landlords and property managers throughout the Bear River Region of northern Utah (N = 134). The survey contained a variety of questions that assessed landlord attitudes and knowledge toward those experiencing homelessness as well as their comfortability in renting to these individuals. Results revealed that landlords would like to help solve homelessness in their community, but they do not know where to start. Additionally, results showed that landlords’ willingness to rent to individuals experiencing homelessness is dependent on contextual factors, such as having more information regarding the individual, their income, past rental history, and other factors. Finally, results showed that landlords had biases toward specific groups of individuals experiencing homelessness (e.g., landlords felt more comfortable renting to those with physical disabilities than those with substance misuse histories). Results are discussed in context of program, policy, and research implications.

Identifying Risk Factors That Increase Analgesic Requirements at Discharge Among Patients With Burn Injuries.

Patients with burn injuries require large doses of opioids and gabapentinoids to achieve pain control and are often discharged from hospital with similar amounts. This study aimed to identify patient risk factors that increase analgesic requirements among patients with burn injuries and to determine the relationship between opioid and gabapentinoid use. Patient charts from July 1, 2015 to 2018 were reviewed retrospectively to determine analgesic requirements 24 hours before discharge. Linear mixed regression models were performed to determine patient risk factors (age, gender, history of substance misuse, TBSA of burn, length of stay in hospital, history of psychiatric illness, or surgical treatment) that may increase analgesic requirements. This study found that patients with a history of substance misuse (P = .01) or who were managed surgically (P = .01) required higher doses of opioids at discharge. Similarly, patients who had undergone surgical debridement required more gabapentinoids (P < .001). For every percent increase in TBSA, patients also required 14 mg more gabapentinoids (P = .01). In contrast, older patients (P = .006) and those with a longer hospital stay (P = .009) required fewer amounts of gabapentinoids before discharge. By characterizing factors that increase analgesic requirements at discharge, burn care providers may have a stronger understanding of which patients are at greater risk of developing chronic opioid or gabapentinoid misuse. The quantity and duration of analgesics prescribed at discharge may then be tailored according to these patient specific risk factors.

Social-Ecological Predictors of Opioid Use Among Adolescents With Histories of Substance Use Disorders.

Adolescent opioid misuse is a public health crisis, particularly among clinical populations of youth with substance misuse histories. Given the negative and often lethal consequences associated with opioid misuse among adolescents, it is essential to identify the risk and protective factors underlying early opioid misuse to inform targeted prevention efforts. Understanding the role of parental risk and protective factors is particularly paramount during the developmental stage of adolescence. Using a social-ecological framework, this study explored the associations between individual, peer, family, community, and school-level risk and protective factors and opioid use among adolescents with histories of substance use disorders (SUDs). Further, we explored the potential moderating role of poor parental monitoring in the associations between the aforementioned risk and protective factors and adolescent opioid use. Participants included 294 adolescents (Mage = 16 years; 45% female) who were recently discharged from substance use treatment, and their parents (n = 323). Results indicated that lifetime opioid use was significantly more likely among adolescents endorsing antisocial traits and those whose parents reported histories of substance abuse. Additionally, adolescents reporting more perceived availability of substances were significantly more likely to report lifetime opioid use compared to those reporting lower perceived availability of substances. Results did not indicate any significant moderation effects of parental monitoring on any associations between risk factors and lifetime opioid use. Findings generally did not support social-ecological indicators of opioid use in this high-risk population of adolescents, signaling that the social-ecological variables tested may not be salient risk factors among adolescents with SUD histories. We discuss these findings in terms of continuing care options for adolescents with SUD histories that target adolescents’ antisocial traits, perceived availability of substances, and parent histories of substance abuse, including practical implications for working with families of adolescents with SUD histories.

Substance misuse teaching: a patient safety issue

AimsClinical substance misuse presentations are commonly managed by Psychiatry Core Trainees (CTs) out of hours. However, specialist teaching is not included in the Maudsley Training Program (MTP) induction. We aimed to investigate whether this was of clinical concern and, if so identify interventions to address it.BackgroundThe association of substance misuse disorder and mental illness is widely recognised. The Adult Psychiatric Morbidity Survey 2014 reported that half of people dependent on drugs other than cannabis were receiving mental health treatment. Substance use substantially impacts clinical risk; 57% of patient suicides in 2017 had a history of substance misuse. It also effects emergency psychiatric services: 55-80% of patients detained under S136 are intoxicated. Therefore, it is imperative for patient safety that CTs can assess and manage these patients appropriately.The Royal College of Psychiatrists recognises the need for specialist substance misuse knowledge and skills, and lists this as a key ‘Intended Learning Outcome’ for CTs. Unfortunately, the availability of specialist drug and alcohol service placements for CTs has significantly declined. Only one placement is available per MTP rotation. Teaching is therefore relied upon to gain these competencies.MethodUsing a cross-sectional survey we explored CTs confidence in recognising and managing substance misuse presentations, knowledge of where to seek guidance and asked for teaching suggestions. We surveyed two CT1 cohorts in 2017 and 2019.ResultFifty-one CTs took the survey. Of these 92% did not feel prepared to manage acute substance intoxication or withdrawal and 96% would like relevant teaching at the start of CT1. Furthermore, 67% did not know where they could seek guidance.CTs felt confident at recognising and managing alcohol related presentations. However, they were less confident in recognising opioid withdrawal, how to safely prescribe opioid substitution therapy (OST), and the usual doses of OST (65%, 94%, 94% rated ‘neither confident nor not confident’ or below, respectively). CTs were not confident at recognising GBL and cannabinoid withdrawal, principles of harm minimisation, assessing readiness to change, delivering Brief Interventions and teaching patients to use Naloxone.ConclusionThe results were exceptionally similar between cohorts, demonstrating reliability of our findings and that CTs lack of substance misuse knowledge is a significant clinical concern.To address this deficit of knowledge, we are writing an introductory lecture with supporting guidance in the induction pack, developing an online video resource, and moving key substance misuse lectures to earlier in the MTP taught programme.

The hidden cost of not having a dual diagnosis team (an audit looking at inpatient admissions for Redbridge Community Recovery Team West)

AimsCo-existing mental illness and substance misuse is highly prevalent within the UK, with approximately 40% of people diagnosed with psychosis having a history of substance misuse. However, in Redbridge we currently do not have access to a dual diagnosis team or integrated care.This audit aims to assess the health and social implications of fragmented care, plus the effectiveness of mental health services in assessing patients with dual diagnosis and referring to specialist misuse teams. We used the NICE guidelines on co-existing severe mental illness and substance misuse [CG120] to help guide our recommendations.MethodWe identified 50 out of 359 patients within our service who were admitted to psychiatric hospital over a one year period (between 01/11/2019- 01/11/2020).We looked at medication compliance, use of the Mental Health Act and accommodation status to compare between those with and without known dual diagnosis. We used frequency and length of admission as indicators of how successfully patients were being managed in the community and the cost to the hospital trust. Urine drug screening and referral to substance misuse services were chosen as markers of whether patients were being appropriately managed on admission.ResultA higher percentage of patients with dual diagnosis were detained under the Mental Health Act compared to those without substance misuse (89% versus 72%). They were more likely to have no fixed abode (28% versus 13%) and be non-compliant with treatment pre-admission (83% versus 56%). Patients with dual diagnosis also had a higher number of hospital admissions, with a greater proportion having 3 admissions that year (11% versus 3%).Only 50% of patients with known dual diagnosis had a urine drug screen performed on admission and just 25% of patients who were currently misusing substances were referred to specialist services by the inpatient team.ConclusionOur audit found that there are overall poorer outcomes for patients with dual diagnosis versus a psychiatric illness only. It is evident that integration of services will improve the care we are able to provide and reduce costs associated with multiple admissions to hospital.We identified three key areas for improvement. Firstly, we advised on the need to improve documentation. Additionally, we recommend ensuring assessment of current drug misuse is done on admission, including performing simple tests such as urine drug screening. Finally, we highlighted the need to improve discussions about substance misuse with patients, within teams and between services, aiming for integrated and holistic care.

An audit of admission clerking of patients in Heddfan, Adult Mental Health Unit in BCUHB - north Wales

AimsTo ensure admission clerking includes salient features needed for the management of both physical and mental health of the patient and also to aid in administrative purposes.MethodThe audit included a team of doctors reviewing the admission clerking notes for 50 patients in the General Adult Psychiatric unit in-patient ward.We created a standard questionnaire-based on Intended learning outcome of core training in psychiatry CT1-CT3 from Royal College of Psychiatry and standard textbooks.Our aim is to achieve 100 % compliance in clerkingResultIt was noted that only 30% wrote their GMC number, 4% added route of admission of the patient and a mere 8% filled the Consultants name. Though almost everyone had written the presenting complaints, the other aspects such as history of presenting illness, medical and family history, Allergy status and substance misuse history were missing in many clerking notes. None of them had filled in details of personal history and very few did a risk assessment.Further lacuna was noted with Mental state examination. Physical examination was also noted to be incomplete. While more than 50% had completed the Blood investigations and ECG, half of them had not documented it and that meant searching in the entire file. A mere 20% filled the nursing observation level whilst none had completed the formulation in the notes.ConclusionAdmission clerking is a vital source of information that would be needed for the formulation of patients diagnosis and future management.Apart from this, it also is needed for further continuity of care.Hence this vital source of information will need to be shared with the junior doctors who will be clerking the patient and seeing them in the first instance.We, therefore, intend to create a complete clerking proforma along with physical health proforma to aid us in this respect.We will audit initially in the first round and then plan to introduce a proforma for Clerking and physical examination based on the findings.We will re-audit to see if the standards are achieved after using the proforma and will consider a Quality improvement project based on this topic

Identifying Risk Factors for Re-admission: A Service Evaluation from an Adult Inpatient Mental Health Unit

AimsTo identify risk factors for re-admission to an acute inpatient general adult mental health ward. There is need to ensure that mental health services adapt to the increasing demand for inpatient bedsMethodWe conducted a single centre retrospective analysis of electronic records of 85 discharges from an adult mental health unit from 4th March 2019 – 5th August 2019. We collected information on demographics, admission details, substance use, forensic history, diagnosis as per the International Classification of Diseases 10th Edition (ICD-10), and discharge details and compared two cohorts; those re-admitted within three months of discharge and those who were not. Odds ratio (OR), 95% confidence intervals (CI) and p values were calculated where possible.ResultAmong seventeen service users who were re-admitted within the three month period there were nine women and eight men. There was no difference in ethnicity, employment or marital status. The mean length of admission for those readmitted was 48.2 days (range 1–140 days) and 47.1 days (range 1–350 days) for those who were not readmitted. Certain features were more prevalent among the readmitted group including forensic history (58.8% [10] vs 26.5% [18], OR 3.97, CI 1.31–11.9, p value 0.007), substance misuse history (70.6% [12] vs 55.9% [38], OR 1.89, CI 0.60–5.97, p value 0.138), previous contact with mental health services (100% [17] vs 76.5% [52]) and the rate of detention under the Mental Health Act at point of admission (76.5% [13] vs 66.2% [45], OR 1.66, CI 0.49, 5.67, p value 0.209).Among those readmitted, a diagnosis of emotionally unstable personality disorder (17.6% [3] vs 10.3% [7], OR 1.87, CI 0.43,-8.14, p values 0.203) and substance misuse disorder (41.2 % [7] vs 17.6 % [12], OR 3.27, CI 1.04–10.31, p value 0.218) were more prevalent. They were more likely to use illicit substances whilst they were an inpatient (23.5% [4] versus 7.6% [5], OR 3.88, CI 0.92–16.43, p value 0.033) and to be involved in police incidents (35.3% [6] versus 17.6% [12], OR 2.55, CI 0.79–8.23, p value 0.059).ConclusionOur trends demonstrate that people with substance misuse, emotionally unstable personality disorder and forensic history are more likely to be readmitted to an adult mental health inpatient unit. They were more likely to misuse illicit substances and be involved with police during admission.

67 Identifying Risk Factors that Increase Analgesic Requirements at Discharge Among Patients with Burn Injuries

Abstract Introduction Opioids and neuropathic pain agents (NPAs) like gabapentin and pregabalin are commonly prescribed in large doses to achieve adequate pain control among patients with burn injuries. This patient population is therefore at greater risk of becoming dependent and misusing analgesics following their injuries. Factors that increase the risk of chronic use of opioids or NPAs among this patient population has not yet been characterized. The purpose of this study was to identify factors that increase the amount of analgesics required by patients with acute burn injuries at the time of discharge. Methods Patient charts from July 1, 2015 - 2018 were reviewed retrospectively to determine opioid and neuropathic pain agent (NPAs) requirements 24 hours before discharge (n = 199). Regression models were performed to determine whether the following risk factors increased analgesic requirements at discharge: surgical intervention; age; gender; TBSA; history of psychiatric disorder; and history of substance misuse. Results Patients with a history of substance misuse or who were managed surgically required higher doses of opioids at discharge compared to those without a history of misuse or those who were managed conservatively (p = 0.01 and 0.02, respectively). Similarly, patients who had undergone surgery required more NPAs compared to those who did not have surgical debridement of their injuries (p &amp;lt; 0.001). For every percent increase in TBSA, patients required 14 mg more NPAs (p = 0.01). In contrast, older patients and those with a longer hospital stay required fewer amounts of NPAs before they were discharged from hospital. For every increase in years of age, patients required on average 7 mg less NPAs (p = 0.006), and for each additional day in a patient’s length of stay, patients required 6 mg less NPAs (p = 0.009). Conclusions Predictors of high analgesic requirements at discharge include patients with a history of substance misuse, those who underwent surgical debridement of their burn injuries, and patients with higher TBSA. Characterizing patient risk factors that increase analgesic requirements may help burn care providers tailor how much narcotics and NPAs to prescribe each patient at discharge.

66 Prescribing Patterns of Opioids and Adjunctive Analgesics for Patients with Burn Injuries

Abstract Introduction Large quantities of analgesics are prescribed to control pain among patients with burn injuries and may lead to chronic use and dependency. This study aimed to determine whether patients are overprescribed analgesics at discharge and to identify factors that influence prescribing patterns. Methods A retrospective review of patient charts (n = 199) between July 1, 2015 - 2018 were reviewed from a registry at a single burn center. Opioid, neuropathic pain agent (NPAs), acetaminophen, and ibuprofen quantities given before and at discharge were compared. Linear mixed regression models were used to identify factors that increased the amount of analgesics prescribed among burn care providers. Results On average, patients were prescribed significantly more analgesics at discharge compared to what was consumed pre-discharge (p &amp;lt; 0.0001). Specifically, on average, providers did not overprescribe the daily dose of analgesics, but overprescribed the duration of pain medications required. For every increase in percent TBSA, 14 MEQ more opioids, 203 mg more NPAs, 843 mg more acetaminophen, and 126 mg more ibuprofen were prescribed (p &amp;lt; 0.05). Surgery was a predictor for higher opioid and NPA prescriptions (p = 0.03), while length of stay was associated with fewer NPAs prescribed (p = 0.04). Fewer ibuprofen were given to patients with a history of substance misuse (p = 0.01). Conclusions The quantity of analgesics prescribed at discharge varied widely and often prescribed for long durations of time. Standardized prescribing guidelines should be developed to optimize how analgesics are prescribed at discharge.

The characteristics of homicide perpetrators in a medium secure forensic hospital: A study from dundrum hospital

IntroductionThe majority of homicides in society are not associated with mental illness, however there is an established association between homicide and schizophrenia. Homicide perpetrated by mentally disordered offenders is a leading reason for admission to secure forensic psychiatric hospitals.ObjectivesTo investigate the clinical characteristics of those with a history of completed homicide in the CMH Dundrum.MethodsThis study was a cross sectional study of a cohort of patients in the Central Mental Hospital who had completed homicide (n=63).ResultsA total of 136 patients were included, 46.3% (n=63) of whom had committed homicide. Mean age of homicide perpetrators at admission was 34.6 years old (median 33.4, s.d. = 9.72). The most common diagnosis was schizophrenia (n=40, 63.5%). 73.0% (n=46) had a history of substance misuse. 36.5% (n=23) had a diagnosis of a personality disorder, including traits only. The most common victim type was a family member (n=32, 50.8%). Patients with a history of homicide had better scores on dynamic risk of violence (F=8.553, p=0.004), programme completion (F=8.258, p=0.005) and recovery (F=3.666, p=0.058) compared to non-homicide offenders, however they also had significantly longer mean length of stay, 12.7 years v 7.5 years (F=9.634,p=0.002).ConclusionsHomicide perpetrators with a mental illness constitute a significant portion of the forensic mental health population and a high number of these offences were against family members. A history of homicide among forensic in-patients is associated with a longer length of stay which has implications for service development into the future.

Substance use amongst adult patients admitted to an irish acute mental health unit

IntroductionComorbid substance misuse in mental illness presents a significant challenge to mental health services. It may lead to higher rates of relapse, hospital admissions and poorer treatment outcomes. Up to 47% of inpatients in Irish mental health units may experience substance misuse. Despite the Irish government’s ‘Vision for Change’ policy (2006), access to specialised services remains variable.ObjectivesEvaluate: -prevalence of substance misuse at an Irish mental health unit. -quality and detail of the recorded substance misuse history. -access to specialised services for patients experiencing substance misuse.MethodsA retrospective chart review of inpatients in a mental health unit over 12 months, was completed. Information recorded included: demographic details, diagnosis, substance use history; access to substance misuse services. Microsoft Excel was utilised for data input and analysis.Results267 patients were admitted over twelve months. Substance misuse was the primary diagnosis of 6% and the secondary diagnosis of 67%. 46% of patients reported current substance misuse, 52% reported historical substance misuse. Frequency and quantity of use was documented in 65% and 48% of cases respectively. 4% of patients with a substance misuse history were in current contact with addiction services.ConclusionsAlthough 46% of patients reported substance misuse, only 4% were in contact with specialised addiction services. This highlights a significant unmet need. There was variability in the quality of the recorded substance misuse history. In order to fully understand comorbid substance misuse, this be addressed. The addition of a more formatted substance misuse section, to admission proformas, may help to alleviate this issue.

Demographic, Behavioral, and Proximal Risk Factors for Gambling Disorder in the US Military.

To estimate the diagnostic prevalence and incidence of gambling disorder among United States service members and to identify associated risk factors, including demographics, history of mental illness or substance misuse, and proximity to legalized gambling vicinities. Gambling disorder cases comprised active component Service members who received a pathological or problem gambling diagnosis between October 1, 2005 and September 30, 2015. There were 901 cases (392 incidents) during the study period. Controls were matched on the case military entrance date (N = 43,564). Geospatial distance between gambling venue and military treatment facilities were calculated, then multivariable logistic regression and survival analyses were conducted. The 10-year prevalence of gambling disorder was 6.6 per 100,000. Men were 3.5 times more likely than women to receive a gambling disorder diagnosis. Other risk factors included age over 24, Asian or Black race, formerly married, and enlisted rank. The odds of gambling disorder increased with duration and proximity to gambling venues, ranging from 2.0 to 3.9. Service members with prior substance misuse or mental health conditions were 3.9 times and 6.3 times more likely to receive a disordered gambling diagnosis than those without substance misuse or mental illness history, respectively. The results of this study reveal that proximity to gambling venues and slot machines on bases, as well as a history of substance misuse or mental disorders, are important risk factors for gambling disorder in the US military. Department of Defense screening policies that focus on high-risk populations are appropriate. (Am J Addict 2021;00:00-00).

Hepatitis C prevalences in the psychiatric setting: Cost-effectiveness of scaling-up screening and direct-acting antiviral therapy

Background & AimsPatients hospitalised because of mental illness often have risk factors for contracting HCV. Scaling-up HCV screening for all psychiatric inpatients as a case-detection strategy for viral elimination is underexplored. This study aimed to evaluate the cost-effectiveness of scaling-up HCV screening and treatment for psychiatry hospital admissions in Switzerland vs. the current standard-of-care risk-based approach, where only those with a history of substance misuse disorder are offered testing.MethodsHCV prevalence by history of substance misuse disorder was analysed in medical records from inpatient admissions to a Swiss psychiatry department. Cost-effectiveness was analysed from a healthcare provider perspective through a decision-tree screening model, using these HCV prevalence data. Model and parameter uncertainty were assessed using deterministic and probabilistic sensitivity analyses.ResultsPrevalence of HCV in psychiatry inpatients with a history of substance misuse disorder (n = 1,013) was 25.7%, compared with 3.5% among the remaining inpatients (n = 3,535). Scaling up HCV screening and treatment for all psychiatry admissions was cost-effective vs. the risk-based approach, with an incremental cost-effectiveness ratio of US$9,188 per quality-adjusted life-year gained. The incremental cost-effectiveness ratio remained cost-effective considering a HCV prevalence as low as 0.07%. The population-level net monetary benefit of the generalised screening approach was US$435,156,348, with 917 additional patients per year detected and treated at a cost of US$3,294 per person (vs. US$2,122 under risk-based screening).ConclusionsScaling up HCV screening and treatment at diagnosis with all-oral, interferon-free regimens as a generalised approach for psychiatric admissions was cost-effective and could support reaching World Health Organization targets for HCV elimination by 2030.Lay summaryPatients hospitalised because of mental illness often have risk factors for HCV. We found that testing all psychiatry patients in hospital for HCV was cost-effective compared with testing only patients who have a history of substance misuse. Scaling up HCV testing and treatment could help to wipe out HCV.

Characteristics of patients admitted to an adult PICU as compared to general adult inpatient units: a service evaluation

Background: There is a need to ensure that mental health services adapt to the increasing demand for inpatient beds, particularly within PICUs. This study aims to identify risk factors and assess demographics of patients which may increase the risk of admission or transfer to a PICU.&lt;br/&gt; Method: A retrospective analysis of 85 discharges from an adult mental health unit. We collected data on demographics, admission, ICD-10 diagnosis and readmission figures. We compared two cohorts: those who required admission to a PICU and those who did not.&lt;br/&gt; Results: 18 (21.2%) patients were admitted to the PICU. They were younger, more likely to be male, single and unemployed. PICU admissions were more likely to have a forensic history (p = 0.009), substance misuse history (p = 0.074), to require seclusion (p&lt;0.0001), police involvement (p = 0.443), physical health input in the form of senior medical or surgical advice (p = 0.026) and assessment at an acute hospital (p = 0.015). Schizophrenia and schizoaffective disorders were less common than substance misuse disorders within the PICU cohort (p = 0.535). They were also more likely to be discharged to another PICU and to be re-admitted.&lt;br/&gt; Conclusion: This population demonstrated that F10–19 diagnoses were the most frequent within the PICU cohort which contradicts the previous literature. We identified risk factors for admission to a PICU, demonstrating the demand for inpatient services to adapt to the needs and demographics of patients and allowing early identification of high risk individuals.

Risk factors for emergence agitation in adults after general anesthesia: A systematic review and meta-analysis.

Emergence agitation (EA) is an adverse post-operative complication that increases the risk for injury, self-extubation, hemorrhages, and prolonged hospitalization. This meta-analysis aims to define the risk factors for adult EA after general anesthesia and provide recommendations for clinical practice. Embase, PubMed, Medline, and the Cochrane Library databases were comprehensive retrieved. Observational studies that reported the risk factors for adult EA were enrolled. Review Manager 5.4 was used to analyze the extracted data. Eighteen observational studies involving 16, 678 adult patients were enrolled in this study. Eighteen pre-operative and nineteen intraoperative factors with unadjusted data, and five pre-operative and five intraoperative factors with adjusted data were meta-analyzed separately. Among them, seven factors (age, male, smoking, history of substance misuse, inhalational anesthesia, urinary catheter, complain of pain, or need analgesic drug use in post-anesthetic care unit) were the risk factors no matter meta-analyzed by unadjusted data or adjusted data. Intraoperative use of benzodiazepines was the risk factor when meta-analyzed by adjusted data, but not unadjusted data. Moreover, age and inhalational anesthesia were not the risk factors when omitted one study for sensitivity analysis, and history of substance misuse could not do sensitivity analysis. Based on this meta-analysis, male, smoking, urinary catheter, and post-operative pain are the risk factors, while age, inhalational anesthesia, history of substance misuse, and intraoperative use of benzodiazepines are the possible risk factors for adult EA. This systematic review and meta-analysis identify risk factors associated with the occurrence of agitation during emergence from general anesthesia. As might be expected, the strongest factors are generally things which are irritating or painful for patients, but cannot necessarily be avoided.