1. Substance abuse comorbidity in hospitalized psychiatric patients Population – 470 consequently admitted hospitalized patients Kfar Shaul – 250 patients Tel Ha-Shomer – 220 patients

2. Substance abuse comorbidity in hospitalized psychiatric patients Age – 18-70 years old Up to 24 years old – 87 patients (18.5%) 25 – 44 years old – 224 patients (47.7%) 45 and more years old – 159 patients (33.8%)

3. Age- Kfar Saul vs. Tel Ha Shomer Kfar SaulTel Ha Shomer Statistic analysis df=1 18-24 years old 51 (20.4 %) 66 (30 %)p=0.05 25-44 years old 143 (57.2%)81(36.8 %)p=0.000 45 and more years old 56 (22.4%)73 (33.2%)P=0.01

4. Sex Female – 165 patients (35% ) Male – 305 patients (65 %) Place of birth Israel – 308 patients (65,5%) West-Europe,America, Australia, South Africa - 112 patients (23.8%) East-Asia, Africa, Middle East – 46 patients (9.8%) Other – 2 patients (0.4%) Substance abuse comorbidity in hospitalized psychiatric patients

5. Origin-Kfar Shaul vs. Tel ha Shomer Kfar-ShaulTel-Ha- Shomer Statistic analysis df=1 Israel174 (69.6%) 134 (60.9%) p=0.05 West59 (24.6%)57 (25.9%)NS East17 (6.8%)29 (13.2)p=0.03

6. Substance abuse comorbidity in hospitalized psychiatric patients Working status FrequencyPercent Working Students (incl. eshiva) Unemployed Social security (mental problems) Social security (other problems) Other 107 20 40 178 56 69 22.8 4.3 8.5 37.9 11.9 14.7

7. Substance abuse comorbidity in hospitalized psychiatric patients Working status-Kfar Saul vs.Tel-Ha-Shomer Kfar ShaulTel-Ha- Shomer Statistical Analysis df=1 Working Students (incl. eshiva) Unemployed Social security (mental problems) Social security (other problems) Other 34 (13.6%) 16 (6.4%) 27 (10.8%) 116 ( 46.4%) 20 (8.0%) 37 (14.8%) 73 (33.2%) 4 (1.8%) 13 (5.9%) 62 (28.1%) 36 (16.3%) 32 (14.5%) p=000 p=0.02 p=0.01 p=0.000 p=0.006 NS

8. Substance abuse comorbidity in hospitalized psychiatric patients Marital status FrequencyPercent married15132.1 single22547.9 divorced8518.1 widow51.1 other40.9

9. Substance abuse comorbidity in hospitalized psychiatric patients Marital status - Kfar Shaul vs. Tel-Ha-Shomer Kfar ShaulTel-Ha- Shomer Statistical Analysis df=1 married63 (25.2%)88 (40%)p=0.001 single135 (54%)90 (40.9%)p=0.005 divorced47 (18.8%)38 (17.2%)NS widow2 (0.8%)0NS other2 (0.8%)2 (0.9%)NS

10. Substance abuse comorbidity in hospitalized psychiatric patients Past psychiatric history yes – 391 patients (83.2 %) no – 71 patients (15.5 %) unclear – 6 (1.3%)

11. Substance abuse comorbidity in hospitalized psychiatric patients Diagnosis FrequencyPercent Organic disorders (incl. mental disorders due to drug abuse) 337.1% Schizophrenia, schizophrenoform and schizoaffective d-r 23750.4% Affective disorders12626.8% Anxiety disorders4810.8% Personality disorders265.4%

12. Substance abuse comorbidity in hospitalized psychiatric patients Diagnosis Kfar Shaul vs. Tel-Ha-Shomer Kfar ShaulTel-Ha- Shomer Organic disorders (incl. mental disorders due to drug abuse) 28 (11.2%)5 (2.2%)p=0.000 Schizophrenia, schizophrenoform and schizoaffective d-r 142 (56.8%)95 ( 43.2%)p=0.004 Affective disorders52 (20.8%)74 (33.6%)p=0.002 Anxiety disorders14 (5.6%)34 (15.4%)p=0.001 Personality disorders14 (5.6%)12 (5.6%)NS

13. Substance abuse comorbidity in hospitalized psychiatric patients Life time prevalence of drug abuse Positive (self report) – 113 patients 24.0% Cannabis – 93 patients (19.7%) Opioid – 27 patients (5.7%) Cocaine – 13 patients (2.7%) Amphetamine – 16 patients (3.4%) Methamphetamine – 31 patients (6.6%)

14. Substance abuse comorbidity in hospitalized psychiatric patients Life time prevalence - frequency of abuse 2 - 10 cases per month – 42 patients more than 10 cases – 77 patients unclear – 27 patients

15. Non-active substance abusers Kfar-Shaul vs. Tel-Ha-Shomer Tel-Ha- Shomer Kfar-ShaulTotalStatistical Analysis df=1 20 (9.1%)15 (6%)35 (7.4%)NS

16. Substance abuse comorbidity in hospitalized psychiatric patients Non-active abusers diagnosis (N = 35) FrequencyPercent Organic d-rs (incl. due to substance abuse) 38.6 Schizophrenia, schizophrenoform d-r and schizoaffective 2262.9 Affective d-rs617.1 Anxiety d-rs12.9 Personality d-rs38.6

17. Substance abuse comorbidity in hospitalized psychiatric patients Frequency of abuse CannabisAmpheta mine Methamp hetamine OpioidCocaine 2-10 cases/ month 1641045 10 and more 3506120 unclear61263

18. Frequency of abuse of different drugs: Kfar- Shaul vs. Tel-Ha-Shomer DrugNum of abusers % of Total num of patients Kfar- Shaul % Kfar- Shaul Tel-Ha- Shomer % Tel- Ha- Shomer Statistical Analysis df=1 Ampheta mine 51.141.610.5NS Cocaine71.541.631.4NS Methamp hetamine 183.8135.252.3NS Opiates234.9197.641.80.004 Cannabis5411.13915.6156.80.003

19. Substance abuse comorbidity in hospitalized psychiatric patients Active abuse of the drugs (last month) 18 patients - positive for urine tests, but negative in self reports 34 patients - positive for urine tests and self report 24 patients - positive for self report, but negative for urine tests Total – 78 patients

20. Substance abuse comorbidity in hospitalized psychiatric patients Urine tests THC (Cannabis) - 30 positive Methamphetamine - 7 positive Amphetamine - 3 positive Cocaine - 5 positive Opioid - 17 positive Total – 52 positive

21. Substance abuse comorbidity in hospitalized psychiatric patients Abusers vs. nonusers – age Abusers N=78 Nonusers N=392 Statistical Analysis df=1 Up to 24 years24 (30.8%)63 (16.1%)p<0.001 25-44 years41 (52.6%)183 (46.7%) NS 45-64 years12 (15.4%)117 (29.8%) p<0.001 65-70 years1 (1,2 %)29 (7.4%)NS

22. Substance abuse comorbidity in hospitalized psychiatric patients Abusers vs. nonusers-sex Abusers n=78 Nonusers n= 392 Male60 (76.9%)245 (62.5%) Female18 (23.1%)147 (37.5%) p<0.05

23. Substance abuse comorbidity in hospitalized psychiatric patients Abusers vs. nonusers-marital status Abusers n=78 Nonusers N=392 Statistical Analysis df=1 Married10 (12.8%)141 (36%)p<0.001 Single52 (66.7%)173 (44.1%)p<0.001 Divorced16 (20.5%)69 (17.6%)NS Widow05 (1.3%)NS Other04 (1%)NS

24. Substance abuse comorbidity in hospitalized psychiatric patients Abusers vs. nonusers-country of origin Abusers N=78 Nonusers N=392 Statistical Analysis df=1 Israel52 (66.7%)256 (65.6%) NS Asia, Middle East, North Africa 2 (4.3%)44 (11.3%) p<0.05 Europe, South Africa, America, Australia 24 (30.8%)88 (22.6%) p< 0.05 Other02 (0,5%)NS

25. Substance abuse comorbidity in hospitalized psychiatric patients Abusers vs. nonusers-working status Abusers n=78 Nonusers n=392 Statistical Analysis df=1 Working16 (20.5%)91 (23.2%)NS Students (inc. eshiva)7 (9%)13 (3.3%)NS Unemployed9 (11.5%)31 (7.9%)NS Soc. security due to mental problems 25 (32%)153 (39.1%)NS Soc. security due to other problems 8 (10.3%)48 (12.2%)NS Other13 (16.7%)56 (14.3%)NS

26. Substance abuse comorbidity in hospitalized psychiatric patients Abusers vs. nonusers-diagnosis Abusers (n=78)Nonusers (n=392) Organic d-rs (incl. due to substance abuse) 19 (24.4%)14 (3.7%) Schizophrenia, schizophrenoform d-r and schizoaffective 37 (47.4%)200 (51%) Affective d-rs14 (17.9%)112 (28.5%) Anxiety d-rs2 (2.6%) 46 (11.7%) Personality d-rs6 (7.7%)20 (5.1%)

27. Substance abuse comorbidity in hospitalized psychiatric patients Abusers vs. nonusers-diagnosis (without organic d-rs) Abusers n=59 Nonusers n=378 Statistical Analysis df=1 Schizophrenia, schiphrenoform schizoaffective d-rs 37 (62.7%)200 (52.9%)p=0.06 Affective d-rs14 (23.7%)112 (29.6%)NS Anxiety d-rs 2 (3.4%)46 (12.1%)NS Personality d-rs6 (10.2%)20 (5.3%)NS

28. Substance abuse comorbidity in hospitalized psychiatric patients Duration of drug abuse vs. duration of mental disorder Tel-Ha- Shomer Kfar- Shaul TotalStatistical Analysis df=2 Duration of drug abuse is longer than that of mental problems 27 (56.3%)10 (24.4%)37 (41.6%)p = 0.004 Duration of drug abuse is similar to that of mental problems 11 (22.9%)22 (53.7%)33 (37.1%)p = 0.004 Duration of mental problems is longer than that of drug abuse 10 (20.8%)9 (22.0%)19 (21.3%)NS

29. Substance abuse comorbidity in hospitalized psychiatric patients Cannabis abuser vs. nonusers-diagnosis Abusers n=54 Nonusers n=392 Organic (incl. due to substance abuse) 14 (25.9%)14 (3.7%) Schizophrenia, schizoaffective, schizophrenoform 27 (50%)200 (51%) Affective d-rs9 (16.7%)112 (28.5%) Anxiety d-rs046 (11.7%) Personality d-rs4 (7.4%)20 (4.5%)

30. Substance abuse comorbidity in hospitalized psychiatric patients Cannabis abusers vs. nonusers - diagnosis (without organic) Abusers n=40 Nonusers N=378 Statistical Analysis df=1 Schizophrenia, schizoaffective, schizophrenoform 27 (67.5%)200 (52.9%)p=0.014 Affective d-rs9 (22.5%)112 (29.6%)NS Anxiety d-rs046 (12.2%)NS Personality d-rs4 (10%)20 ( 5.3 %)NS

31. Substance abuse comorbidity in hospitalized psychiatric patients Psycho stimulants (amphetamine, methamphetamine, cocaine) - diagnosis Amphet amine Methamph etamine CocaineTotal Organic (incl. due to substance abuse) 1023 (10.3%) Schizophrenia, schizoaffective, schizoprenoform 164121 (72.5%) Affective d-rs1023 (10.3%) Anxiety d-rs0112 (6.9%) Personality d-rs0000 Total185629

32. Psycho stimulant’s abusers n=26 Nonusers n=378 Statistical Analysis df=1 Schizophrenia, schizoaffective, schizoprenoform 21 (80.7%)200 (52.9%)p=0.001 Affective d-rs3 (11.5%)112 (29.6%)p=0.03 Anxiety d-rs2 (7.7%)46 (12.2 %)NS Personality d-rs020 (5.3%)NS Substance abuse comorbidity in hospitalized psychiatric patients Psycho stimulant’s abusers vs. nonusers (diagnosis without organic d-rs)

33. Substance abuse comorbidity in hospitalized psychiatric patients Opioid abusers vs. nonusers-diagnosis Opioid abusers n=22 Nonusers N=392 Organic d-rs (incl. due to substance abuse) 9 (27.3%) 14 (3.7%) Schizophrenia, schizoaffective, schizofreniform 7 (31.8%) 200 (51%) Affective d-rs5 (22.7%)112 (28.5%) Anxiety d-rs0 46 (11.7%) Personality d-rs1 (4.5%) 20 (5.1%)

34. Substance abuse comorbidity in hospitalized psychiatric patients Opioid abusers vs. nonusers-diagnosis (without organic) Opioid abusers n=13 Nonusers N=378 Statistical Analysis df=1 Schizophrenia, schizoaffective, schizofrenoform 7 (53.8 %)200 (52.9%)NS Affective d-rs5 (38.5%)112 (29.6%)NS Anxiety d-rs046 (12.1%)NS Personality d-rs1 (7.7 %)20 (5.3 %)NS

35. Substance abuse comorbidity in hospitalized psychiatric patients PANSS (positive scale) - cannabis abusers vs. nonusers MeanStandard deviation tdfp Cannabis abusers n=54 16.1288.030542.5104660.012 Nonusers n= 392 19.05568.29962

36. Substance abuse comorbidity in hospitalized psychiatric patients PANNS (positive) – subscales: cannabis abusers vs nonusers P1 (delusions), P2 (conceptual disorganization), P6 (suspiciousness) – rates of the abusers were higher, but not significantly.

37. Substance abuse comorbidity in hospitalized psychiatric patients PANSS (positive) - subscales: abusers vs. nonusers Rates of the abusers were significantly higher then the nonusers: P3 (hallucinatory behavior) – p=0.011 P4 (excitement) – p= 0.004 P5 (grandiosity) – p= 0.006 P7 (hostility) – p= 0.024

38. Substance abuse comorbidity in hospitalized psychiatric patients PANSS (general scale) – cannabis abusers vs. nonusers MeanStandard deviatn. Tdfp Cannabis abusers n=54 33.01859.317242.7274660.007 Nonusers N=394 37.357511.1955

39. G5 (mannerism and posturing), G10 (disorientation), G15 (preoccupation) and G16 (active social avoidance) - rates of the abusers were lower, but not significantly. Substance abuse comorbidity in hospitalized psychiatric patients PANSS (general scale) – subscales: cannabis abusers vs. nonusers

40. Substance abuse comorbidity in hospitalized psychiatric patients PANSS (general) – subscales: cannabis abusers vs. nonusers G9 (unusual thought content), G11 (poor attention), G12 (lack of judgment and insight) - rates of the abusers were higher, but not significantly.

41. Substance abuse comorbidity in hospitalized psychiatric patients PANSS (general) – subscales: cannabis abusers vs. nonusers G8 (uncooperativeness) – rates of the abusers were significantly higher (p=0.001)

42. Substance abuse comorbidity in hospitalized psychiatric patients PANSS (general) – subscales: cannabis abusers vs. nonusers Rates of the abusers were significantly lower: G1 (somatic concern) p=0.001 G2 (anxiety) p=0.000 G3 (guilt feelings) p=0.000 G4 (tension) p=0.000 G6 (deression) p=0.000 G7 (motor retardation) p= 0.001 G13 (disturbance of volition) p=0.002 G14 (poor impulse control) p=0.001

43. Substance abuse comorbidity in hospitalized psychiatric patients PANSS (negative scale): cannabis abusers vs. nonusers MeanStandard deviatn. tdfp Cannabis abusers n=54 13.81486.867631.1844660.2 Nonusers n=394 14.98316.44593

44. Substance abuse comorbidity in hospitalized psychiatric patients PANSS (negative) – subscales: cannabis abusers vs. nonusers N3 (poor rapport), N5 (difficulty in abstract thinking) – rates of the abusers were higher, but not significantly.

45. Substance abuse comorbidity in hospitalized psychiatric patients PANSS (negative) – subscales: cannabis abusers vs. nonusers N1 (blunted affect), N2 (emotional withdrawal), N6 (lack of spontaneity/conversational flow) – rates of the abusers were lower, but not significantly

46. Substance abuse comorbidity in hospitalized psychiatric patients PANSS (negative) – subscales: cannabis abusers vs. nonusers Rates of the abusers were significantly lower: N4 (social withdrawal) p= 0.04 N7 (stereotyped thinking) p= 0.037

47. Substance abuse comorbidity in hospitalized psychiatric patients YMRS Scale – cannabis abusers vs. nonusers MeanStandard deviatn. tdfp Cannabis abusers n=54 6.777810.825661.1584660.115 Nonusers n=394 4.91067.754404

48. Substance abuse comorbidity in hospitalized psychiatric patients YMRS – subscales: cannabis abusers vs. nonusers YMRS1 (elevated mood), YMRS2 (increased motor activity), YMRS4 (sleep), YMRS5 (irritability), YMRS6 (speech), YMRS8 (content), YMRS9 (disruptive/aggressive behavior), YMRS10 (appearance) – rates of the abusers were higher, but not significantly.

49. Substance abuse comorbidity in hospitalized psychiatric patients YMRS – subscales: cannabis abusers vs. nonusers YMRS3 (sexual interest) – rates of the abusers were lower, but not significantly

50. Substance abuse comorbidity in hospitalized psychiatric patients YMRS – subscales: cannabis abusers vs. nonusers Rates of the abusers were significantly higher: YMRS7 (language/thought) – p=0.001 YMRS11 (insight) – p=0.002

51. Substance abuse comorbidity in hospitalized psychiatric patients HAM-D: cannabis abusers vs. nonusers MeanStandard deviatn. tdfp Cannabis abusers n=54 5.944410.29093.5354680.000 Nonusers n=394 12.896613.9465

52. Substance abuse comorbidity in hospitalized psychiatric patients HAM-D – subscales: cannabis abusers vs. nonusers HAM-D13 (general somatic symptoms) and HAM-D20 (paranoid symptoms) – rates of the abusers were higher, but not significantly

53. Substance abuse comorbidity in hospitalized psychiatric patients HAM-D – subscales: cannabis abusers vs. nonusers Rates of the abusers were lower, but not significantly: HAM-D5 (middle insomnia) HAM-D7 (work and activities) HAM-D15 (hyposhondriasis) HAM-D16 (lost of weight) HAM-D17 (insight) HAM-D19 (depersonalization and derealization)

54. Substance abuse comorbidity in hospitalized psychiatric patients HAM-D – subscales: cannabis abusers vs. nonusers Rates of the users were significantly lower: HAM-D1 (depressed mood) – p=0.000 HAM-D2 (feeling of guilt) – p=0.000 HAM-D3 (suicide) – p=0.011 HAM-D4 (early insomnia) – p=0.000 HAM-D6 (late insomnia) – p=0.006 HAM-D8 (retardation) – p=0.006 HAM-D9 (agitation) – p=0.000 HAM-D10 (psychotic anxiety) – p=0.000

55. Substance abuse comorbidity in hospitalized psychiatric patients HAM-D – subscales: cannabis abusers vs. nonusers (continued) Rates of the abusers were significantly lower: HAM-D11(somatic anxiety) – p=0.000 HAM-D12 (somatic symptoms-gastrointestinal) – p=0.006 HAM-D14 (somatic symptoms-genital) – p=0.002 HAM-D18 (diurnal variation) – p=0.01 HAMD-D21 (obsessive and compulsive symptoms) – p=0.002

56. Substance abuse comorbidity in hospitalized psychiatric patients PANNS (positive scale) – stimulants abusers vs. nonusers MeanStandard deviatn tdfp Stimulants abusers n=29 19.09.296061.6094660.11 Nonusers n=394 16.32288.02299

57. Substance abuse comorbidity in hospitalized psychiatric patients PANNS (negative scale) – stimulants abusers vs. nonusers MeanStandard deviatn tdfp Stimulants abusers n=29 14.86916.880430.2774660.78 Nonusers n=394 14.48005.83895

58. Substance abuse comorbidity in hospitalized psychiatric patients PANNS (general scale) – stimulants abusers vs. nonusers MeanStandard deviatn tdfp Stimulants abusers n=29 39.909711.175720.4344660.664 Nonusers n=394 35.9209.21466

59. Substance abuse comorbidity in hospitalized psychiatric patients YMRS scale – stimulants abusers vs. nonusers MeanStandard deviatn tdfp Stimulants abusers n=29 5.24007.671810.0724660.943 Nonusers n=394 5.11968.21056