Objectives This article examines agreement between physicians and psychiatric inpatients on the presence of comorbid substance abuse. In addition, inpatients with comorbid substance abuse were compared on demographic and diagnostic-related symptoms with those with a single, non–substance-related disorder. Methods At admission and discharge, 539 patients completed self-report measures of substance use and diagnostic symptoms. Their attending physicians and nurses completed rating scales in the same time frame. In addition, physician discharge diagnoses were examined. Results For 69% of patients there was agreement between patients and physicians for the absence (30.4%) or presence (38.6%) of substance abuse. For 31%, there was disagreement; 10% were those in whom physicians diagnosed substance abuse but patients denied it, and 21% endorsed substance abuse which their physicians did not diagnose. Also, those who were not substance users tended to receive more severe clinician ratings but self-reported fewer symptoms. They also were more likely to be older, have longer lengths of stay, and to have been admitted involuntarily. Conclusions A considerable number of psychiatric inpatients are underdiagnosed for comorbid substance abuse. Multimodal means of assessment would probably enhance the inclusion of such diagnoses. Also, differences in symptoms may suggest differences in treatment regimens.

Inpatient mental health readmission rates have increased dramatically in recent years, with a subset of consumers referred to as revolving-door patients. In an effort to reduce the financial burden associated with these patients and increase treatment efficacy, researchers have begun to explore factors associated with increased service utilization. To date, predictors of increased service usage are remarkably discrepant across studies. Further exploration, therefore, is needed to better explicate the relevance of “traditional” predictors and also to identify alternate strategies that may assist in predicting rehospitalization. One method that may be helpful in identifying patients at high risk is the development of a psychometric screening procedure. As a means to this end, the present study was designed to assess the potential usefulness of psychometric data in predicting mental health service utilization. The sample consisted of 131 patients hospitalized during an index period of 8 months at an acute-care psychiatric hospital. Number of readmissions was recorded in a 9 month post-index period. Measures completed during the index admission included the Brief Psychiatric Rating Scale-Anchored (BPRS-A), Symptom Checklist-90-Revised (SCL-90-R), Kaufman Brief Intelligence Test (K-BIT), and the Beck Depression Inventory (BDI). Results indicated that psychometric data accounted for significant variance in predicting past, present and future mental health service utilization. The BPRS-A, SCL-90-R, and BDI show particular promise as time efficient psychometric screening instruments that may better enable practitioners to identify patients proactively who are at increased risk for rehospitalization. Implications are discussed with regard to patient-treatment matching and discharge planning.

This study assessed whether a secondary diagnosis of a substance use disorder in hospitalized people with bipolar disorder was associated with poorer outcomes on self-reported measures of mood (Profile of Mood States), subjective distress (Behavior and Symptom Identification Scale), and coping resources (Coping Resources Inventory), and with specific patient characteristics. Sixty-two patients with bipolar disorder and a secondary diagnosis of a substance use disorder and 60 patients with only a bipolar disorder diagnosis participated. Patients with bipolar disorder and a secondary diagnosis of a substance use disorder perceived significantly more impairment on all three measures than did patients without the secondary diagnosis. Moreover, the background characteristics of a history of violence, past or current involvement with the criminal justice system, and not having an antipsychotic medication prescribed during hospitalization had the strongest association with having a secondary diagnosis of a substance use disorder among the characteristics examined. These findings suggest the existence of a subgroup of patients with substance abuse and bipolar disorders who have substantial psychosocial impairment and probably require more intense treatment.

Ethnic differences in psychopharmacological treatment have received much attention in the last two decades. Most of the research efforts conducted so far in the field of ethnopsychopharmacology have focused on comparative responses to neuroleptics and lithium between white and Asian-American patients, and on comparative responses to tricyclic antidepressants among white, African-American and Hispanic patients. In this article we focus on the response to neuroleptic treatment among white, African-American and Hispanic patients suffering from schizophrenia. Our findings suggest that Hispanic patients need lower doses of neuroleptics than white or African-American patients to attain a similar response in the treatment of schizophrenia. Additionally, our study suggests that, if weight is taken to consideration, African-American patients need the same dose of neuroleptics as do white patients in order to attain a similar response in the treatment of schizophrenia. Further studies are suggested to confirm our findings.

Differences in response to psychopharmacologic agents according to race has so far primarily focused on investigations related to the response of Asian-American patients to neuroleptics and lithium. In this article, we present evidence which depicts that black patients need lower doses of tricyclic antidepressants (TCAs) than white patients to attain a similar response in the treatment of major depression. Likewise, we also advance that black patients might need lower doses of selective serotonin re-uptake inhibitor antidepressants (SSRIs) than white patients to attain a similar response in the treatment of major depression. Further studies are suggested to confirm these findings.

Wolf‐Klein and colleagues' clock drawing test (CDT) performance was compared with Pfeiffer's Short Portable Mental Status Questionnaire (Pfeiffer) scores in 145 outpatient geropsychiatry patients. Although normal CDT results were almost always associated with normal Pfeiffer scores, 21% of Pfeiffer normal individuals drew abnormal clocks. Age, but not gender or education, was significantly associated with this finding. Almost all the Pfeiffer normal subjects who drew abnormal clocks were diagnosed with primary psychiatric disorders (85%) or neurologically based organic mood and anxiety disorders (12%); only one (3%) had dementia. We suggest the discrepant performance between the CDT and Pfeiffer may result from psychiatric illness. Contributing to this may be CDT sensitivity to executive skills dysfunction. This dyscontrol can occur in patients with dementia and other neurological disorders, but also presents in some primary mental disorders. Older age may heighten this impairment. In a typical geropsychiatry clinic, the CDT will not have high specificity for Alzheimer's disease as reported by Wolf‐Klein and her colleagues. This results from the presence of many patients with primary psychopathology, some of whom will draw abnormal clocks, and a limited number with dementia—particularly Alzheimer's disease. Abnormal CDT results of geropsychiatry outpatients must therefore be interpreted carefully. Additional conclusions regarding the study results are discussed. © 1997 John Wiley & Sons, Ltd.