Background: A large number of substance use disorders are increasingly associated with complex clinical presentations and unknown mental and medical risks, presenting a growing challenge for mental health worldwide. Research exploring the interplay between substance use and psychiatric disorders remains limited in Eastern Europe. Objectives: We investigated the demographic and clinical features of 203 patients admitted to a major Romanian psychiatric hospital, aiming to clarify the patterns of dual diagnosis and symptomatology within this vulnerable population. Results: Cannabis, novel psychoactive substances and unknown substances were the most commonly used drugs. Psychiatric comorbidity was rather the rule than the exception within our group. Cluster analysis revealed three distinct symptom profiles: manic/psychotic, negative affective and disorganized. While individual drug type did not independently predict symptom severity or readmission risk, a significant interaction effect between drug use and psychiatric comorbidity influenced symptom cluster membership. Conclusions: These findings highlight the complexity and heterogeneity of dual diagnoses and underline the importance of an integrated, multidisciplinary approach in addiction medicine.

Background/Objectives: The rapid diagnosis of tuberculous pleural effusion (TPE) presents significant challenges for clinicians due to its paucibacillary nature. Routine biochemical markers may complement microbiological and molecular tests, especially in resource-limited settings. The objective of this study was to evaluate the diagnostic performance of pleural fluid adenosine deaminase (ADA), lactate dehydrogenase (LDH), total protein (TP), and the ADA/LDH and ADA/TP ratios for tuberculous pleural effusion, using Löwenstein–Jensen culture and Xpert MTB/RIF as microbiological reference standards Methods: We conducted a retrospective study (2016–2024) including 325 consecutive patients investigated for suspected TPE in a tertiary hospital. ADA, TP and LDH were measured, and additional ratio-based indices (ADA/TP, ADA/LDH) were calculated for 325 pleural fluid (PF) samples. Löwenstein–Jensen (LJ) culture (with MPT64 confirmation) and GeneXpert MTB/RIF (Xpert MTB/RIF) were used as separate microbiological reference standards. Sensitivity (Se), specificity (Sp), and areas under the ROC curve (AUC) were estimated, and optimal thresholds were determined using the Youden index. Results: Among 325 pleural fluid samples, 23 (7.1%) were culture-positive. Xpert MTB/RIF was performed in 73/325 patients (22.5%), with Mycobacterium tuberculosis detected in 19/73 (26.0%) tested samples. In PF, ADA provided the best performance against culture, with Se of 100%. Correlation analysis in PF showed a moderate positive association between TP and LDH (p < 0.0001). Conclusions: Among routine biochemical markers, PF ADA shows high NPV. Integrating these rapid, low-cost tests alongside LJ culture and Xpert MTB/RIF may streamline the diagnostic pathway for TPE.