Use of potentially abusive psychotropic substances in psychiatric inpatients.

A series of 417 consecutively admitted psychiatric inpatients were studied with regard to their use of potentially abusive psychotropic substances in the last 3 months preceding admission. In all patients face-to-face interviews were performed; in 354 of them urine specimens could also be tested. Alcohol and benzodiazepines belonged to the most frequently used substances followed by cannabis, opiates and cocaine. Barbiturates, hallucinogens and amphetamine derivatives were only exceptionally reported. The most important finding of the study is that every fifth patient regularly used "hard" drugs (opiates and/or cocaine), every fourth patient illegal drugs and every third patient alcohol. Substances were found in 54% of all urine specimens; methadone, opiates and cocaine were hardly found alone. For the latter substances excellent agreement was found between interview reports and urine exams. Excluding patients diagnosed as substance-use disorders, there were no statistically significant differences between schizophrenic, affective, neurotic/stress/somatoform and other disorders with regard to the use of "hard" drugs and illegal drugs. Regular substance use correlated with much worse psychosocial adjustment. Substance use has to be explored and considered in every individual psychiatric inpatient.

ECT-Induced and Drug-Induced Hypomania.

In a retrospective chart study of 1,057 hospital admissions of endogenous depressives between 1920 and 1981, 139 patients (13%) had received electroconvulsive therapy (ECT), and 12% of them switched to hypomania. Within a subgroup of 524 psychotic unipolar depressives, 79 received ECT and eight (10%) switched to hypomania, whereas among those not treated with ECT only 16 of 445 patients (3.6%) switched to hypomania (p < 0.01). In psychotic bipolar patients the switch rates with and without ECT did not differ significantly (30% vs. 32%). Among untreated unipolar depressives hospitalized between 1920 and 1943, before the introduction of ECT or antidepressants, 3.9% switched to hypomania. Among unipolar patients admitted after 1957 and treated by antidepressants 4% switched to hypomania; among bipolar patients, 31% switched to hypomania. We find no evidence for hypomania being induced by standard antidepressants. Without classifying depressive patients into manic and nonmanic based on the previous history, studies of drug-induced hypomania cannot be conclusive. These observations strongly support the hypothesis of an ECT-induced switch from depression to hypomania.