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Psychiatric Hospitalizations of Chronic Psychotic Disorder Patients With and Without Dual Diagnosis, Israel, 1963-2016.
J Dual Diagn. 2019 Jul-Sep; 15(3):130-139.JD

Abstract

Objective:

A significant proportion of patients with severe mental illness also experience substance use disorder. For these dual diagnosis (DD) patients, treatment is more complicated and prognosis is worse. Despite the introduction of the Community Rehabilitation of Persons With Mental Health Disability Law in 2000 and ongoing national mental health reforms, psychiatric services in Israel are not meeting the needs of an increasing number of DD patients. This study examines, for the first time in Israel, the prevalence of DD and patterns of psychiatric hospitalizations of chronic psychotic disorder patients with and without substance use disorder.

Methods:

The National Psychiatric Case Registry provided data on 18,684 persons with schizophrenia/schizoaffective disorders, aged 18-65, with a psychiatric hospitalization during the period 1963-2016 (with at least one hospitalization in 2010-15). Patients were considered as having DD if their substance use disorder was indicated in at least two, or 20%, of hospitalizations. Regression modeling predicted hospitalization measures (number of hospitalizations, total days hospitalized, length of stay). Results were also analyzed by legal status of admission (voluntary or involuntary; psychiatrist-ordered and court-ordered).

Results:

One-third of patients with chronic psychotic disorder met DD criteria, with a threefold higher rate among males (37.1%) than females (12.8%). Particularly high rates of DD (nearly 50%) were noted among male immigrants from Ethiopia. Compared with non-substance use disorder patients, DD patients had a significantly younger mean age at first hospitalization and shorter average length of stay per hospitalization but a greater number of hospitalizations and total hospital days (p < .0001 for all comparisons). The associations between DD status and hospitalization characteristics remained significant even after accounting for the effects of confounding factors. Hospitalization characteristics were also associated significantly with sex, population group, age, age at first hospitalization, and country of origin. The rate of court-ordered observation or hospitalization was threefold higher in the DD group.

Conclusions:

These findings, which broadly align with other countries, reflect a scarcity of outpatient services for DD patients with schizophrenia/schizoaffective disorder and substance use disorder. To achieve long-term mental health improvements, an expansion of community-based integrative treatment and rehabilitation services is needed in Israel.

Authors+Show Affiliations

The Hebrew University of Jerusalem , Jerusalem , Israel.Department for the Treatment of Substance Abuse, Ministry of Health , The Hebrew University of Jerusalem, Jerusalem , Israel.Jerusalem Mental Health Center, The Hebrew University of Jerusalem , Jerusalem , Israel.Faculty of Medicine, The Hebrew University of Jerusalem , Jerusalem , Israel.Hebrew University-Hadassah Braun School of Public Health & Community Medicine, The Hebrew University of Jerusalem , Jerusalem , Israel.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31079564

Citation

Florentin, S, et al. "Psychiatric Hospitalizations of Chronic Psychotic Disorder Patients With and Without Dual Diagnosis, Israel, 1963-2016." Journal of Dual Diagnosis, vol. 15, no. 3, 2019, pp. 130-139.
Florentin S, Rosca P, Raskin S, et al. Psychiatric Hospitalizations of Chronic Psychotic Disorder Patients With and Without Dual Diagnosis, Israel, 1963-2016. J Dual Diagn. 2019;15(3):130-139.
Florentin, S., Rosca, P., Raskin, S., Bdolah-Abram, T., & Neumark, Y. (2019). Psychiatric Hospitalizations of Chronic Psychotic Disorder Patients With and Without Dual Diagnosis, Israel, 1963-2016. Journal of Dual Diagnosis, 15(3), 130-139. https://doi.org/10.1080/15504263.2019.1609149
Florentin S, et al. Psychiatric Hospitalizations of Chronic Psychotic Disorder Patients With and Without Dual Diagnosis, Israel, 1963-2016. J Dual Diagn. 2019 Jul-Sep;15(3):130-139. PubMed PMID: 31079564.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Psychiatric Hospitalizations of Chronic Psychotic Disorder Patients With and Without Dual Diagnosis, Israel, 1963-2016. AU - Florentin,S, AU - Rosca,P, AU - Raskin,S, AU - Bdolah-Abram,T, AU - Neumark,Y, Y1 - 2019/05/12/ PY - 2019/5/14/pubmed PY - 2020/6/2/medline PY - 2019/5/14/entrez KW - Substance use disorder KW - chronic psychotic disorders KW - dual diagnosis KW - hospitalization characteristics KW - length of stay KW - schizophrenia SP - 130 EP - 139 JF - Journal of dual diagnosis JO - J Dual Diagn VL - 15 IS - 3 N2 - Objective: A significant proportion of patients with severe mental illness also experience substance use disorder. For these dual diagnosis (DD) patients, treatment is more complicated and prognosis is worse. Despite the introduction of the Community Rehabilitation of Persons With Mental Health Disability Law in 2000 and ongoing national mental health reforms, psychiatric services in Israel are not meeting the needs of an increasing number of DD patients. This study examines, for the first time in Israel, the prevalence of DD and patterns of psychiatric hospitalizations of chronic psychotic disorder patients with and without substance use disorder. Methods: The National Psychiatric Case Registry provided data on 18,684 persons with schizophrenia/schizoaffective disorders, aged 18-65, with a psychiatric hospitalization during the period 1963-2016 (with at least one hospitalization in 2010-15). Patients were considered as having DD if their substance use disorder was indicated in at least two, or 20%, of hospitalizations. Regression modeling predicted hospitalization measures (number of hospitalizations, total days hospitalized, length of stay). Results were also analyzed by legal status of admission (voluntary or involuntary; psychiatrist-ordered and court-ordered). Results: One-third of patients with chronic psychotic disorder met DD criteria, with a threefold higher rate among males (37.1%) than females (12.8%). Particularly high rates of DD (nearly 50%) were noted among male immigrants from Ethiopia. Compared with non-substance use disorder patients, DD patients had a significantly younger mean age at first hospitalization and shorter average length of stay per hospitalization but a greater number of hospitalizations and total hospital days (p < .0001 for all comparisons). The associations between DD status and hospitalization characteristics remained significant even after accounting for the effects of confounding factors. Hospitalization characteristics were also associated significantly with sex, population group, age, age at first hospitalization, and country of origin. The rate of court-ordered observation or hospitalization was threefold higher in the DD group. Conclusions: These findings, which broadly align with other countries, reflect a scarcity of outpatient services for DD patients with schizophrenia/schizoaffective disorder and substance use disorder. To achieve long-term mental health improvements, an expansion of community-based integrative treatment and rehabilitation services is needed in Israel. SN - 1550-4271 UR - https://www.unboundmedicine.com/medline/citation/31079564/Psychiatric_Hospitalizations_of_Chronic_Psychotic_Disorder_Patients_With_and_Without_Dual_Diagnosis_Israel_1963_2016_ L2 - https://www.tandfonline.com/doi/full/10.1080/15504263.2019.1609149 DB - PRIME DP - Unbound Medicine ER -