Escalating patterns of emergency health care prior to first admission with amphetamine psychosis: A window of opportunity?

•Health service contact escalates before a first amphetamine-related psychosis.•Prior mental health care is less common than for other psychoses.•Prior Emergency Department or medical/surgical admission is more common.•Substance misuse, accidents, injuries and infectious diseases are frequent.•Early detection and referral might prevent some later psychoses.

AimTo describe health service contact in the two years prior to a first hospital admission with amphetamine-related psychosis, and to identify possible opportunities for early intervention.MethodRoutine health data collections were used to identify 6130 persons aged 16-65 who had a first hospital admission with amphetamine-related psychosis in New South Wales (NSW), Australia, between 2005 and 2016. Health service contacts in the two years prior to first admission were identified, using public hospital, emergency department and community mental health data. Prior care was compared to 41,444 people with first psychosis admissions without amphetamine diagnoses.ResultsTwo thirds of people with amphetamine-related psychosis had health service contact in the two years prior to their first psychosis admission. Of these, 45% had ED contacts and 30% had prior general hospital admissions. The likelihood of contact escalated throughout the two years prior to admission. Prior substance-related conditions, infectious diseases, injuries and accidents were common. Compared to other first psychosis admissions, people with amphetamine-related psychoses were less likely to have prior specialised mental health care (OR 0.84, 95% CI 0.78, 0.89) and more likely to have prior general health care (OR 1.40, 95% CI 1.29, 1.51).ConclusionEmergency departments and units treating people with infectious diseases or injuries should consider strategies to detect amphetamine and other substance use. Early detection and referral to specialist mental health or drug and alcohol care may prevent some amphetamine-related psychoses.