Psychosis and substance abuse: cause, effect or coincidence?

An association between substance abuse and major psychiatric illness is increasingly well recognised, but most studies have been conducted in the USA and have focussed upon patients with schizophrenia rather than other disorders. We conducted a survey of 38 consecutively admitted patients with DSM-III-R functional psychoses. A semi-structured substance abuse interview was administered and a urine specimen for drug metabolite screening requested. The prevalence of cigarette smoking (63%) and current illicit drug use (26%) were higher than general population norms. The 16 subjects with schizophrenia and related disorders were more likely to smoke cigarettes than the 22 patients with an affective disorder (p = 0.008, odds ratio 8.4, 95% Cl 1.3-69.6), and showed tendencies to more illicit drug and alcohol consumption. Illicit drug users were more likely to have a forensic history and less likely to have entered further education. Substance abuse is common among patients with psychoses, particularly in those with schizophrenia and related disorders. All psychotic patients should have a detailed drug history taken, and therapeutic attempts made to reduce consumption.

A successful implementation of a hospital pharmacy computer module.

The Mississauga Hospital Pharmacy Department recently implemented the unit dose dispensing portion of a hospital-wide computer system. Initially, a pharmacist was assigned to the position of Computer Preceptor to build the data base and help coordinate the implementation process. A joint management/staff Computer Advisory Committee was also formed. This group revised job descriptions, workload priorities and the physical layout of the department and directed the implementation plan. Staff training was conducted at first on a "volunteer" basis, followed by a formal program, using a training manual developed by a staff pharmacist. Staff concerns were constantly monitored and various "morale boosters" were utilized. The computerized dispensing was run parallel with the manual system on two nursing units for one week prior to undertaking a step-by-step conversion of the hospital. Following the "break-in" period, procedures will be formalized and quality assurance programs established.