Helping dual-diagnosis patients
GP trainees working with psychiatric acute care teams will be familiar with readmissions to psychiatric inpatient units.
We asked our psychiatric and GP trainees if they believed readmission rates were also influenced by comorbid drug and alcohol abuse or dependence.
We retrospectively reviewed hospital admission data between 1 January 2010 and 31 December 2010. Out of 577 admissions to our inpatient unit, the total number of dual diagnoses at discharge was 198 (34%).
This included a primary psychiatric diagnosis along with the diagnosis of comorbid drug or alcohol use, abuse or dependence.
We had 96 readmission during this period. Some 69 were readmitted once, 17 twice, nine three times and one patient was readmitted five times – and 43 (45%) had dual diagnoses.
Comorbid use of drugs or alcohol does contribute significantly to readmission.
Admissions such as the above also lead to ongoing use of illicit substances in hospital.
This has implications for the ethos of the unit and a significant bearing on the use of the Mental Health Act and depot medications, which generate need for admissions to the psychiatric intensive care unit and contribute to increased length of stay in hospital.(1)
Short hospitalisations and more use of home treatment teams have been proposed as a way to deal with these issues.(2) For those with comorbidities, this would only lead to revolving-door admissions with shorter periods of remission.(3)
As part of a proposed dual-diagnosis treatment model, we have agreed to establish so-called ‘contracts' with these patients, where we engage them in determining their own motivation to stop abusing drugs or alcohol.
GPs among others will benefit from our results in helping them to evaluate long-term outcomes for dual-diagnosis patients.
From Dr Indira Vinjamuri,
Consultant, general adult psychiatry, Liverpool
Dr Alister Pinto,
Core psychiatry trainee, old-age psychiatry, Liverpool
1 Suchyta MR, Beck CJ, Key CW et al. Substance dependence and psychiatric disorders are related to outcomes in a mixed ICU population. Intensive Care Med 2008;34:2264-7
2 Barbato A, Parabiaghi A, Panicali F et al. Do patients improve after short psychiatric admission? A cohort study in Italy. Nord J Psychiatry 2011;65:251-8
3 Botha UA, Koen L, Joska JA et al. The revolving door phenomenon in psychiatry: comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country. Soc Psych Epidemol 2010;45:461-8