Acute intoxication and substance abuse among patients presenting to a psychiatric emergency service

It is common for patients to arrive at the Psychiatric Emergency Service (PES) under the influence of a variety of drugs. The purpose of this study was to 1) determine what impact there was on the PES of patients who arrive after engaging in substance abuse within the 24 hours prior to arrival; and 2) describe some of the parameters associated with substance abuse and mental illness in the PES setting. Consecutive evaluations done at the PES during the study month were reviewed retrospectively utilizing the extensive material collected in the screening chart. Of the 294 evaluations, 32.0% (n = 94) were on patients with acute intoxication and 17.0% (n = 50) had a primary diagnosis of substance abuse or dependence; 49 of 50 presented with active substance abuse. Schizophrenic and personality disorder patients presented with significant levels of acute intoxication (25.2%, 26/103), whereas substance use rate was quite low for patients with affective disorder, adjustment disorder, and other diagnoses. Alcohol was the overwhelming drug of choice by all diagnostic groups, making it difficult to determine group differences in choice of drug. Both the univariate and multivariate studies presented demonstrate that regardless of diagnosis, the impact of substance abusing patients is substantial. They present with high acuity (usually acutely suicidal), require high levels of behavior management, and spend more time in the PES. However, they have much less need for psychiatric hospitalization. In contrast, the patients presenting with psychosis also have a high rate of behavior management needs, but these patients are very likely to be hospitalized. These findings suggest that an important role for the PES is a "filter" to triage patients to the appropriate treatment setting and that this role is fulfilled when the PES is able to provide sufficient time and resources for evaluation and/or stabilization.