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Substance Use and Psychiatric Disorders in Patients Referred to Consultation-Liaison Psychiatry Within a Regional General Hospital

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Abstract

Little is known about important biopsychosocial differences between patients depending on the number of diagnosed comorbid psychiatric disorders, including the presence or absence of substance use disorder (SUD) comorbidity. This study investigated for differences in psychosocial disadvantage, psychiatric disorders, and health service utilization amongst 194 general hospital patients referred to consultation-liaison psychiatry (CLP) with either no psychiatric diagnosis, single psychiatric diagnosis, multiple (non-SUD) psychiatric diagnoses, or one or more psychiatric diagnoses plus SUD comorbidity. The results revealed that SUDs were the commonest diagnostic category (34%). The SUD comorbidity group had the highest rates of disadvantaged housing, were prescribed the most psychoactive medications, and 20% prematurely self-discharged against medical advice. Increased SUDs were associated with reduced length of stay, men, younger age, increased investigations, and reduced private health insurance subscription. Patients with SUD comorbidity versus multiple psychiatric diagnoses had reduced odds of adjustment disorder, somatic symptom disorder, and insomnia disorder. Post-traumatic stress disorder was the strongest predictor of multiple SUDs, followed by cluster B personality disorders. In conclusion, SUDs have become a leading clinical focus for CLP. The presence or absence of SUDs amongst patients with multiple disorders has important implications for engagement in treatment, patterns of comorbidity, and prescribing practices.

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References

  • AIHW. (2012). Comorbidity of mental disorders and physical conditions 2007. Cat. no. PHE 155. Australian Institute of Health and Welfare.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5, 5th ed. American Psychiatric Association.

  • Bourgeois, J. A., Wegelin, J. A., Servis, M. E., & Hales, R. E. (2005). Psychiatric diagnoses of 901 inpatients seen by consultation-liaison psychiatrists at an academic medical center in a managed care environment. Psychosomatics, 46, 47–57.

    Article  Google Scholar 

  • Buckley, P. F., & Brown, E. S. (2006). Prevalence and consequences of dual diagnosis. The Journal of Clinical Psychiatry, 67(7), e01.

    Article  Google Scholar 

  • Butler, K., Reeve, R., Viney, R., & Burns, L. (2016). Estimating prevalence of drug and alcohol presentations to hospital emergency departments in NSW, Australia: Impact of hospital consultation liaison services. Public Health Research and Practice, 26(4).

  • Chandarana, P. C., Conlon, P., & Steinberg, N. (1988). The evaluation of a consultation-liaison service. General Hospital Psychiatry, 10(5), 378–381.

    Article  CAS  Google Scholar 

  • Clarke, D. M., & Smith, G. C. (1995). Consultation-liaison psychiatry in general medical units. The Australian and New Zealand Journal of Psychiatry, 29(3), 424–432.

    Article  CAS  Google Scholar 

  • Desai, N. D., Shah, S. N., Shah, S. H., Sharma, E., & Zankat, D. (2016). Patterns of psychiatric referrals in tertiary care hospital: An overview of consultation liaison psychiatry. National Journal of Integrated Research in Medicine, 7(2), 56–60.

    Google Scholar 

  • Devasagayam, D., & Clarke, D. (2016). Evaluation of consultation-liaison psychiatry referrals from a critical care unit of an outer suburban hospital. Australasian Psychiatry, 24(2), 168–172.

    Article  Google Scholar 

  • Diefenbacher, A., & Strain, J. J. (2002). Consultation-liaison psychiatry: Stability and change over a 10-year-period. General Hospital Psychiatry, 24(4), 249–256.

    Article  Google Scholar 

  • Diehl, A., Nakovics, H., Croissant, B., Reinhard, I., Kiefer, F., & Mann, K. (2009). Consultation-liaison psychiatry in general hospitals: Improvement in physicians’ detection rates of alcohol use disorders. Psychosomatics, 50(6), 599–604.

    Google Scholar 

  • Dilts Jr., S. L., Mann, N., & Dilts, J. G. (2003). Accuracy of referring psychiatric diagnosis on a consultation-liaison service. Psychosomatics, 44(5), 407–411.

    Article  Google Scholar 

  • Donald, F., Arunogiri, S., & Lubman, D. I. (2019). Substance use and borderline personality disorder: Fostering hope in the face of complexity. Australasian Psychiatry, 27(6), 569–572.

    Article  Google Scholar 

  • Holmes, A., Handrinos, D., Theologus, E., & Salzberg, M. (2011). Service use in consultation-liaison psychiatry: Guidelines for baseline staffing. Australasian Psychiatry, 19(3), 254–258.

    Article  Google Scholar 

  • Huyse, F. J., Herzog, T., Lobo, A., Malt, U. F., Opmeer, B. C., Stein, B., de Jonge, P., van Dijck, R., Creed, F., Crespo, M. D., Cardoso, G., Guimaraes-Lopes, R., Mayou, R., van Moffaert, M., Rigatelli, M., Sakkas, P., & Tienari, P. (2001). Consultation-liaison psychiatric service delivery: Results from a European study. General Hospital Psychiatry, 23(3), 124–132.

    Article  CAS  Google Scholar 

  • Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231–244.

    Article  CAS  Google Scholar 

  • Krautgartner, M., Alexandrowicz, R., Benda, N., & Wancata, J. (2006). Need and utilization of psychiatric consultation services among general hospital inpatients. Social Psychiatry and Psychiatric Epidemiology, 41(4), 294–301.

    Article  Google Scholar 

  • Lipowski, Z. J., & Wolston, E. J. (1981). Liaison psychiatry: Referral patterns and their stability over time. The American Journal of Psychiatry, 138(12), 1608–1611.

    Article  CAS  Google Scholar 

  • Loewenstein, R. J., & Sharfstein, S. S. (1983). Psychiatric consultations at the NIH. General Hospital Psychiatry, 5(2), 83–87.

    Article  CAS  Google Scholar 

  • Lubman, D. I., Hall, K., Pennay, A., & Rao, S. (2011). Managing borderline personality disorder and substance use - An integrated approach. Australian Family Physician, 40(6), 376–381.

    Google Scholar 

  • Lyne, J., O’Donoghue, B., Bonnar, M., Golden, D., McInerney, C., Callanan, I., et al. (2010). Reasons for referral and consultation liaison psychiatry diagnoses. lr. Journal of Psychiatry in Medicine, 27(3), 123–129.

    Google Scholar 

  • McKegney, F. P., McMahon, T., & King, J. (1983). The use of DSM-III in a general hospital consultation-liaison service. General Hospital Psychiatry, 5(2), 115–121.

    Article  CAS  Google Scholar 

  • Mills, K. L., Teesson, M., Ross, J., & Peters, L. (2006). Trauma, PTSD, and substance use disorders: Findings from the Australian National Survey of Mental Health and Well-Being. The American Journal of Psychiatry, 163(4), 652–658.

    Article  Google Scholar 

  • Nesse, R. M., & Berridge, K. C. (1997). Psychoactive drug use in evolutionary perspective. Science, 278(5335), 63–66.

    Article  CAS  Google Scholar 

  • Nordeck, C. D., Welsh, C., Schwartz, R. P., Mitchell, S. G., Cohen, A., O’Grady, K. E., & Gryczynski, J. (2018). Rehospitalization and substance use disorder (SUD) treatment entry among patients seen by a hospital SUD consultation-liaison service. Drug and Alcohol Dependence, 186, 23–28.

    Article  Google Scholar 

  • Pagura, J., Stein, M. B., Bolton, J. M., Cox, B. J., Grant, B., & Sareen, J. (2010). Comorbidity of borderline personality disorder and posttraumatic stress disorder in the U.S. population. Journal of Psychiatric Research, 44(16), 1190–1198.

    Article  Google Scholar 

  • Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L. L., & Goodwin, F. K. (1990). Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA, 264(19), 2511–2518.

    Article  CAS  Google Scholar 

  • Rothenhausler, H. B., Ehrentraut, S., & Kapfhammer, H. P. (2001). Changes in patterns of psychiatric referral in a German general hospital: Results of a comparison of two 1-year surveys 8 years apart. General Hospital Psychiatry, 23(4), 205–214.

    Article  CAS  Google Scholar 

  • Simon, G. E., & VonKorff, M. (1991). Somatization and psychiatric disorder in the NIMH Epidemiologic Catchment Area study. The American Journal of Psychiatry, 148(11), 1494–1500.

    Article  CAS  Google Scholar 

  • Smith, G. C., Clarke, D. M., & Handrinos, D. (1995). Recognising drug and alcohol problems in patients referred to consultation-liaison psychiatry. The Medical Journal of Australia, 163(6), 307 310-302.

    Article  CAS  Google Scholar 

  • Smith, G. C., Clarke, D. M., & Herrman, H. E. (1993). Establishing a consultation-liaison psychiatry clinical database in an Australian general hospital. General Hospital Psychiatry, 15(4), 243–253.

    Article  CAS  Google Scholar 

  • Smothers, B. A., Yahr, H. T., & Ruhl, C. E. (2004). Detection of alcohol use disorders in general hospital admissions in the United States. Archives of Internal Medicine, 164(7), 749–756.

    Article  Google Scholar 

  • Tadros, G., Salama, R. A., Kingston, P., Mustafa, N., Johnson, E., Pannell, R., & Hashmi, M. (2013). Impact of an integrated rapid response psychiatric liaison team on quality improvement and cost savings: The Birmingham RAID model. The Psychiatrist, 37, 4–10.

    Article  Google Scholar 

  • Tran, Q. N., Lambeth, L. G., Sanderson, K., de Graaff, B., Breslin, M., Huckerby, E. J., et al. (2020). Trend of emergency department presentations with a mental health diagnosis in Australia by diagnostic group, 2004-05 to 2016-17. Emergency Medicine Australasia, 32(2), 190–201.

    Article  Google Scholar 

  • Trull, T. J., Freeman, L. K., Vebares, T. J., Choate, A. M., Helle, A. C., & Wycoff, A. M. (2018). Borderline personality disorder and substance use disorders: An updated review. Borderline Personal Disord Emot Dysregul, 5, 15.

    Article  Google Scholar 

  • Wancata, J., Benda, N., Windhaber, J., & Nowotny, M. (2001). Does psychiatric comorbidity increase the length of stay in general hospitals? General Hospital Psychiatry, 23(1), 8–14.

    Article  CAS  Google Scholar 

  • Wand, A. P. F., Wood, R., Macfarlane, M. D., & Hunt, G. E. (2016). Comparison of consultation-liaison psychiatry services for inner-city, district or regional general hospitals using a common tool: Does one size fit all? Journal of Psychosomatic Research, 84, 13–21.

    Article  Google Scholar 

  • Wapp, M., van de Glind, G., van Emmerik-van Oortmerssen, K., Dom, G., Verspreet, S., Carpentier, P. J., Ramos-Quiroga, J. A., Skutle, A., Bu, E. T., Franck, J., Konstenius, M., Kaye, S., Demetrovics, Z., Barta, C., Fatséas, M., Auriacombe, M., Johnson, B., Faraone, S. V., Levin, F. R., Allsop, S., Carruthers, S., Schoevers, R. A., Koeter, M. W. J., van den Brink, W., Moggi, F., & IASP Research Group. (2015). Risk factors for borderline personality disorder in treatment seeking patients with a substance use disorder: An international multicenter study. European Addiction Research, 21(4), 188–194.

    Article  Google Scholar 

  • Wood, R., Wand, A. P., & Hunt, G. E. (2015). Relationship between timeliness of contact and length of stay in older and younger patients of a consultation-liaison psychiatry service. BJPsych Bulletin, 39(3), 128–133.

    Article  Google Scholar 

  • Zimmerman, M., & Mattia, J. I. (1999). Psychiatric diagnosis in clinical practice: Is comorbidity being missed? Comprehensive Psychiatry, 40(3), 182–191.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank Dr StellaMay Gwini for assistance with the study design and statistical analysis and Professor Trisha Dunning for proofreading the article.

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Authors and Affiliations

  1. Mental Health Drug and Alcohol Services, University Hospital Geelong, Bellarine Street, Geelong, Victoria, 3220, Australia

    Murray G. Tucker, Harry Hill, Emma Nicholson & Steven Moylan

  2. School of Medicine, Deakin University, Geelong, Victoria, Australia

    Harry Hill & Steven Moylan

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  1. Murray G. Tucker
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  2. Harry Hill
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Correspondence to Murray G. Tucker.

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Ethical approval was waived by the Barwon Health Research Ethics, Governance, and Integrity Unit in view of the retrospective nature of the study and de-identified patient information (reference 18/25)

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Tucker, M.G., Hill, H., Nicholson, E. et al. Substance Use and Psychiatric Disorders in Patients Referred to Consultation-Liaison Psychiatry Within a Regional General Hospital. Int J Ment Health Addiction 21, 37–50 (2023). https://doi.org/10.1007/s11469-021-00576-1

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