Treatment retention in women's residential chemical dependency treatment: the effect of admission with children.

In the United States there has been an increased interest in the development of treatment programs that admit chemically dependent women with their children. The Salvation Army Family Treatment Services in Honolulu, Hawaii has had a long history of admitting women both with and without their children to long-term residential treatment. This has provided an opportunity to study the differences in treatment retention between these two groups. Subjects were 130 females who participated in treatment between 1988 and 1993. Analyses were conducted to determine whether there were different outcomes for women with children in treatment and women without children in treatment, with regard to type of discharge and length of time in treatment. Results were significant and clearly indicated better retention rates for women who participated in treatment with their children.

Characteristics of psychiatric emergency room patients with alcohol- or drug-induced disorders.

Although emergency room psychiatrists are often faced with evaluating and planning treatment for patients who abuse substances, there is limited information about the characteristics of emergency room patients with alcohol- or drug-induced disorders. The authors describe the demographic and clinical characteristics of 343 consecutive patients referred to a general hospital's emergency psychiatry service. The 114 patients diagnosed as having an alcohol- or drug-induced disorder were younger and were more often male, unemployed, and homeless than patients with disorders not induced by substance abuse. They also demonstrated increased suicidality. Alcohol was the predominant substance that contributed to psychiatric emergencies, but a surprising number of patients were diagnosed as having amphetamine-induced disorders, possibly representing an important trend.

Methamphetamine in psychiatric emergencies.

This study examines the clinical characteristics of patients with methamphetamine-induced organic mental disorders that were seen in a psychiatric emergency service. This was a highly dysfunctional group, requiring psychiatric hospitalization in 90% of cases. The most consistent clinical feature was the presence of an organic delusional syndrome, with paranoid ideation and hallucinations. Methamphetamine abusers were also unique in their propensity for violence; 43% of the group had clear histories of aggression towards others. The increasing use of methamphetamine together with its ability to produce severe dysfunction is a major concern of professionals and communities alike in terms of treatment [corrected].

Underdiagnosis of psychoactive-substance-induced organic mental disorders in emergency psychiatry.

The tendency of emergency psychiatrists to make alcohol- and drug-related diagnoses was examined before and after the addition of a standardized psychoactive substance use questionnaire. The addition of the questionnaire resulted in a significant increase in the number of psychoactive-substance-induced organic mental disorder (substance-induced disorder) diagnoses. The questionnaire selectively increased the recognition of nonalcoholic substance-induced disorders while not significantly increasing the diagnoses of alcohol-induced disorders when alcohol was used alone. This suggests that nonalcoholic substance-induced disorders are underdiagnosed in emergency psychiatry. With the increase in the diagnoses of substance-induced disorders, there was a significant decrease in the frequency of psychotic disorder diagnoses and a significant increase in the frequency of adjustment disorder diagnoses. The clinical impact of underdiagnosing and misdiagnosing substance-induced disorders is discussed. Overall, the findings suggest that an increased awareness of substance use history, by the use of a standardized questionnaire, is an effective means of increasing the diagnostic yield of substance-induced disorders in the psychiatric emergency room. Follow-up studies using urine drug screening are recommended.

Marijuana sensitivity and panic anxiety.

The authors explore the relationship between marijuana smoking and panic anxiety by examining the effects of marijuana smoking on patients with panic anxiety compared with marijuana's effects on both patient and nonpatient controls. Patients with panic anxiety were found to be particularly likely to experience increased anxiety while smoking marijuana. The majority of panic anxiety patients spontaneously stopped using marijuana because of increased anxiety; continued marijuana smoking in these individuals was found to be infrequent. The results suggest that current marijuana use is atypical of panic anxiety patients.