Unbound MEDLINE

Diagnosing psychotic disorders in the emergency department in the context of substance use.

Abstract

OBJECTIVE
For patients who are actively using a substance and experience psychotic symptoms, determining whether the psychotic symptoms are due to a primary psychotic disorder or are substance induced is challenging, especially in emergency departments, where historical information is limited. This study examined the accuracy and subsequent treatment implications of emergency department diagnoses among substance-using patients who were having their first psychotic episode.
METHODS
Emergency department diagnoses for 302 patients were compared with best-estimate longitudinal diagnoses (BELDs) based on research assessments at three time points (baseline, six months, and 12 months).
RESULTS
Of the 223 patients whose symptoms were diagnosed in the emergency department as a primary psychotic disorder, one-quarter were determined by the BELD to have substance-induced psychosis or no psychosis. Overall, the diagnostic agreement was only fair (kappa=.32). Patients with an emergency department diagnosis of primary psychosis were significantly more likely than those with an emergency department diagnosis of substance-induced psychosis to be hospitalized, started on antipsychotic medication, and referred to mental health services instead of treatment for substance use (p<.001). Patients given an emergency department diagnosis of primary psychosis who were found by the BELD to have substance-induced psychosis or no psychosis were significantly more likely to be treated for a psychotic disorder rather than for substance-induced psychosis (p<.001)
CONCLUSIONS
Clinicians in psychiatric emergency departments appear to have a tendency to attribute psychotic symptoms to a primary psychotic disorder rather than to concurrent substance use. Given that the diagnosis has significant implications for future management, it is important to improve diagnostic approaches in the emergency department.

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  • Publisher Full Text
  • Authors

    Schanzer BM, First MB, Dominguez B, Hasin DS, Caton CL

    Institution

    Department of Psychiatry, Columbia University, New York, NY 10043, USA. bms12@columbia.edu

    Source

    Psychiatric services (Washington, D.C.) 57:10 2006 Oct pg 1468-73

    MeSH

    Adolescent
    Adult
    Demography
    Diagnosis, Differential
    Emergency Medical Services
    Female
    Humans
    Longitudinal Studies
    Male
    Middle Aged
    Psychotic Disorders
    Questionnaires
    Referral and Consultation
    Substance-Related Disorders

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    17035567