Substance-induced Psychotic Disorders in an Emergency Department

Abstract

Introduction

Substance abuse has been correlated with psychotic disorders albeit more accurate details on causality remain to be assessed. Furthermore, the prevalence and prognosis of substance-induced psychotic disorders have not been clearly established.

Method

Retrospective study performed in 124 patients assessed in an Emergency Department (ED) due to psychotic symptoms over a 6-month period. Medical records were reviewed to obtain clinical and socio-demographic variables.

Objectives

(1) To analyse substance abuse patterns among ED psychotic patients; (2) to estimate the prevalence of substance-induced psychotic disorders in ED; (3) to underpin the socio-demographic and clinical variables associated.

Results

Personal history of substance abuse: THC 31.5%, alcohol 29%, cocaine 18.5%, benzodiazepines 18.5%, opiates 6.5%, MDMA 4%, amphetamines 3.2%, hallucinogens 2.4%. Accumulated time interval of substance abuse prior to psychotic onset: 0–5 years 15% (3.9% developed psychosis during the first year of cannabis use), 5–10 years 9.2%, more than 10 years 20.8%. Urine testing for drug misuse undertaken in 80.6% of cases: positives 53%, negatives 47%. Among positive urine test results: THC 16.5%, benzodiazepines 16.5%, cocaine 6.1%, opiates 5.1%, alcohol 0.9%, amphetamines 0.8%, hallucinogens 0.8%. Substance-induced psychotic disorder (F19.15) was diagnosed among 20.4% of patients. This diagnosis was 1.5 times more prevalent among males. Forty-eight percent of patients were single, 36% married, 12% divorced, 4% widowers. Habitat: 68% urban, 34% rural. Highest prevalence group 36 – 50 year olds.

Conclusions

Both substance abuse and substance-induced psychotic disorders are highly prevalent in our sample. Their socio-demographic and clinical profile is similar to that found in schizophrenia. Further refinements of these findings are warranted.

Disclosure of interest

The authors have not supplied their declaration of competing interest.