Substance Abusers in an Acute Psychiatric Facility: A Diagnostic and Logistic Challenge

Acute resident psychiatric facilities in Norway usually get their patients after referral from a medical doctor. Acute psychiatric wards are the only places accepting persons in need of emergency hospitalisation when emergency units in somatic hospitals do not accept the patient. Resident patients at one random chosen day were scrutinized in an acute psychiatric facility with 36 beds serving a catchment area of 165？000. Twenty-five patients were resident in the facility at that particular day. Eight of 25 resident patients (32.0%) in the acute wards were referred for a substance-induced psychosis (SIP). Another patient may also have had a SIP, but the differential diagnostic work was not finished. A main primary diagnosis of substance use was given in the medical reports in only 12.9% of patients during the last year. Given that the chosen day was representative of the year, a majority of patients with substance abuse problems were given other diagnoses. There seems to be a reluctance to declare the primary reason for an acute stay in a third of resident stays. Lack of specialized emergency detoxification facilities may have contributed to the results. 1. Introduction Acute treatment of substance abuse is handled differently from country to country. The abusers may be referred to a somatic hospital, taken care of in police custody, by specialized detoxification centres or within the realms of an acute psychiatric hospital. Referral from a medical doctor is the main route to a resident stay in an acute psychiatric facility in Norway. Patients with substance abuse problems often have symptoms as dramatic as the mainstream patients referred to an acute psychiatric facility, even when comorbid psychiatric diseases in the substance abusers are lacking [1]. Health and social workers contemplating referral of a person with acute stress or severe suicidal or violent behaviour may have difficulties differentiating between substance abuse and psychiatric morbidity. Substance-induced suicidal admissions to an acute psychiatric facility may be frequent as shown in a study from the USA [2]. Such patients have a high degree of addiction severity with only temporary substance-induced suicidal ideas. They are automatically offered highly qualified and expensive services even if not in need of them. The authors argue that psychiatric inpatient services should provide specific and intensive addiction intervention treatment or that the outpatient addiction services/relevant addiction detoxification units could be able to provide such emergency inpatient services even for