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Citation
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Johnson JM, Wu CY, Winder GS, Casher MI, Marshall VD, Bostwick JR. J. Dual Diagn. 2016; 12(3-4): 244-251. |
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Affiliation
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Department of Pharmacy Services , University of Michigan , Ann Arbor , Michigan USA , jkingsbu@med.umich.edu. |
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Abstract
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OBJECTIVE This study examines the association between cannabis use and the hospital course of patients admitted to the psychiatric inpatient unit with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder. Many confounding variables potentially contribute to the clinical presentation of hospitalized patients in the psychiatric unit. Illicit drug use, in particular, has been associated with acute agitation, and questions can be raised as to what lasting effects drug use prior to admission may have throughout a patient's hospital stay.
METHODS Subjects with a discharge diagnosis of bipolar disorder, schizophrenia, schizoaffective disorder, or psychosis not otherwise specified (NOS) (N = 201) were retrospectively identified, and those with positive admission urine drug screen for cannabis were compared to negative counterparts. Agitation and aggression were measured using an adaptation of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC). These markers were also quantified by comparing charted episodes of restraint and seclusion and administration of as needed medications, such as benzodiazepines and antipsychotics.
RESULTS Positive urine drug screen for cannabis was correlated with young (p = 0.001) males (p = 0.003) with bipolar disorder (p = 0.009) exhibiting active manic symptoms (p = 0.003) at the time of admission. Cannabis use was further associated with a shorter length of stay (p = 0.008), agitation triggering adapted PANSS-EC nursing assessments (p = 0.029), and oral as needed medications (p = 0.002) for agitation.
CONCLUSIONS Cannabis use, as defined by positive urine drug screen, was more common in patients with bipolar disorder and was accompanied by a higher incidence of inpatient agitation. Although these patients also had short hospital lengths of stay, there was no clear relationship between level of agitation and length of stay across all patient groups. One possible explanation for patients with bipolar disorder experiencing short lengths of stay is that their source of agitation may be more closely related to a complex effect of cannabis use rather than a sole etiology of mental illness. Inpatient clinicians should be aware of patient cannabis use proximate to admission.
Language: en |