Prevalence of current substance misuse in psychiatric in-patients: Results of a survey in a University Teaching Hospital, Ireland.

Brief report: Dr Ajay Dixit(1) & Dr Ann Payne(2)

1) Registrar, Psychiatry 2) Consultant Psychiatrist

Home Based Crisis Team,

North Lee Mental Health Services, Cork, Ireland

Correspondence to: drajaydixit@yahoo.com

Background:Substance misuse (mainly alcohol) is

very common in psychiatric patients.Accounts for ~15% of acute

psychiatric admissions (HRB, 2007).Substance misuse complicates an

individual’s management in Adult Mental Health services.

Co-morbidity (simultaneous presence of 2 or more disorders) of mental illness and substance misuse is well established.

Co-morbidity has been associated with: increased psychiatric admissions, violence, suicidal behaviour, excess service costs and poor treatment outcome. (Weaver et al, 2003).

Ireland has one of the highest per capita annual consumptions of alcohol in Europe.

The improved management of substance misuse is one of the important recommendations of the expert group on mental health policy in Ireland. (A vision for change, 2006).

Substance misuse is often under-reported by the patients and under-detected by the doctors. (Beaurepaire et al, 2007).

Method:Four month prospective prevalence study,

conducted from October 2006 to February 2007, on 100 consecutive admissions, to a 50 bed acute psychiatric unit, Mercy University Hospital, Cork.

Patients’ records, across two geographically defined sectors with the highest bed usage (Cork City North-west & City North-east) were reviewed within 4 days of admission.

Aims: Study aimed to examine the overall

prevalence of substance misuse in those admitted to the acute psychiatric unit.

Method (continued):

Patient demographics were noted and admission diagnoses were grouped in 5 broad categories:

1) substance misuse/dependence 2) depression and or anxiety3) psychosis (including bipolar affective

disorder)4) personality disorders 5) other diagnosesSubstance misuse proximal to the admission

(reflecting the current usage) was also noted.

22%

25%

53%

Primary reason for admission

(100 admissions to St Michaels Unit October 2006 to February 2007)

Substance misuse only

Co-morbid substance misuse with mental health diagnosis

Mental health diag-nosis only

Results:

Substance misuse only

Co-morbid sub-stance misuse

with mental health diagnosis

Mental health diagnosis only

0

10

20

30

40

50

60

19 2228

33

25

Age>45yrs

Age<45yrs

Significance p<0.01 Odds Ratio 6.5 (CI 1.8-23)

Primary reason for admission (n=100)

Substance misuse only

Co-morbid sub-stance misuse

with mental health diagnosis

Mental health diagnosis only

0

10

20

30

40

50

60

1418

22

87

31

Females

Males

Significance p<0.05 Odds Ratio 3 (CI 1.1-8)

Primary reason for admission (n=100)

Substance misuse only

Co-morbid sub-stance misuse

with mental health diagnosis

Mental health diagnosis only

0

10

20

30

40

50

60

7 714

15 18

39Readmission

First ad-mission

Not statistically significant

Primary reason for admission (n=100)

These findings were generally consistent with findings of previous international studies.

Discussion:This Irish study reports a very high

prevalence 47% (CI 37-57%) of current substance misuse in psychiatric in-patients of the acute psychiatric unit at a University Hospital in Ireland.

Men to women ratio, in patients with substance misuse, was 2:1(32:15).

This was statistically significant at p<0.01.87% (41/47) of patients with substance

misuse were aged less than 45years, compared to 53% (28/53) who were not misusing any substance & this was statistically significant at p<0.05.

Recommendations:

This is a small scale study, at one acute psychiatric unit in a teaching hospital in Ireland.

Limitations:

Further studies are required to improve the power of the study.

It would be interesting to note, what percentage of patients with substance misuse were referred to the addiction services.

Acknowledgements:

Beaurepaire R, Lukasiewicz M, Beauverie et al. (2007). Comparison of self-reports and biological measures for alcohol, tobacco, and illicit drugs consumption in psychiatric in-patients. European psychiatry 22; 540-548.

Daly, A, Walsh, D and Moran, R. (2007). Activities of Irish Psychiatric Units and Hospitals, 2006. Dublin: Health Research Board. www.hrb.ie

Department of Health and Children (2006) A vision for change: recommendations of the Expert Group on Mental Health Policy. Dublin: The Stationery Office. www.ndc.hrb.ie

Weaver T, Madden P, Charles V, et al. (2003) Co-morbidity of substance misuse and mental illness in community mental health and substance misuse. Br J Psychiatry,183, 304-313.

References:

Thank you to HBCT members who helped collate the data - John Black, Damien Fleming, Mark Ruddle, Barbara Shorten & Martina Cullinane - to Jackie Shone who helped with the primary diagnosis data and to Keren Lilley who compiled the graphs.