Substance misuse in the psychiatric emergency service; a descriptive study

Area of Science:

• Psychiatry
• Emergency Medicine
• Addiction Medicine

Background:

• Substance misuse is prevalent in psychiatric emergency services (PES).
• Traditional screening tools are often inadequate for detecting substance misuse in this setting.
• Characterizing substance misuse patterns in PES is crucial for improving patient care.

Purpose of the Study:

• To characterize substance misuse in the PES.
• To identify variables that could aid in screening patients with substance misuse.
• To differentiate between primary (PSM), comorbid (CSM), and no substance misuse (NSM) patients.

Main Methods:

• Prospective data collection from over 18,000 visits to four PESs in Quebec, Canada.
• Inclusion of nursing staff subjective ratings on the contribution of substance misuse to visits.
• Categorization of patients into PSM, CSM, and NSM groups.

Main Results:

• Substance misuse accounted for 21% of all diagnoses, with alcohol being the most frequent substance.
• Depressive disorders were common primary diagnoses in CSM, while personality and substance misuse disorders were frequent secondary diagnoses in PSM.
• Key differentiating variables included prior substance misuse history, recent use (within 48 hours), and nursing staff ratings, though the latter had limited data availability.

Conclusions:

• Substance misuse is a significant factor in PES visits.
• Specific variables like substance misuse history and recency of use show potential for screening.
• Nursing staff ratings are promising but require better data capture for practical implementation.