番茄社区

COLORADO SPRINGS, Colo. -- A history of violence and having an impulsive or behavioral disorder were predictors of substance use among youths admitted to a child and adolescent psychiatry inpatient unit, researchers reported.

In an assessment of 816 urine toxicology reports, patients were significantly more likely to have positive urine screens if they had a history of violence (OR 2.32, 95% CI 1.42-3.79, P<0.001) or impulsive or behavioral disorders (OR 2.18, 95% CI 1.22-3.91, P=0.009), Sean Lynch, MD, of the Icahn School of Medicine at Mount Sinai in New York City, reported in a poster session at the Neuroscience Education Institute Congress here.

Patient age was also a significant predictor of substance use (OR 1.69, 95% CI 1.49-1.93, P<0.001).

"Really the big predictors were violence and issues with impulse control," Lynch told 番茄社区. "So people that had a diagnosis of intermittent explosive disorder, oppositional defiant disorder, and people that have been arrested or have documented violence in their chart were over two times as likely to be found positive for substance use."

Lynch explained that substance use in the children and adolescents has been associated with significant psychological, neurological, and medical complications, but he and his team felt there was too little research on substance use among young patients admitted to the psychiatric unit.

So the researchers collected the data from inpatient children and adolescents in the psychiatry unit at Mount Sinai Morningside Hospital from June 2018 through November 2021, with about half of the data collected prior to the COVID-19 pandemic. Lynch noted that there was no difference in the rates of substance use associated with the pandemic.

In total, the team reviewed 1,101 patient charts, including admission notes and discharge summaries, to collect data on behavioral and demographic characteristics of the patients. A history of violence was indicated in the charts and had been determined by in-hospital interviews with the patient and their parents.

Overall, they analyzed 816 urine toxicology reports, of which 147 were positive for substance use.

Positive results included cannabis (84.4%), benzodiazepines (12.2%), stimulants (7.5%), opioids (3.4%), and other substances (7.5%). Lynch said prescription drugs were not included in the positive test group.

"We really tried to nail it on the urine toxicology reports, because that's an objective measure of substance use," Lynch said. "We didn't want to use what the parents think they're using, what's documented in the chart. We have a lab test. We can see it. We know what's there."

Lynch said some of the findings were surprising. For instance, he said, race was not a predictor of substance use.

"Hispanic race was actually found to be a protective factor against substance use," he said. "Most of the literature out there is saying that Black kids [and] Hispanic kids, that's who's using the substances, [but] that's not what we found at all."

The study was limited by its retrospective nature, which can introduce bias and error, the researchers noted. Also, patients who didn't provide urine for toxicology testing may be more likely to have substance-related issues, they said. They also noted that two of the most commonly used substances, alcohol and nicotine, are not measured in urine toxicology.

Still, Lynch said he and his team hoped their analysis will shed light on the predictors for substance use in this population of youths who become psychiatry inpatients.

"We really were interested in trying to figure out what the predictors were of active substance use because that's going to be where providers are going to be able to kind of find ways to intervene," Lynch said.

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