Substance abuse comorbidity in hospitalized psychiatric patients Population – 470 consequently admitted hospitalized patients Kfar Shaul – 250 patients

Substance abuse comorbidity in hospitalized psychiatric patients

Population – 470 consequently admitted hospitalized patients

Kfar Shaul – 250 patientsTel Ha-Shomer – 220 patients


Age – 18-70 years oldUp to 24 years old – 87 patients (18.5%)25 – 44 years old – 224 patients (47.7%)45 and more years old – 159 patients (33.8%)

Age- Kfar Saul vs. Tel Ha ShomerKfar Saul Tel Ha

ShomerStatisticanalysisdf=1

18-24 years old

51 (20.4 %) 66 (30 %) p=0.05

25-44 years old

143 (57.2%) 81(36.8 %) p=0.000

45 and more years old

56 (22.4%) 73 (33.2%) P=0.01

SexFemale – 165

patients (35% )

Male – 305 patients (65 %)

Place of birthIsrael – 308 patients

(65,5%)West-Europe ,America,

Australia, South Africa -112 patients (23.8%)

East-Asia, Africa, Middle East – 46 patients (9.8%)

Other – 2 patients (0.4%)


Origin-Kfar Shaul vs. Tel ha Shomer

Kfar-Shaul Tel-Ha-Shomer

Statistic analysisdf=1

Israel 174 (69.6%)

134(60.9%)

p=0.05

West 59 (24.6%) 57 (25.9%) NS

East 17 (6.8%) 29 (13.2) p=0.03


Working status

Frequency PercentWorkingStudents (incl. eshiva)UnemployedSocial security (mental problems)Social security (other problems)Other

107 20

40

178

5669

22.84.3

8.5

37.9

11.914.7


Working status-Kfar Saul vs.Tel-Ha-ShomerKfar Shaul Tel-Ha-

ShomerStatistical Analysis df=1

WorkingStudents (incl. eshiva)UnemployedSocial security (mental problems)Social security (other problems)Other

34 (13.6%)16 (6.4%)

27 (10.8%)116 ( 46.4%)

20 (8.0%)

37 (14.8%)

73 (33.2%)4 (1.8%)

13 (5.9%)62 (28.1%)

36 (16.3%)

32 (14.5%)

p=000p=0.02

p=0.01p=0.000

p=0.006

NS


Marital status

Frequency Percent

married 151 32.1

single 225 47.9

divorced 85 18.1

widow 5 1.1

other 4 0.9

Substance abuse comorbidity in hospitalized psychiatric patients Marital status - Kfar Shaul vs. Tel-Ha-Shomer

Kfar Shaul Tel-Ha-Shomer

Statistical Analysis df=1

married 63 (25.2%) 88 (40%) p=0.001

single 135 (54%) 90 (40.9%) p=0.005

divorced 47 (18.8%) 38 (17.2%) NS

widow 2 (0.8%) 0 NS

other 2 (0.8%) 2 (0.9%) NS


Past psychiatric historyyes – 391 patients (83.2 %)no – 71 patients (15.5 %)

unclear – 6 (1.3%)


Diagnosis

Frequency PercentOrganic disorders (incl. mental disorders due to drug abuse)

33 7.1%

Schizophrenia, schizophrenoform and schizoaffective d-r

237 50.4%

Affective disorders 126 26.8%Anxiety disorders 48 10.8%Personality disorders 26 5.4%


Diagnosis Kfar Shaul vs. Tel-Ha-ShomerKfar Shaul Tel-Ha-

ShomerOrganic disorders (incl. mental disorders due to drug abuse)

28 (11.2%) 5 (2.2%) p=0.000

Schizophrenia, schizophrenoform and schizoaffective d-r

142 (56.8%) 95 ( 43.2%) p=0.004

Affective disorders 52 (20.8%) 74 (33.6%) p=0.002

Anxiety disorders 14 (5.6%) 34 (15.4%) p=0.001

Personality disorders 14 (5.6%) 12 (5.6%) NS


Life time prevalence of drug abuse Positive (self report) – 113 patients 24.0%Cannabis – 93 patients (19.7%)Opioid – 27 patients (5.7%)Cocaine – 13 patients (2.7%)Amphetamine – 16 patients (3.4%)Methamphetamine – 31 patients (6.6%)


Life time prevalence - frequency of abuse

2 - 10 cases per month – 42 patientsmore than 10 cases – 77 patientsunclear – 27 patients

Non-active substance abusers Kfar-Shaul vs. Tel-Ha-Shomer

Tel-Ha-Shomer

Kfar-Shaul Total Statistical Analysis df=1

20 (9.1%) 15 (6%) 35 (7.4%) NS

Miun

Substance abuse comorbidity in hospitalized psychiatric patients Non-active abusers diagnosis (N = 35)

Frequency Percent

Organic d-rs (incl. due to substance abuse)

3 8.6

Schizophrenia, schizophrenoform d-r and schizoaffective

22 62.9

Affective d-rs 6 17.1

Anxiety d-rs 1 2.9

Personality d-rs 3 8.6


Frequency of abuse

Cannabis Amphetamine

Methamphetamine

Opioid Cocaine

2-10 cases/month

16 4 10 4 5

10 and more

35 0 6 12 0

unclear 6 1 2 6 3

Miun

Frequency of abuse of different drugs: Kfar-Shaul vs. Tel-Ha-Shomer

Drug Num of abusers

% of Total num of patients

Kfar-Shaul

% Kfar-Shaul

Tel-Ha-Shomer

% Tel-Ha-Shomer


Amphetamine

5 1.1 4 1.6 1 0.5 NS

Cocaine 7 1.5 4 1.6 3 1.4 NS

Methamphetamine

18 3.8 13 5.2 5 2.3 NS

Opiates 23 4.9 19 7.6 4 1.8 0.004

Cannabis 54 11.1 39 15.6 15 6.8 0.003

Miun


Active abuse of the drugs (last month) 18 patients - positive for urine tests, but

negative in self reports34 patients - positive for urine tests and self

report24 patients - positive for self report, but

negative for urine testsTotal – 78 patients


Urine testsTHC (Cannabis) - 30 positiveMethamphetamine - 7 positiveAmphetamine - 3 positiveCocaine - 5 positiveOpioid - 17 positive

Total – 52 positive


Abusers vs. nonusers – age

AbusersN=78

NonusersN=392


Up to 24 years 24 (30.8%) 63 (16.1%) p<0.001

25-44 years 41 (52.6%) 183 (46.7%)

NS

45-64 years 12 (15.4%) 117 (29.8%)

p<0.001

65-70 years 1 (1,2 %) 29 (7.4%) NS


Abusers vs. nonusers-sex

Abusersn=78

Nonusersn= 392

Male 60 (76.9%) 245 (62.5%)

Female 18 (23.1%) 147 (37.5%)

p<0.05


Abusers vs. nonusers-marital status

Abusers n=78

NonusersN=392


Married 10 (12.8%) 141 (36%) p<0.001

Single 52 (66.7%) 173 (44.1%) p<0.001

Divorced 16 (20.5%) 69 (17.6%) NS

Widow 0 5 (1.3%) NS

Other 0 4 (1%) NS


Abusers vs. nonusers-country of origin

Abusers N=78

Nonusers N=392


Israel 52 (66.7%) 256 (65.6%)

NS

Asia, Middle East, North Africa

2 (4.3%) 44 (11.3%)

p<0.05

Europe, South Africa, America, Australia

24 (30.8%) 88 (22.6%)

p< 0.05

Other 0 2 (0,5%) NS

Substance abuse comorbidity in hospitalized psychiatric patients Abusers vs. nonusers-working status

Abusersn=78

Nonusersn=392


Working 16 (20.5%) 91 (23.2%) NSStudents (inc. eshiva) 7 (9%) 13 (3.3%) NS

Unemployed 9 (11.5%) 31 (7.9%) NS

Soc. security due to mental problems

25 (32%) 153 (39.1%) NS

Soc. security due to other problems

8 (10.3%) 48 (12.2%) NS

Other 13 (16.7%) 56 (14.3%) NS


Abusers vs. nonusers-diagnosis

Abusers (n=78) Nonusers (n=392)


19 (24.4%) 14 (3.7%)

Schizophrenia, schizophrenoform d-r and schizoaffective

37 (47.4%) 200 (51%)

Affective d-rs 14 (17.9%) 112 (28.5%)

Anxiety d-rs 2 (2.6%) 46 (11.7%)

Personality d-rs 6 (7.7%) 20 (5.1%)


Abusers vs. nonusers-diagnosis (without organic d-rs) Abusers n=59

Nonusers n=378


Schizophrenia, schiphrenoform schizoaffective d-rs

37 (62.7%) 200 (52.9%) p=0.06

Affective d-rs 14 (23.7%) 112 (29.6%) NS

Anxiety d-rs 2 (3.4%) 46 (12.1%) NS

Personality d-rs 6 (10.2%) 20 (5.3%) NS


Duration of drug abuse vs. duration of mental disorder Tel-Ha-Shomer

Kfar-Shaul

Total Statistical Analysis df=2

Duration of drug abuse is longer than that of mental problems

27 (56.3%) 10 (24.4%) 37 (41.6%) p = 0.004

Duration of drug abuse is similar to that of mental problems

11 (22.9%) 22 (53.7%) 33 (37.1%) p = 0.004

Duration of mental problems is longer than that of drug abuse

10 (20.8%) 9 (22.0%) 19 (21.3%) NS

Substance abuse comorbidity in hospitalized psychiatric patients Cannabis abuser vs. nonusers-diagnosis

Abusers n=54

Nonusers n=392

Organic (incl. due to substance abuse)

14 (25.9%) 14 (3.7%)

Schizophrenia, schizoaffective,schizophrenoform

27 (50%) 200 (51%)

Affective d-rs 9 (16.7%) 112 (28.5%)

Anxiety d-rs 0 46 (11.7%)



Cannabis abusers vs. nonusers - diagnosis (without organic)

Abusers n=40

NonusersN=378


Schizophrenia,schizoaffective, schizophrenoform

27 (67.5%) 200 (52.9%) p=0.014

Affective d-rs 9 (22.5%) 112 (29.6%) NS

Anxiety d-rs 0 46 (12.2%) NS

Personality d-rs 4 (10%) 20 ( 5.3 %) NS


Psycho stimulants (amphetamine, methamphetamine, cocaine) - diagnosis

Amphetamine

Methamphetamine

Cocaine Total

Organic(incl. due to substance abuse)

1 0 2 3 (10.3%)

Schizophrenia, schizoaffective, schizoprenoform

16 4 1 21 (72.5%)

Affective d-rs 1 0 2 3 (10.3%)

Anxiety d-rs 0 1 1 2 (6.9%)

Personality d-rs 0 0 0 0

Total 18 5 6 29

Psycho stimulant’s abusers n=26

Nonusersn=378


Schizophrenia, schizoaffective, schizoprenoform

21 (80.7%) 200 (52.9%) p=0.001

Affective d-rs 3 (11.5%) 112 (29.6%) p=0.03

Anxiety d-rs 2 (7.7%) 46 (12.2 %) NS

Personality d-rs 0 20 (5.3%) NS


Psycho stimulant’s abusers vs. nonusers (diagnosis without organic d-rs)

Substance abuse comorbidity in hospitalized psychiatric patientsOpioid abusers vs. nonusers-diagnosis

Opioid abusers n=22

NonusersN=392


9 (27.3%) 14 (3.7%)

Schizophrenia, schizoaffective, schizofreniform

7 (31.8%) 200 (51%)

Affective d-rs 5 (22.7%) 112 (28.5%)

Anxiety d-rs 0 46 (11.7%)



Opioid abusers vs. nonusers-diagnosis (without organic) Opioid abusers n=13

NonusersN=378


Schizophrenia,schizoaffective,schizofrenoform

7 (53.8 %) 200 (52.9%) NS

Affective d-rs 5 (38.5%) 112 (29.6%) NS

Anxiety d-rs 0 46 (12.1%) NS

Personality d-rs 1 (7.7 %) 20 (5.3 %) NS


PANSS (positive scale) - cannabis abusers vs. nonusers

Mean Standard deviation

t df p

Cannabisabusersn=54

16.128 8.03054 2.510 466 0.012

Nonusersn= 392

19.0556 8.29962


PANNS (positive) – subscales: cannabis abusers vs nonusers

P1 (delusions), P2 (conceptual disorganization), P6 (suspiciousness) – rates of the abusers were higher, but not significantly.

Substance abuse comorbidity in hospitalized psychiatric patients PANSS (positive) - subscales: abusers vs.

nonusers

Rates of the abusers were significantly higher then the nonusers:

P3 (hallucinatory behavior) – p=0.011P4 (excitement) – p= 0.004P5 (grandiosity) – p= 0.006P7 (hostility) – p= 0.024


PANSS (general scale) – cannabis abusers vs.

nonusers Mean Standard

deviatn.T df p

Cannabis abusersn=54

33.0185 9.31724 2.727 466 0.007

NonusersN=394

37.3575 11.1955

G5 (mannerism and posturing), G10 (disorientation), G15 (preoccupation) and G16 (active social avoidance) - rates of the abusers were lower, but not significantly.

Substance abuse comorbidity in hospitalized psychiatric patients PANSS (general scale) – subscales: cannabis

abusers vs. nonusers


PANSS (general) – subscales: cannabis abusers vs. nonusers

G9 (unusual thought content), G11 (poor attention), G12 (lack of judgment and insight) - rates of the abusers were higher, but not significantly.



G8 (uncooperativeness) – rates of the abusers were significantly higher

(p=0.001)



Rates of the abusers were significantly lower:G1 (somatic concern) p=0.001G2 (anxiety) p=0.000G3 (guilt feelings) p=0.000G4 (tension) p=0.000G6 (deression) p=0.000G7 (motor retardation) p= 0.001G13 (disturbance of volition) p=0.002G14 (poor impulse control) p=0.001


PANSS (negative scale): cannabis abusers vs. nonusers

Mean Standard deviatn.

t df p


13.8148 6.86763 1.184 466 0.2

Nonusersn=394

14.9831 6.44593


PANSS (negative) – subscales: cannabis abusers vs. nonusers

N3 (poor rapport), N5 (difficulty in abstract thinking) – rates of the abusers were higher, but not significantly.



N1 (blunted affect), N2 (emotional withdrawal), N6 (lack of spontaneity/conversational flow) – rates of the abusers were lower, but not significantly



Rates of the abusers were significantly lower:

N4 (social withdrawal) p= 0.04 N7 (stereotyped thinking) p= 0.037


YMRS Scale – cannabis abusers vs. nonusers

Mean Standard deviatn.

t df p


6.7778 10.82566 1.158 466 0.115

Nonusersn=394

4.9106 7.754404


YMRS – subscales: cannabis abusers vs. nonusers

YMRS1 (elevated mood), YMRS2 (increased motor activity), YMRS4 (sleep), YMRS5 (irritability), YMRS6 (speech), YMRS8 (content), YMRS9 (disruptive/aggressive behavior), YMRS10 (appearance) – rates of the abusers were higher, but not significantly.



YMRS3 (sexual interest) – rates of the abusers were lower, but not significantly



Rates of the abusers were significantly higher:

YMRS7 (language/thought) – p=0.001 YMRS11 (insight) – p=0.002

Substance abuse comorbidity in hospitalized psychiatric patients HAM-D: cannabis abusers vs. nonusers

Mean Standarddeviatn.

t df p

Cannabisabusersn=54

5.9444 10.2909 3.535 468 0.000

Nonusersn=394

12.8966 13.9465


HAM-D – subscales: cannabis abusers vs. nonusers

HAM-D13 (general somatic symptoms) and HAM-D20 (paranoid symptoms) – rates of the abusers were higher, but not significantly



Rates of the abusers were lower, but not significantly:

HAM-D5 (middle insomnia)HAM-D7 (work and activities)HAM-D15 (hyposhondriasis)HAM-D16 (lost of weight)HAM-D17 (insight)HAM-D19 (depersonalization and derealization)



Rates of the users were significantly lower:HAM-D1 (depressed mood) – p=0.000HAM-D2 (feeling of guilt) – p=0.000HAM-D3 (suicide) – p=0.011HAM-D4 (early insomnia) – p=0.000HAM-D6 (late insomnia) – p=0.006HAM-D8 (retardation) – p=0.006HAM-D9 (agitation) – p=0.000HAM-D10 (psychotic anxiety) – p=0.000


HAM-D – subscales: cannabis abusers vs.nonusers (continued)

Rates of the abusers were significantly lower: HAM-D11(somatic anxiety) – p=0.000HAM-D12 (somatic symptoms-gastrointestinal) –

p=0.006HAM-D14 (somatic symptoms-genital) – p=0.002HAM-D18 (diurnal variation) – p=0.01HAMD-D21 (obsessive and compulsive symptoms) –

p=0.002


PANNS (positive scale) – stimulants abusers vs. nonusers

Mean Standarddeviatn

t df p

Stimulantsabusersn=29

19.0 9.29606 1.609 466 0.11

Nonusersn=394

16.3228 8.02299


PANNS (negative scale) – stimulants abusers vs. nonusers


t df p


14.8691 6.88043 0.277 466 0.78

Nonusersn=394

14.4800 5.83895


PANNS (general scale) – stimulants abusers vs. nonusers


t df p


39.9097 11.17572 0.434 466 0.664

Nonusersn=394

35.920 9.21466


YMRS scale – stimulants abusers vs. nonusers


t df p


5.2400 7.67181 0.072 466 0.943

Nonusersn=394

5.1196 8.21056

Documents

Substance abuse comorbidity in hospitalized psychiatric patients Population – 470 consequently admitted hospitalized patients Kfar Shaul – 250 patients