A psychosocial profile of absconders from a psychiatric unit of a general hospital [abstract]

OBJECTIVE: To identify the significant psychosocial variables in a cohort of absconders from a psychiatric unit of a general hospital. METHOD: This study looked at the demographic and clinical aspects of patients who absconded from a psychiatric unit (Ward 21, University Hospital of the West Indies) over an 18-month period from January 2000 to June 2001. The variables observed were age, gender, diagnosis, period of time between admission to the ward and absconding, substance abuse and rate of absconding for each month during the 18-month period. The rate of patients absconding from the unit was calculated as the number of patients who absconded divided by the total number of patients admitted for that month. RESULTS: The monthly rate of absconding for the overall period observed was 2.98 percent. Of the patients who absconded, 95 percent were male, 71 percent were within the age range 15-34 years, 52.4 percent were frequent users of marijuana, 52.4 percent absconded within the first 6 days of admission and the most common diagnosis in the cohort was substance induced psychosis (33.3 percent). CONCLUSION: Patients who absconded from Ward 21 were mainly young males who were marijuana substance abusers who absconded early in their admission to the ward. This profile has guided the design of more efficient therapeutic management programmes on the unit. (AU)

Characteristics of freebase cocaine psychosis

Psychosis was present in 29 percent of cocaine disordered patients hospitalized in 1985 during an epidemic of freebase cocaine abuse in the Bahamas. Record reviews revealed that a variety of psychotic phenomenologic patterns were presented. Prior major mental disorders and increased dosage of cocaine were more common among psychotic than non psychotic patients. Violent behaviour was common among cocaine patients, especially those with psychosis. We conclude that freebase cocaine psychosis is neither rare nor benign. (AU)

Role of cannabis in psychiatric disturbance

Clinical observation suggests that cannabis is implicated in some types of psychiatric disturbance. A record of admissions to two urban and four rural hospitals in Jamaica is examined along with details of individual cases. One third of male admissions to the psychiatric hospital have used cannabis. Of 74 males admitted to another psychiatric service over a 12-month period, 29 had used cannabis. Ten of these patients were diagnosed as "ganja psychosis" and four others were classified as "marijuana-modified mania." At another psychiatric service, 54 of 223 admissions (24.2 percent) for functional psychosis presented with cannabis usage as a contributory factor. These 54 patients included 14 and seven cases of hypomanic and depressive reactions, respectively. At three other rural general hospitals, psychiatric admissions for psychosis showed 11 of 51, seven of 18, and 39 of 75 patients, respectively, in whom cannabis was considered directly responsible. These findings lend support to the idea of causation of illness or modification of existing illness. The negative findings of controlled studies in the same country are not inconsistent. A suggested classification for adverse reactions to cannabis offerred by one author is recommended, because it is in accord with common local clinical experience.(AU)

Marijuana modified mania

A syndrome seen in four Jamaican patients is described in which increased use of marihuana followed the onset of symptoms of a hypomanic nature. At the time of admission to the hospital the patients exhibited persecutory delusions, auditory hallucinations, withdrawal, and thought disorder. Within three to four days after admission, manic or hypomanic symptoms emerged. It is suggested that these patients had mania and that excess marihuana usage was symptomatic of their illness, leading to a transient, marihuana-induced, schizophreniform phase of their manic illness. A plea is made for a broader approach to the psychiatric implications of marihuana use.(AU)

Cannabis induced psychosis

Nine patients who were known to have taken cannabis in the form of cigarettes were admitted to hospital. The features of the illness being aggressive behaviour, gross psychomotor overactivity, bizarre grandiose delusions, passivity and an amnesia for the onset of their illness. Following the acute phase of the illness a chronic picture gradually presents lasting an indefinite time characterised by a persistence of the amnesia, flattening of affect and a mild to moderate degree of remaining thought fragmentation. The nature of the illness and the relationship to the taking of the drug cannabis were discussed (AU)