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.

中文翻译：

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1963 年至 2016 年以色列有和没有双重诊断的慢性精神病患者的精神病住院情况

摘要 目的：很大比例的严重精神疾病患者也有物质使用障碍。对于这些双重诊断（DD）患者，治疗更复杂，预后更差。尽管在 2000 年引入了精神健康残疾人社区康复法和正在进行的国家精神健康改革，以色列的精神科服务并不能满足越来越多的 DD 患者的需求。本研究首次在以色列调查了 DD 的流行情况以及患有和不患有物质使用障碍的慢性精神病患者的精神病住院模式。方法：国家精神病病例登记处提供了 18,684 名 18-65 岁精神分裂症/分裂情感障碍患者的数据，在 1963-2016 年期间住院治疗（2010-15 年至少住院一次）。如果患者在至少两次或 20% 的住院治疗中表明他们的物质使用障碍，则认为患者患有 DD。回归模型预测住院措施（住院次数、住院总天数、住院时间）。结果还按入院的法律状态（自愿或非自愿；精神病医生下令和法院下令）进行了分析。结果：三分之一的慢性精神障碍患者符合 DD 标准，男性 (37.1%) 的比率是女性 (12.8%) 的三倍。在来自埃塞俄比亚的男性移民中注意到特别高的 DD 率（近 50%）。与非物质使用障碍患者相比，DD 患者首次住院时的平均年龄明显更小，每次住院的平均住院时间更短，但住院次数和总住院天数更多（所有比较 p < .0001）。即使考虑了混杂因素的影响，DD 状态和住院特征之间的关联仍然显着。住院特征也与性别、人群、年龄、首次住院年龄和原籍国显着相关。DD 组的法院命令观察或住院率高出三倍。结论：这些发现与其他国家大体一致，反映了患有精神分裂症/分裂情感障碍和物质使用障碍的 DD 患者的门诊服务稀缺。