New Guideline to Manage Psychosis With Co-existing Substance Misuse

National Institute for Health and Clinical Excellence (NICE) (UK) has published a new clinical guideline that aims to help ensure people diagnosed with a form of psychosis, who also misuse substances, can be identified and treated effectively

Approximately 40% of people who have been diagnosed with psychosis have also misused a substance at some point in their lifetime. This is at least double the rate seen in the general population. Director of the Centre for Clinical Practice at NICE, Dr Fergus Macbeth, points out that “when these two conditions co-exist, patients can spend twice as long in hospital, compared with those who do not misuse substances. They experience poorer physical health, are less likely to take prescribed medication and more likely to ‘drop out’ of services. However, at present less than a fifth of people who have coexisting psychosis and substance misuse receive treatment for their substance misuse. This guideline aims to help healthcare professionals guide people with psychosis and coexisting substance misuse to stabilize, reduce or stop their substance misuse, to improve treatment adherence and outcomes, and to enhance their lives.”

Recommendations include:

* Increased recognition of psychosis with coexisting substance misuse in adults and young people by healthcare professionals in all settings, including primary care, secondary care mental health services, and emergency departments.
* Mental health services should consider seeking specialist advice and initiating joint working arrangements with substance misuse specialist.
*Healthcare professionals in substance misuse services should be competent to recognize the signs and symptoms of psychosis and undertake a mental health needs and risk assessment sufficient to know how and when to refer to secondary care mental health services.
*Inpatient mental health services should ensure that they have policies and procedures for promoting a therapeutic environment free from drugs and alcohol that have been developed together with service users and their families, carers or significant others.
*Specific issues for young people with psychosis and coexisting substance misuse: Those providing and commissioning services should ensure that age-appropriate mental health services are available for young people with psychosis and coexisting substance misuse and transition arrangements to adult mental health services are in place where appropriate.

Dr Tim Kendall, Director of the National Collaborating Centre for Mental Health states that “this new guideline isn’t about substance misuse causing psychosis, but about effectively managing the two conditions together. A person diagnosed with psychosis is twice as likely to also misuse substances – one of the reasons for this is that people with psychosis can often take various non-prescribed substances as a way of coping with their symptoms, and for a third of people with psychosis, this can lead to harmful or dependent use.”

NICE Press Release