title: Alcohol and substance use by patients with psychosis presenting to an emergency department: changing patterns.
abstract: OBJECTIVE
  The aim of this study was to determine the incidence of alcohol and other substance use in patients presenting to an emergency department with acute psychiatric illnesses and to clarify the role of urine drug screens.
  
  
  METHODS
  This was an unblinded prospective (observational) cohort study incorporating retrospective review of patient medical records, history of alcohol and substance use, results of urine drug screens and blood alcohol concentrations.
  
  
  RESULTS
  Of 196 acute psychotic patients, 104 were diagnosed with schizophrenia and 92 with "other psychosis". Results of urine drug screens were consistent with self-reported use of substances and only identified an additional 5% of substance users. Cannabis was the commonest illicit substance used by both groups of patients, followed by psychostimulants, mainly amphetamines. Younger males were more likely to use psychostimulants and to present with violence.
  
  
  CONCLUSIONS
  Patients with co-existing mental health problems and substance use present a major problem for our emergency departments. Cannabis was the most common substance used. Youth, male gender and psychostimulant use are associated with violent presentations. A comprehensive history of alcohol and substance use is important to implement appropriate dual diagnosis treatment. Urine drug screening is recommended for patients who do not admit to substance use.
authors.affiliation: Herbert Street Drug and Alcohol Clinic, Royal North Shore Hospital, Australia. nlatt@mail.usyd
authors.forename: Noeline
authors.initials: N
authors.lastname: Latt
authors.forename: Stephen
authors.initials: S
authors.lastname: Jurd
authors.forename: Christopher
authors.initials: C
authors.lastname: Tennant
authors.forename: John
authors.initials: J
authors.lastname: Lewis
authors.forename: Lewis
authors.initials: L
authors.lastname: Macken
authors.forename: Anthony
authors.initials: A
authors.lastname: Joseph
authors.forename: Alan
authors.initials: A
authors.lastname: Grochulski
authors.forename: Lidia
authors.initials: L
authors.lastname: Long
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000437:Alcoholism / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D019969:Amphetamine-Related Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy; D001569:Benzodiazepines; D002492:Central Nervous System Depressants / Q000097:blood; D017831:Diagnosis, Dual (Psychiatry) / Q000706:statistics & numerical data; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004632:Emergency Medical Services; D000431:Ethanol / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000150:complications / Q000523:psychology / Q000628:therapy; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000150:complications / Q000628:therapy; D011618:Psychotic Disorders / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D012559:Schizophrenia / Q000150:complications; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D014754:Violence; D055815:Young Adult
chemical_list: D002492:Central Nervous System Depressants; D001569:Benzodiazepines; D000431:Ethanol