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Psychiatry Education Forum Academy Forums Forum Discussions DD between dual pathology VS. Substance induced mental illness? Reply To: DD between dual pathology VS. Substance induced mental illness?

  • Harvinder

    May 16, 2021 at 11:54 am

    Hi Ahmed. I did the inpatient + consultation-liaison psychiatry work for 5 years before moving to outpatient psychiatry work now. It can be difficult to differentiate these two conditions initially and it can vary from 24 hr (in mild intoxication cases) to even 5 (or more) days for either high dose substance abuse or combined substance use. I never placed a timing on medical clearance for this reason and will always work with our medical unit colleagues to decide.

    Our goal was to admit patients to the medical unit if:

    • Unstable vitals, or
    • need for multiple PRN medications to control the aggression, or
    • abnormal labs (electrolytes, ammonia, or CPK levels)

    I think building a good relationship with your medical unit physician is most important, as you can transfer them quickly in case patient is admitted first to psychiatry unit & they destabilized medically.

    The question regarding the decision between admission to detoxification unit versus the acute psychiatric unit is similarly not the same for every patient. In these cases: admit to acute psychiatric unit only if patient is actively suicidal or at risk of self-harm or to others. Otherwise I don’t see any reasons to not do the detoxification first and then transfer to acute psychiatric unit if a patient is still having at-risk symptoms.

    What criteria or guidelines you follow in your hospital.