Adolescents and Dual Diagnosis in a Psychiatric Emergency Service

Authors

  • José Luis Matali Parc Sanitari Sant Joan de Déu, Barcelona (España). CIBERSAM
  • Oscar Andión Hospital Universitari Vall d’Hebron. Barcelona (Spain). CIBERSAM
  • Marta Pardo Parc Sanitari Sant Joan de Déu, Barcelona (España). CIBERSAM
  • Raquel Iniesta Sant Joan de Deu Foundation. Barcelona (Spain). CIBERSAM
  • Eduard Serrano Parc Sanitari Sant Joan de Déu, Barcelona (España). CIBERSAM
  • Luis San Parc Sanitari Sant Joan de Déu, Barcelona (España). CIBERSAM

DOI:

https://doi.org/10.20882/adicciones.783

Keywords:

adolescent, substance use, dual disorder, Emergency Department

Abstract

In recent years, both the prevalence of drug use and related child and adolescent psychiatric emergencies have risen sharply. There are few studies about the impact on child and adolescent emergency services. This study has a twofold aim. The first is to describe the prevalence of substance use disorders, mental disorders and dual diagnosis (substance use problems plus mental disorder) in adolescents in psychiatric emergency service. The second is to analyze clinical and healthcare differences between patients with dual diagnosis and patients with a mental disorder without substance use disorder.We retrospectively reviewed 4012 discharge forms for emergencies treated at the psychiatric emergency department during the period 2007-2009. We obtained a sample of 1795 visits. This sample was divided into two groups: the dual diagnosis group (n = 477) and the psychiatric disorder group (n = 1318).The dual diagnosis group accounted for 26.5% of psychiatric emergencies analyzed. Compared to the psychiatric disorder group,the dual diagnosis group had significantly more conduct disorders, social problems, involuntariness in the visit, less hospital admissions and less connection with the healthcare network.Adolescents with a dual diagnosis account for a high percentage of visits at child and adolescent psychiatric emergency services. This patient group requires specialized care both at emergency services and in specific units. Accordingly, these units should play a triple role when handling dual diagnosis: detection, brief treatment and referral to a specialised unit.

Author Biographies

José Luis Matali, Parc Sanitari Sant Joan de Déu, Barcelona (España). CIBERSAM

Adolescent Drug Unit. Child and Adolescent Psychiatric and Psychology Department

Oscar Andión, Hospital Universitari Vall d’Hebron. Barcelona (Spain). CIBERSAM

Psychiatry Department

Marta Pardo, Parc Sanitari Sant Joan de Déu, Barcelona (España). CIBERSAM

Adolescent Drug Unit. Child and Adolescent Psychiatric and Psychology Department

Raquel Iniesta, Sant Joan de Deu Foundation. Barcelona (Spain). CIBERSAM

Methodology and Statistic Service

Eduard Serrano, Parc Sanitari Sant Joan de Déu, Barcelona (España). CIBERSAM

Adolescent Drug Unit. Child and Adolescent Psychiatric and Psychology Department

Luis San, Parc Sanitari Sant Joan de Déu, Barcelona (España). CIBERSAM

Adolescent Drug Unit. Child and Adolescent Psychiatric and Psychology Department

References

Arias Constantí, V., Sanz Marcos, N., Trenchs Sainz de La Maza, V., Curcoy Barcenilla, A. I., Matalí Costa, J., y Luaces Cubells, C. (2010). [Psychoactive drugs use and related visits of adolescents to the emergency department]. Medicina Clínica, 134, 583–586. doi:10.1016/j.medcli.2010.01.019

Behrendt, S., Wittchen, H.-U., Höfler, M., Lieb, R., y Beesdo, K. (2009). Transitions from first substance use to substance use disorders in adolescence: is early onset associated with a rapid escalation? Drug and Alcohol Dependence, 99, 68–78. doi:10.1016/j.drugalcdep.2008.06.014

Bender, R., y Lange, S. (2001). Adjusting for multiple testing--when and how? Journal of Clinical Epidemiology, 54, 343–349. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11297884

Chen, P., y Jacobson, K. C. (2012). Developmental trajectories of substance use from early adolescence to young adulthood: gender and racial/ethnic differences. The Journal of Adolescent Health: official publication of the Society for Adolescent Medicine, 50, 154–163. doi:10.1016/j.jadohealth.2011.05.013

Chi, F. W., Sterling, S., y Weisner, C. (2006). Adolescents with co-occurring substance use and mental conditions in a private managed care health plan: prevalence, patient characteristics, and treatment initiation and engagement. The American Journal on Addictions / American Academy of Psychiatrists in Alcoholism and Addictions, 15, S67–79. doi:10.1080/10550490601006022

Christodulu, K. V, Lichenstein, R., Weist, M. D., Shafer, M. E., y Simone, M. (2002). Psychiatric emergencies in children. Pediatric Emergency Care, 18, 268–270. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12187132

Chun, T. H., Spirito, A., Hernández, L., Fairlie, A. M., Sindelar-Manning, H., Eaton, C. A., y Lewander, W. J. (2010). The significance of marijuana use among alcohol-using adolescent emergency department patients. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine, 17, 63–71. doi:10.1111/j.1553-2712.2009.00615.x

Chung, T., Colby, S. M., O’Leary, T. A., Barnett, N. P., y Monti, P. M. (2003). Screening for cannabis use disorders in an adolescent emergency department sample. Drug and Alcohol Dependence, 70, 177–186. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12732411

Curran, G. M., Sullivan, G., Williams, K., Han, X., Allee, E., y Kotrla, K. J. (2008). The association of psychiatric comorbidity and use of the emergency department among persons with substance use disorders: an observational cohort study. BMC Emergency Medicine, 8, 17. doi:10.1186/1471-227X-8-17

Díaz, R., Goti, J., García, M., Gual, A., Serrano, L., González, L., … Castro-Fornieles, J. (2011). Patterns of substance use in adolescents attending a mental health department. European Child y Adolescent Psychiatry, 20, 279–289. doi:10.1007/s00787-011-0173-5

Dorfman, D. H., Trokel, M., Lincoln, A. K., y Mehta, S. D. (2010). Increased prevalence of behavioral risks among adolescent and young adult women with psychological distress in the emergency department. Pediatric Emergency Care, 26, 93–98. doi:10.1097/PEC.0b013e3181cdb883

Goldstein, A. B., Frosch, E., Davarya, S., y Leaf, P. J. (2007). Factors associated with a six-month return to emergency services among child and adolescent psychiatric patients. Psychiatric Services (Washington, D.C.), 58, 1489–1492. doi:10.1176/appi.ps.58.11.1489

Goldstein, A. B., y Horwitz, S. M. (2006). Child and adolescent psychiatric emergencies in nonsuicide-specific samples: the state of the research literature. Pediatric Emergency Care, 22, 379–384. doi:10.1097/01.pec.0000216565.26123.34

Grupp-Phelan, J., Mahajan, P., Foltin, G. L., Jacobs, E., Tunik, M., Sonnett, M., … Dayan, P. (2009). Referral and resource use patterns for psychiatric-related visits to pediatric emergency departments. Pediatric Emergency Care, 25, 217–220. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19382317

Larm, P., Hodgins, S., Larsson, A., Samuelson, Y. M., y Tengström, A. (2008). Long-term outcomes of adolescents treated for substance misuse. Drug and Alcohol Dependence, 96, 79–89. doi:10.1016/j.drugalcdep.2008.01.026

Mahajan, P., Alpern, E. R., Grupp-Phelan, J., Chamberlain, J., Dong, L., Holubkov, R., … Foltin, G. L. (2009). Epidemiology of psychiatric-related visits to emergency departments in a multicenter collaborative research pediatric network. Pediatric Emergency Care, 25, 715–720. doi:10.1097/PEC.0b013e3181bec82f

Martín-Santos, R., Fonseca, F., Domingo-Salvany, A., Ginés, J. M., Imaz, M. L., Navinés, R., Pascual, J. C. y Torrens, M. (2006). Dual diagnosis in the psychiatric emergency room in Spain. The European Journal of Psychiatry, 20, 147-156. doi: 10.4321/S0213-61632006000300002

Matalí Costa, J. L., Pardo Gallego, M., Trenchs Sainz de la Maza, V., Serrano Troncoso, E., Gabaldon Fraile, S., y Luaces Cubells, C. (2009). [Adolescent drug use. Ethical dilemma in the diagnostic-therapeutic approach]. Anales de Pediatría (Barcelona), 70, 386–390. doi:10.1016/j.anpedi.2008.12.006

Matalí Costa, J. L., Serrano Troncoso, E., Pardo Gallego, M., Trenchs Sainz de la Maza, V., Curcoy Barcenilla, A., Luaces Cubells, C., y San Molina, L. (2012). [Profile of adolescents seen in emergency departments with acute alcohol poisoning]. Anales de Pediatría (Barcelona), 76, 30–37. doi:10.1016/j.anpedi.2011.07.003

Nogué, S., Amigó, M., Galicia, M. (2014). Raves, consumo de drogas y asistencia en urgencias. Adicciones, 26, 189-190.

Observatorio Español sobre Drogas. (2013). Encuesta estatal sobre el consumo de drogas en enseñanzas secundarias (ESTUDES) 1994-2013. En: Observatorio Español de la Droga y las Toxicomanías. Madrid: Delegación Gobierno para el Plan Nacional sobre Drogas.

Roberts, R. E., Roberts, C. R., y Xing, Y. (2007). Comorbidity of substance use disorders and other psychiatric disorders among adolescents: evidence from an epidemiologic survey. Drug and Alcohol Dependence, 88, S4–13. doi:10.1016/j.drugalcdep.2006.12.010

Sanz Marcos, N., Arias Constantí, V., Trenchs Sainz de la Maza, V., Curcoy Barcenilla, A. I., Matalí Costa, J., y Luaces Cubells, C. (2009). [Acute ethanol intoxication in a paediatric emergency department]. Anales de Pediatría (Barcelona), 70, 132–136. doi:10.1016/j.anpedi.2008.10.006

Sindelar-Manning, H., Lewander, W., Chun, T., Barnett, N., y Spirito, A. (2008). Emergency department detection of adolescents with a history of alcohol abuse and alcohol problems. Pediatric Emergency Care, 24, 457–461. doi:10.1097/PEC.0b013e31817de330

Soto, E. C., Frederickson, A. M., Trivedi, H., Le, A., Eugene, M. C., Shekher, M., … Correll, C. U. (2009). Frequency and correlates of inappropriate pediatric psychiatric emergency room visits. The Journal of Clinical Psychiatry, 70, 1164–1177. doi:10.4088/JCP.08m04839

Spirito, A., Monti, P. M., Barnett, N. P., Colby, S. M., Sindelar, H., Rohsenow, D. J., … Myers, M. (2004). A randomized clinical trial of a brief motivational intervention for alcohol-positive adolescents treated in an emergency department. The Journal of Pediatrics, 145, 396–402. doi:10.1016/j.jpeds.2004.04.057

Stolle, M., Sack, P.M., y Thomasius, R. (2009). Binge drinking in childhood and adolescence: epidemiology, consequences, and interventions. Deutsches Ärzteblatt International, 106, 323–328. doi:10.3238/arztebl.2009.0323

Tuchman, E. (2010). Women and addiction: the importance of gender issues in substance abuse research. Journal of Addictive Diseases, 29, 127–138. doi:10.1080/10550881003684582

Van Hook, S., Harris, S. K., Brooks, T., Carey, P., Kossack, R., Kulig, J., y Knight, J. R. (2007). The “Six T’s”: barriers to screening teens for substance abuse in primary care. The Journal of Adolescent Health: official publication of the Society for Adolescent Medicine, 40, 456–461. doi:10.1016/j.jadohealth.2006.12.007

Velasco Arnaiz, E., Trenchs Sainz de la Maza, V., Curcoy Barcenilla, A. I., Velasco Rodríguez, J., Matalí Costa, J. L. L., y Luaces Cubells, C. (2010). [Who gives a positive cannabis in paediatric emergencies?]. Anales de Pediatría (Barcelona), 72, 385–390. doi:10.1016/j.anpedi.2010.01.015

Whitmore, E.A. y Riggs, P. D. (2006). Developmentally informed diagnostic and treatment considerations comorbid conditions. In H. A. L. y C. L. Rowe (Edit.), Adolescent Substance Abuse: Research and Clinical Advances (pp. 265–283). Cambridge: Cambridge University Press.

Published

2016-03-02

Issue

Section

Originals