1
|
Burrer A, Egger ST, Spiller TR, Kirschner M, Homan P, Seifritz E, Vetter S. Examining the impact of substance use on hospital length of stay in schizophrenia spectrum disorder: a retrospective analysis. BMC Med 2024; 22:233. [PMID: 38853281 PMCID: PMC11163832 DOI: 10.1186/s12916-024-03447-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 05/28/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Among patients diagnosed with schizophrenia, the presence of substance use poses an aggravating comorbidity, exerting a negative impact on the course of the disease, adherence to therapeutic regimens, treatment outcomes, duration of hospital stays, and the frequency of hospitalizations. The primary objective of the present study is to investigate the relationship between comorbid substance use disorders, antipsychotic treatment, and the length of stay in individuals hospitalized for treatment of schizophrenia. METHODS We conducted a retrospective analysis of electronic health records spanning a 12-month period, specifically focusing on adult patients diagnosed with schizophrenia who were discharged from the University Hospital of Psychiatry Zurich between January and December 2019. We documented the number and types of diagnosed substance use disorder, the antipsychotic treatment, the length of stay, and the number of previous hospitalizations for each patient. RESULTS Over a third (n = 328; 37.1%) of patients with schizophrenia had comorbid substance use with cannabis being the most frequent consumed substance. Patients with substance use (either single or multiple) were more frequently hospitalized; those with multiple substance use more frequently than those with a single substance use (F(2, 882) = 69.06; p < 0.001). There were no differences regarding the rate of compulsory admission. Patients with no substance use had a lower HoNOS score at discharge (F(2, 882) = 4.06). Patients with multiple substance use had a shorter length of stay (F(2, 882) = 9.22; p < 0.001), even after adjusting for duration of illness, previous hospitalizations, diagnosis, and antipsychotic treatment. CONCLUSIONS In patients with schizophrenia, comorbid single or multiple substance use has a relevant negative impact on treatment and thus on the course of disease. Substance use in patients with schizophrenia should therefore receive special attention in order to reduce re-hospitalization rates and improve the clinical outcome.
Collapse
Affiliation(s)
- Achim Burrer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
| | - Stephan T Egger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Tobias R Spiller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Matthias Kirschner
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Philipp Homan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| |
Collapse
|
2
|
Patel R, Chan KMY, Palmer EOC, Valko M, Guruswamy G, Ker S, Batra G, Rentería ME, Kollins SH. Associations of comorbid substance use disorders with clinical outcomes in schizophrenia using electronic health record data. Schizophr Res 2023; 260:191-197. [PMID: 37683509 PMCID: PMC10881404 DOI: 10.1016/j.schres.2023.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 07/10/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND AND HYPOTHESIS Schizophrenia and comorbid substance use disorders (SUDs) are associated with poor treatment outcomes but differences between the associations of different SUDs with clinical outcomes are poorly characterized. This study examines the associations of comorbid SUDs with clinical outcomes in schizophrenia using a largescale electronic health record (EHR) database. DESIGN Real-world data (RWD) analysis using the NeuroBlu database; de-identified EHR data were analysed. Multivariable logistic regression, Poisson and CoxPH models were used to compare the associations of specific comorbid SUDs with outcome variables. RESULTS Comorbid SUD was significantly different on all outcome measures compared to no SUD (U = 1.44e7-1.81e7, all ps < .001), except number of unique antipsychotics (U = 1.61e7, p = .43). Cannabis (OR = 1.58, p < .001) and polysubstance (OR = 1.22, p = .007) use disorders were associated with greater CGI-S. Cannabis (IRR = 1.13, p = .003) and polysubstance (IRR = 1.08, p = .003) use disorders were associated with greater number of unique antipsychotics prescribed, while cocaine (HR = 1.87, p < .001), stimulants (HR = 1.64, p = .024), and polysubstance (HR = 1.46, p < .001) use disorders were associated with a shorter time to antipsychotic discontinuation. Conversely, alcohol use (IRR = 0.83, p < .001), cocaine use (IRR = 0.61, p < .001), opioid use (IRR = 0.61, p < .001), stimulant use (IRR = 0.57, p < .001) and polysubstance use (IRR = 0.87, p < .001) disorders were associated fewer inpatient days. CONCLUSION Comorbid SUDs were generally associated with greater CGI-S and poorer clinical outcomes in patients with schizophrenia. Treatment strategies should target not only schizophrenia symptoms but also comorbid SUD to improve management of both conditions.
Collapse
Affiliation(s)
- Rashmi Patel
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
| | | | | | | | | | - Sheryl Ker
- Holmusk Technologies Inc., New York, NY, USA
| | | | | | | |
Collapse
|
3
|
Gómez-Sánchez-Lafuente C, Guzman-Parra J, Suarez-Perez J, Bordallo-Aragon A, Rodriguez-de-Fonseca F, Mayoral-Cleries F. Trends in Psychiatric Hospitalizations of Patients With Dual Diagnosis in Spain. J Dual Diagn 2022; 18:92-100. [PMID: 35387575 DOI: 10.1080/15504263.2022.2053770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Substance use disorders are highly prevalent in people living with a mental health disorder. Co-occurring substance use disorders have been associated with a worse prognosis and poorer adherence to treatment. The aim of this study was to analyze the temporal trends in the prevalence of substance use disorders in patients admitted to a psychiatric inpatient unit between 1998 and 2020. METHODS This is a retrospective study based on the registry of 18,367 hospitalizations and 7,124 patients with a mental health disorder admitted during the period 1998 to 2020 in Malaga, Spain. Time trend analysis by gender and substance used was calculated using a segmented regression model. The permutation test was used to determine inflection points. A sensitivity analysis was performed based on the assumptions of autocorrelation and homoscedasticity. RESULTS A total of 22.2% of admissions had a diagnosis of mental health disorder and co-occurring substance use disorders. Prevalence was higher among males (30.0%) than females (9.4%; p < .001). Patients with both disorders had a shorter length of stay by 2 days (p < .001) and a younger age at first admission (by 6.5 years; p < .001) compared to patients without substance use disorders. There was no difference in the total number of hospitalizations between the two groups. Psychotic disorders and multiple drug use disorders were the most prevalent diagnoses in men compared to women, whereas personality disorders and alcohol use were the most common diagnoses in women. We observed an increase in the prevalence of dual diagnosis between 2005 and 2020. There was a 3.0% increase in cannabis-related admissions per year during the whole study period (p < .001). Cannabis and cocaine use disorders have become the most prevalent in the last 10 years, while opioid and alcohol use disorders have decreased. CONCLUSIONS Co-occurring substance use disorders are highly prevalent among hospitalized patients. In recent years, the pattern of substance use has shifted, with cannabis being the most prevalent, while opiates and alcohol substance use have decreased. We need to devise a specialized approach and integrative treatment for patients with co-occurring disorders.
Collapse
Affiliation(s)
- Carlos Gómez-Sánchez-Lafuente
- Department of Mental Health, University General Hospital of Malaga, Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain.,Facultad de Psicología, Universidad de Malaga, Malaga, Spain
| | - Jose Guzman-Parra
- Department of Mental Health, University General Hospital of Malaga, Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain
| | - Juan Suarez-Perez
- Department of Mental Health, University General Hospital of Malaga, Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain
| | - Antonio Bordallo-Aragon
- Department of Mental Health, University General Hospital of Malaga, Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain
| | - Fernando Rodriguez-de-Fonseca
- Department of Mental Health, University General Hospital of Malaga, Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain.,Facultad de Psicología, Universidad de Malaga, Malaga, Spain
| | - Fermín Mayoral-Cleries
- Department of Mental Health, University General Hospital of Malaga, Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain
| |
Collapse
|
4
|
Kessler T, Lev-Ran S. The association between comorbid psychiatric diagnoses and hospitalization-related factors among individuals with schizophrenia. Compr Psychiatry 2019; 89:7-15. [PMID: 30557808 DOI: 10.1016/j.comppsych.2018.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 11/30/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Though schizophrenia is associated with substantial psychiatric comorbidity, data pertaining to multiple comorbid psychiatric disorders among individuals with schizophrenia is missing. Furthermore, despite abundant research indicating that the course of schizophrenia is characterized by relapses, often leading to psychiatric emergency room visits and consequent hospitalizations, data regarding the association between different comorbid psychiatric diagnoses among schizophrenia patients, and these hospitalization-related factors is lacking. The aim of this study was to describe the number and types of comorbid psychiatric diagnoses of inpatients diagnosed with schizophrenia, and to explore whether these are associated with hospitalization-related factors. METHODS Registry data from the years 1997-2017 was analyzed from a large psychiatric hospital database. We compared the annual mean number of psychiatric emergency room visits and hospitalizations, as well as mean length of hospitalizations, among individuals with schizophrenia and no additional psychiatric diagnosis, to those with one or more comorbid psychiatric diagnoses. Furthermore, we compared these hospitalization-related based on the different types of the comorbid diagnoses. RESULTS Among inpatient individuals with schizophrenia, the greater the number of comorbid psychiatric diagnoses, the higher the increase in number of emergency room visits and hospitalizations, as well as in the mean length of hospitalizations. Furthermore, all comorbid psychiatric disorders explored were found to be associated with an increase in the mentioned hospital-related factors. Such diagnoses include substance use disorders, bipolar, personality and depressive disorders, which were the most common disorders associated with schizophrenia. CONCLUSIONS Comorbid psychiatric disorders among inpatients with schizophrenia are associated with greater utilization of hospital-related services. These comorbid disorders should be addressed in the assessment and treatment of patients suffering from schizophrenia.
Collapse
Affiliation(s)
- Tal Kessler
- Lev-Hasharon Medical Center, POB 90000, Netanya 42100, Israel.
| | - Shaul Lev-Ran
- Lev-Hasharon Medical Center, POB 90000, Netanya 42100, Israel; Sackler Faculty of Medicine, Tel Aviv University, POB 39040, Tel Aviv 69978, Israel.
| |
Collapse
|
5
|
Jørgensen KB, Nordentoft M, Hjorthøj C. Association between alcohol and substance use disorders and psychiatric service use in patients with severe mental illness: a nationwide Danish register-based cohort study. Psychol Med 2018; 48:2592-2600. [PMID: 29429425 DOI: 10.1017/s0033291718000223] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Substance use disorder is highly prevalent in people with psychiatric disorders, and known to impede the psychiatric treatment. Some studies show increased rates of service use, while others show a decrease. These conflicting results are further hampered by a lack of large-scale studies. The aim of this study was to investigate the association between substance use disorder and psychiatric service use in psychiatric patients. METHODS The study was a prospective registry-based cohort study including patients with severe mental illness. The primary outcome was the number of hospitalisations, bed days and the number of psychiatric emergency department contacts. The association was calculated with incidence rate ratio with 95% confidence intervals. RESULTS The study included all psychiatric patients born since 1955. In total, 21 558 patients with schizophrenia (47.54% with substance use disorder), 80 778 patients with depression (28.78% with substance use disorder), 10 560 patients with bipolar affective disorder (40.08% with substance use disorder) and 69 252 patients with a personality disorder (39.18% with substance use disorder) were included. Patients with comorbid substance use disorder had significantly increased rates of hospitalisations, bed days and psychiatric emergency department contacts (p < 0.001) for the majority of the included substances, compared with patients without such disorders. CONCLUSION Substance use disorder was associated with an increased number of hospitalisations, bed days and increased number of psychiatric emergency department contacts for the majority of the included substances.
Collapse
Affiliation(s)
| | - Merete Nordentoft
- Copenhagen University Hospital, Mental Health Center Copenhagen,Copenhagen,Denmark
| | - Carsten Hjorthøj
- Copenhagen University Hospital, Mental Health Center Copenhagen,Copenhagen,Denmark
| |
Collapse
|
6
|
Vergara-Moragues E, Mestre-Pintó JI, Gómez PA, Rodríguez-Fonseca F, Torrens M, González-Saiz F. Can symptoms help in differential diagnosis between substance-induced vs independent psychosis in adults with a lifetime diagnosis of cocaine use disorder? Psychiatry Res 2016; 242:94-100. [PMID: 27267440 DOI: 10.1016/j.psychres.2016.05.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 04/12/2016] [Accepted: 05/29/2016] [Indexed: 10/21/2022]
Abstract
The main goal of this study it is explore the psychopathological differences between IPD and SIPD in a sample of 125 adults with a lifetime diagnosis of cocaine disorder recruited from treatment setting and through street contacts. A secondary analysis of six cross-sectional studies was conducted between 2000 and 2010. SIPD and IPD were diagnosed using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). 38 subjects (30.4%) were diagnosed with lifetime IPD and 87 (69.6%) with lifetime SIPD. A binomial logistic regression analysis using SIPD as the reference group showed that only previous prison admissions (OR 2.59; 95% CI 1.05, 6.36) and visual hallucinations (OR 5.21; 95% CI 1.54, 17.65) remained significant variables in the group with lifetime SIPD. In the group with lifetime IPD, grandiose delusions (OR 0.19; 95% CI 0.06, 0.60) and disorganized speech (OR 0.16; 95% CI 0.04, 0.61) remained significant. Model predicts the diagnosis of lifetime SIPD with a sensitivity of 80.3% and a specificity of 78.2%. This clinical profile of lifetime SIPD could help distinguish between IPD and SIPD among adults with lifetime diagnosis of cocaine disorder.
Collapse
Affiliation(s)
- Esperanza Vergara-Moragues
- Department of Education and Psychobiology, Universidad Internacional de la Rioja (UNIR). Gran Vía Rey Juan Carlos I, 41, 26002 Logroño, La Rioja, Spain; Red de Trastornos Adictivos, Grupo de Investigación en Neurociencias Traslacional en Adicciones (GRINTA), Universidad de Granada, Spain
| | - Joan I Mestre-Pintó
- Institut Hospital del Mar d'Investigacions Mèdiques, Parc de Salut Mar, Passeig Maritim, 25-29, 08003, Barcelona, Spain; Institut de Neuropsiquiatria i Addictions, Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Maritim, 25-29, 08003, Barcelona, Spain
| | - Pedro Araos Gómez
- FIMABIS, Mental Health Clinical Management Unit, Hospital Carlos Haya, Avda Carlos Haya 82, Pabellón de Gobierno Sótano, 29010 Málaga, Spain
| | - Fernando Rodríguez-Fonseca
- FIMABIS, Mental Health Clinical Management Unit, Hospital Carlos Haya, Avda Carlos Haya 82, Pabellón de Gobierno Sótano, 29010 Málaga, Spain
| | - Marta Torrens
- Institut Hospital del Mar d'Investigacions Mèdiques, Parc de Salut Mar, Passeig Maritim, 25-29, 08003, Barcelona, Spain; Institut de Neuropsiquiatria i Addictions, Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Maritim, 25-29, 08003, Barcelona, Spain
| | - Francisco González-Saiz
- Red de Trastornos Adictivos, Grupo de Investigación en Neurociencias Traslacional en Adicciones (GRINTA), Universidad de Granada, Spain; Community Mental Health Unit of Villamartin, Jerez Hospital, Andalusian Health Service, Avda Feria 58 Villamartin, 11650 Cádiz, Spain.
| |
Collapse
|