Characterizing clinical heterogeneity in an inpatient service treating mental, substance use and concurrent disorders

Abstract

Patients diagnosed with concurrent disorders (CD)—comorbid substance use disorder with other psychiatric conditions—experience poorer clinical outcomes, and significant gaps remain in defining the optimal care path for treating CD. Toward this goal, the primary aim of this study was to characterize individual differences in substance use and psychiatric symptomology in an inpatient clinical sample using a person-centred approach. Admission assessment data from a private inpatient service treating mental disorders, substance use, and concurrent disorders was used (n = 177). Latent profile analysis (LPA) was performed to classify individuals into statistically distinct latent profiles based on their psychiatric symptoms and polysubstance use as covariates. LPA revealed four profiles. Profile 1 (20%) was identified as having low SUD and low psychiatric disorders, profile 2 (65%) was identified as having low SUD and high psychiatric disorders, profile 3 (8%) was characterized as high substance use and moderate psychiatric disorders and profile 4 (7%) was identified as the high SUD and high psychiatric disorders. The participants in the two profiles endorsing high SUDs, Profiles 3 and 4, showed significantly higher impulsivity in terms of higher positive urgency sensation-seeking scores compared to the other profiles and the highest use of cocaine/stimulants than the other two. Identifying clinical heterogeneity by classifying individuals into distinct profiles is a first step toward designing more targeted and personalized interventions in clinically complex inpatient populations.