Use of novel psychoactive substances by inpatients on general adult psychiatric wards

Objectives: Non-illicit alternatives to controlled drugs, known as Novel Psychoactive Substances (NPS) have recently risen to prominence. They are readily available with uncertain pharmacology and no widely available assay. Given that psychiatric patients are at risk of comorbid substance abuse, we hypothesized that NPS use would be present in the psychiatric population, and sought to determine its prevalence and investigate the characteristics of those who use these drugs with a retrospective review of discharge letters. Setting: General adult inpatient wards of a psychiatric hospital in a Scottish city. Participants: All adult inpatients (18-65) discharged from general psychiatric wards between 1/7/14 and 31/12/14. 483 admissions identified, 46 were admissions for maintenance ECT and were excluded. Of the remaining 437 admissions, 49 discharge letters were unobtainable, leaving 388 admissions to analyze. Primary outcome measure: The mention or lack thereof of NPS use in discharge letters was our planned primary outcome measure and was also the primary outcome measure we used in our analysis. Results: NPS use was identified in 22.2% of admissions, contributing to psychiatric symptoms in 59.3%. In comparison to non-users, NPS users were younger (p<0.01), male and more likely to have a forensic history ((p<0.001) for both). The diagnosis of drug-induced psychosis was significantly more likely in NPS users (p<0.001, odds ratio (OR) 18.7, 95% confidence intervals (CI) 8.1-43.0) and the diagnosis of depression was significantly less likely (p<0.005, OR 0.133, CI 0.031-0.558). Use of cannabis was significantly more likely in NPS users (p<0.001, OR 4.2, CI 2.5-7.1), as was substitute opiate prescribing (p<0.001, OR 3.7, CI 1.8-7.4). Conclusions: NPS use was prevalent amongst young, male psychiatric inpatients; in particular those with drug induced psychosis and often occurred alongside illicit drug use.

研究目的：近年来，被称为新型精神活性物质（Novel Psychoactive Substances, NPS）的管制类药物非违禁替代物质日益受到关注。这类物质易于获取，但药理学特性不明，且尚无广泛可用的检测方法。鉴于精神疾病患者共病物质滥用的风险较高，我们假设精神科人群中存在NPS使用情况，并拟通过对出院病历的回顾性分析，明确其患病率并探究此类药物使用者的特征。
研究地点：苏格兰某城市一所精神科医院的普通成人住院病房。
研究对象：2014年7月1日至2014年12月31日期间，于普通精神科病房出院的所有成年住院患者（年龄18~65岁）。本研究共识别出483例住院病例，其中46例为接受维持性电抽搐治疗（ECT）的病例，予以排除。剩余437例病例中，49份出院病历无法获取，最终纳入388例病例进行分析。
主要结局指标：本研究预设并实际采用的主要结局指标为出院病历中是否提及NPS使用情况。
研究结果：22.2%的住院病例中检出NPS使用情况，其中59.3%的病例的精神症状与NPS使用相关。与非使用者相比，NPS使用者年龄更小（p<0.01）、男性占比更高，且既往有司法史的比例更高（两项指标均p<0.001）。NPS使用者被诊断为药物诱导性精神病的概率显著更高（p<0.001，优势比（odds ratio, OR）=18.7，95%置信区间（confidence intervals, CI）：8.1~43.0），而被诊断为抑郁症的概率则显著更低（p<0.005，优势比=0.133，95%置信区间：0.031~0.558）。NPS使用者同时使用大麻的概率显著更高（p<0.001，OR=4.2，95%CI：2.5~7.1），接受替代阿片类药物处方的比例也显著更高（p<0.001，OR=3.7，95%CI：1.8~7.4）。
研究结论：精神科成年住院患者中，年轻男性群体的NPS使用情况较为普遍；此类使用者多被诊断为药物诱导性精神病，且常与违禁药物滥用并存。