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Influence of Drugs of Abuse and Alcohol Upon Patients Admitted to Acute Psychiatric Wards: Physician’s Assessment Compared to Blood Drug Concentrations

Mordal, Jon PhD*†; Medhus, Sigrid MD*†; Holm, Bjørn PhD; Mørland, Jørg PhD§∥; Bramness, Jørgen G. PhD†∥

Journal of Clinical Psychopharmacology: June 2013 - Volume 33 - Issue 3 - p 415–419
doi: 10.1097/JCP.0b013e31828ec934
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In acute psychiatric services, rapid and accurate detection of psychoactive substance intake may be required for appropriate diagnosis and intervention. The aim of this study was to investigate the relationship between (a) drug influence as assessed by physicians and (b) blood drug concentrations among patients admitted to acute psychiatric wards. We also explored the possible effects of age, sex, and psychotic symptoms on physician’s assessment of drug influence. In a cross-sectional study, the sample comprised 271 consecutive admissions from 2 acute psychiatric wards. At admission, the physician on call performed an overall judgment of drug influence. Psychotic symptoms were assessed with the positive subscale of the Positive and Negative Syndrome Scale. Blood samples were screened for a wide range of psychoactive substances, and quantitative results were used to calculate blood drug concentration scores. Patients were judged as being under the influence of drugs and/or alcohol in 28% of the 271 admissions. Psychoactive substances were detected in 56% of the blood samples. Altogether, 15 different substances were found; up to 8 substances were found in samples from 1 patient. Markedly elevated blood drug concentration scores were estimated for 15% of the patients. Physician’s assessment was positively related to the blood drug concentration scores (r = 0.52; P < 0.001), to symptoms of excitement, and to the detection of alcohol, cannabis, and amphetamines. The study demonstrates the major impact of alcohol and drugs in acute psychiatric settings and illustrates the challenging nature of the initial clinical assessment.

From the *Acute Psychiatric Department, Lovisenberg Diakonale Hospital; †Norwegian Centre for Addiction Research, University of Oslo; ‡Department of Research and Development, Lovisenberg Diakonale Hospital; §Norwegian Institute of Public Health, Nydalen; and ∥Institute of Clinical Medicine, University of Oslo, Blindern, Oslo, Norway.

Received November 11, 2010; accepted after revision October 16, 2012.

Reprints: Jon Mordal, PhD, Lovisenberg Diakonale Hospital, Oslo, Norway (e-mail: jon.mordal@siv.no).

The study was funded by a grant from Eastern Norway Health Authorities (No. 206/2005).

© 2013 Lippincott Williams & Wilkins, Inc.