Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #112331

Bella M. Schanzer, MD¹, Randall Sell, ScD², Boanerges Dominguez, MS³, and Carol L. M. Caton, PhD³. (1) Joseph Mailman School of Public Health, Columbia University, 600 W168th St., 5th Flr., New York, NY 10023, 212-305-0425, bms12@columbia.edu, (2) Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, 722 West 168th Street, Suite 1119, New York, NY 10032, (3) Joseph L. Mailman School of Public Health, Columbia University, 1051 Riverside Drive, Unit 56, New York, NY 10032

Objective: Determining whether psychotic symptoms are due to substance use or are part of a primary psychotic disorder is challenging in a psychiatric emergency room (ER) setting given the lack of good historical information. This study aims to develop an ER diagnostic screening tool to facilitate accurate diagnosis of primary versus substance-induced psychosis. Methods: Four hundred newly psychotic patients with a history of substance use were classified as “primary” or “substance-induced” based on structured assessments of diagnosis and pathology done over a twelve-month period. A decision tree developed using clinical presentation probabilities including urine toxicology, temporal relationship of symptoms and use, parental mental illness, co-morbid substance use disorder, visual hallucinations, and negative symptoms was folded back to determine predictive models. Results: The agreement between the baseline ER diagnosis and the one-year study diagnosis was poor (k=0.28), due to the ER misdiagnosing substance-induced psychosis as being primary psychosis. The presentation combining positive urine toxicology, symptoms temporally related to substance use, no parental mental illness history, co-morbid substance use disorder, and no visual hallucinations or negative symptoms had the greatest likelihood (16.8%) of predicting a substance-induced diagnosis. Conclusions: Using standard clinical evaluation, the ER misdiagnosed substance-induced psychosis. The decision model described here is a first-step towards developing a clinically useful tool for ER psychiatrists to improve diagnostic accuracy.

Learning Objectives:

• At the conclusion of the session, the participants in this session will be able to
• 1.Understand the diagnostic challenge facing emergency room in distinguishing between a primary and substance induced psychosis psychiatrists
• 2.The implications of misdiagnosis for the patient
• 3.The utility of a screening tool to improve diagnostic accuracy
• 4.How to use the screening tool in an emergency room setting to diagnose patients presenting with psychosis and substance use

Keywords: Emergency Department/Room, Substance Abuse

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.