scholarly journals 58 Case Report: Clinical Challenges in the Diagnoses and Management of Delirious Mania in a US Veteran with a Mental Health History of Bipolar Disorder

CNS Spectrums ◽  
2019 ◽  
Vol 24 (1) ◽  
pp. 205-206
Author(s):  
Muhammad Zaidi ◽  
Kurt Brown ◽  
Aquanette Brown ◽  
Dominique Neptune ◽  
Vicenzio-Holder Perkins
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Mental Status ◽  
Medical Condition ◽  
Early Recognition ◽  
Psychotic Symptoms ◽  
Medication Regimen ◽  
Health History ◽  
Mental Health History ◽  
History Of

AbstractA 46 year old Caucasian male veteran with a mental health history of Bipolar Disorder was admitted to the inpatient psychiatric unit following an episode of mania. He was re-started on his outpatient medication regimen for mood stabilization with Quetiapine, Lamotrigine, and Clonazepam. He improved initially, however, on hospital Day 3, the veteran was noted to have acute worsening of manic and psychotic symptoms including, decreased need for sleep, excess energy and responding to internal stimuli. Additionally, he developed symptoms which were atypical for mania, including unprovoked agitation, depersonalization, difficulty sustaining attention, and visual hallucinations. These mental status changes were associated with, excessive motor movement, walking with bizarre postures, squatting, laying taut on the ground, and standing still for several minutes in uncomfortable positions. At this time, Seroquel was switched with Olanzapine for management of mania and psychosis. On physical exam, his vital signs were notable for tachycardia and fever, his extremities were noted to have a normal range of motion; he also experienced loss of bowel continence. The treatment team initiated a medical work up for delirium which revealed no infectious, neurological, or metabolic cause. Of note, there was concern for benzodiazepine withdrawal; however, adequate management did not relieve the symptoms. The veteran was transferred to medicine and neurology was consulted to assist with medical workup. His neuroleptic and benzodiazepine medications were discontinued at that time, except for Lamotrigine. The veteran was then transferred back to psychiatry after medical stabilization, Lamotrigine was discontinued at that time. He was started on Haloperidol, Benztropine and restarted on Clonazepam. At this time, veteran experienced improvement on his mental status exam, with resolution of mania, psychosis, and delirium. However, after two days of treatment, he developed acute rigidity in his extremities. Intramuscular Benztropine and Lorazepam improved his rigidity. Haloperidol was discontinued because of side effects and the veteran was managed with Risperidone and Ativan. He continued to show improvement in his mental status examination and was discharged on a medication regimen of Risperidone, Clonazepam, and Benztropine. The veteran experienced signs and symptoms which were atypical in nature for Bipolar Mania, such as fever, movement disorder, and delirium. This presentation is consistent with a rare medical condition, Delirious Mania for which limited research is available. Delirious mania meets the criteria for mania and delirium with out an underlying medical disorder. Delirious mania is a potentially life threatening but under-recognized neuropsychiatric syndrome. Early recognition and aggressive treatment can significantly reduce morbidity and mortality.

scholarly journals THE RELATIONSHIP BETWEEN MENTAL HEALTH HISTORY AND SYMPTOMS, SEX, AND RECOVERY TIME IN A CONCUSSED PEDIATRIC POPULATION

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0023
Author(s):  
Richard Cameron Allred ◽  
Sara Stremlau ◽  
Richard Gerkin ◽  
Steven Erickson ◽  
Jamie Pardini
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Recovery Time ◽  
Pediatric Population ◽  
Return To Play ◽  
Depression Symptoms ◽  
Health History ◽  
Mental Health History ◽  
Recovery Times ◽  
History Of

Background: The Generalized Anxiety Disorder scale (GAD-7) and Patient Health Questionnaire (PHQ-9) are mental health screening instruments that assess symptoms of depression and anxiety. Studies of patients with concussion suggest that history of mental illness is associated with prolonged recovery; however, little research has examined the value of these tools in a concussed pediatric population (Iverson et al., 2017). Hypothesis/Purpose: The purpose of this study was to explore the relation between anxiety and depression symptoms, mental illness history, sex, and time to recover in a concussed pediatric population. We hypothesized that mental health symptoms and history, and female sex would predict longer recoveries in the pediatric population. Methods: IRB-approved retrospective chart review was used for data collection. Demographics, self-reported mental health history, GAD-7, and PHQ-9 scores were acquired for 250 adolescents ages 12-18 (45.2% female) who presented to an outpatient concussion clinic for their initial visit. Days to recover was imputed for all patients who had been discharged by clinic physicians based on international return to play standards. Results: Mann-Whitney U tests were used for analysis of this nonnormally distributed data. Males were found to recover more quickly than females (female median = 15 days, IQR 7-27; male median = 12 days, IQR 6-23; p=.013). No significant differences were observed in days to clearance based on reported history of mental health disorder (p=.066). Individuals who scored above cutoff (see Kroenke et al., 2001; Spitzer et al., 2006) on the GAD-7 (below cutoff median = 12.00 days; above cutoff median = 21.00 days) and PHQ-9 (below cutoff median = 23.5 days; above cutoff median = 57.00 days) required longer recovery times (p <.001). Conclusion: We found longer recovery times in females versus males, and in those whose scores fell above cutoff for the PHQ-9 and GAD-7 at their initial clinic visit. Although a trend existed, there were no significant differences in recovery time for those who reported a mental health history compared to those who did not. Results suggest that the GAD-7 and PHQ-9 may be useful screening measures in a concussion clinic and may provide additional insight into potential recovery times for pediatric patients.

scholarly journals Reactions to abortion and subsequent mental health

2009 ◽  
Vol 195 (5) ◽  
pp. 420-426 ◽  
Author(s):  
David M. Fergusson ◽  
L. John Horwood ◽  
Joseph M. Boden
Keyword(s):  
Mental Health ◽  
Health Outcomes ◽  
Mental Health Problems ◽  
Mental Health Disorders ◽  
Emotional Reactions ◽  
Health History ◽  
Mental Health History ◽  
History Of ◽  
Health Disorders ◽  
The Right

BackgroundThere has been continued interest in the extent to which women have positive and negative reactions to abortion.AimsTo document emotional reactions to abortion, and to examine the links between reactions to abortion and subsequent mental health outcomes.MethodData were gathered on the pregnancy and mental health history of a birth cohort of over 500 women studied to the age of 30.ResultsAbortion was associated with high rates of both positive and negative emotional reactions; however, nearly 90% of respondents believed that the abortion was the right decision. Analyses showed that the number of negative responses to the abortion was associated with increased levels of subsequent mental health disorders (P<0.05). Further analyses suggested that, after adjustment for confounding, those having an abortion and reporting negative reactions had rates of mental health disorders that were approximately 1.4–1.8 times higher than those not having an abortion.ConclusionsAbortion was associated with both positive and negative emotional reactions. The extent of negative emotional reactions appeared to modify the links between abortion and subsequent mental health problems.

scholarly journals Bullying and Students with Disabilities: The Untold Narrative

2012 ◽  
Vol 45 (2) ◽  
Author(s):  
Chad A. Rose ◽  
Susan M. Swearer ◽  
Dorothy L. Espelage
Keyword(s):  
Mental Health ◽  
Developmental Disabilities ◽  
Students With Disabilities ◽  
Poor Response ◽  
Health Issues ◽  
School Bus ◽  
Health History ◽  
Mental Health History ◽  
History Of ◽  
Being Bullied

The documentary Bully was released nationwide in theaters in March 2012. Originally titled The Bully Project, the filmmakers followed five families whose lives had been turned upside down by bullying. Two of the families in the movie lost their sons, Tyler and Ty, to suicide, and three of the youth in the movie,Alex, Kelby, and Ja'Meya, were bullied in school and on the school bus. The movie shows the devastating consequences of bullying and the depressingly poor response on the part of adults. What the movie does not address is the mental health history of one of the boys, who commits suicide, as well as the developmental disabilities affecting another boy in the movie, who was born prematurely (Bazelon, 2012). Understandably, this is a difficult narrative. The filmmakers did not want to delve into the complexity of mental health issues and bullying for fear of creating a story line that those who are bullied are obvious victims. However, by not addressing the issues of ADHD, bipolar disorder, Asperger syndrome, and developmental disabilities, an important narrative was missed. Bullying is a complex phenomenon, and both mental health and physical health difficulties play into involvement in bullying. While there is no narrative that those who are bullied somehow deserve such egregious treatment, we shirk our professional responsibilities if we do not shed light on the compelling evidence that youth with disabilities are at great risk for involvement in bullying-both for bullying others and for being bullied (AbilityPath.org, 2011; Rose, Monda-Amaya, & Espelage, 2011). The purpose of this article is to review the research on bullying and students with disabilities and to propose an inclusive narrative: when differences are celebrated rather than used as fuel for maltreatment, a world will be created where bullying is not tolerated. This will be a better world for everyone.

scholarly journals An Assessment of the Mental Health History of Patients in a Transgender Clinic in Kingston, Ontario

2020 ◽  
Vol 65 (4) ◽  
pp. 281-283
Author(s):  
Jennifer She ◽  
Jennifer McCall ◽  
Jessica Pudwell ◽  
Maria Kielly ◽  
Ashley Waddington
Keyword(s):  
Mental Health ◽  
Health History ◽  
Mental Health History ◽  
History Of

scholarly journals Life After: Examining the Relationship Between Sociobehavioral Factors and Mental Health Among African American Ex-Offenders

2018 ◽  
Vol 62 (12) ◽  
pp. 3873-3889 ◽  
Author(s):  
Carlos C. Mahaffey ◽  
Danelle Stevens-Watkins ◽  
Carl Leukefeld
Keyword(s):  
Mental Health ◽  
African American ◽  
Mental Health Problems ◽  
Health History ◽  
Mental Problems ◽  
Excellent Health ◽  
Mental Health History ◽  
History Of ◽  
Family Mental Health ◽  
The Relationship

Mental health problems are 3 times higher among prisoners than the general population. After release, reentry barriers and other factors can exacerbate mental problems. This study of 250 African American ex-offenders examines the relationship between sociobehavioral factors and mental health. Independent variables included self-reported health, alcohol use, employment, and history of mental problems before prison. Covariates included the number of immediate family with mental problems and the number of serious conflicts with family members or friends. Analyses revealed that men who had serious conflicts, used alcohol more often, reported less than excellent health, and not employed were more likely to report being troubled by mental problems. Family mental health history was not statistically significant. The current study adds to the literature by identifying selected factors associated with the mental health of African American male, ex-offenders. Findings from this study can inform interventions to address mental health issues and reduce recidivism.

Self-Harm and Homeless Adults

Crisis ◽  
2013 ◽  
Vol 34 (5) ◽  
pp. 363-366 ◽  
Author(s):  
Graham Pluck ◽  
Kwang-Hyuk Lee ◽  
Randolph W. Parks
Keyword(s):  
Mental Health ◽  
Psychiatric Admission ◽  
Homeless Adults ◽  
Related Information ◽  
Health History ◽  
Self Injury ◽  
Mental Health History ◽  
History Of ◽  
Self Harm

Background: Homelessness is associated with an increased incidence of mental illness and risk of self-harm, including suicide. Aims: To assess the prevalence of self-harm (including nonsuicidal self-injury and attempted suicide) among a UK sample of homeless adults and to compare demographic, clinical, and homeless-related variables to determine which are linked to self-harm in this population. Method: A sample of 80 homeless adults were interviewed regarding history of self-harm, mental health history, demographic, and homeless-related information. Results: Sixty-eight percent of the sample reported past acts of self-harm. Those with histories of self-harm started using significantly more substances since becoming homeless and were younger when they first became homeless. They were also significantly more likely to have a past psychiatric admission and thoughts of self-harm in the past year. Conclusion: Self-harm is common among homeless adults and linked to long-term and enduring social and mental health concerns.

scholarly journals Bullying and Students with Disabilities: The Untold Narrative

2012 ◽  
Vol 45 (2) ◽  
Author(s):  
Chad A. Rose ◽  
Susan M. Swearer ◽  
Dorothy L. Espelage
Keyword(s):  
Mental Health ◽  
Developmental Disabilities ◽  
Students With Disabilities ◽  
Poor Response ◽  
Health Issues ◽  
School Bus ◽  
Health History ◽  
Mental Health History ◽  
History Of ◽  
Being Bullied

The documentary Bully was released nationwide in theaters in March 2012. Originally titled The Bully Project, the filmmakers followed five families whose lives had been turned upside down by bullying. Two of the families in the movie lost their sons, Tyler and Ty, to suicide, and three of the youth in the movie,Alex, Kelby, and Ja'Meya, were bullied in school and on the school bus. The movie shows the devastating consequences of bullying and the depressingly poor response on the part of adults. What the movie does not address is the mental health history of one of the boys, who commits suicide, as well as the developmental disabilities affecting another boy in the movie, who was born prematurely (Bazelon, 2012). Understandably, this is a difficult narrative. The filmmakers did not want to delve into the complexity of mental health issues and bullying for fear of creating a story line that those who are bullied are obvious victims. However, by not addressing the issues of ADHD, bipolar disorder, Asperger syndrome, and developmental disabilities, an important narrative was missed. Bullying is a complex phenomenon, and both mental health and physical health difficulties play into involvement in bullying. While there is no narrative that those who are bullied somehow deserve such egregious treatment, we shirk our professional responsibilities if we do not shed light on the compelling evidence that youth with disabilities are at great risk for involvement in bullying-both for bullying others and for being bullied (AbilityPath.org, 2011; Rose, Monda-Amaya, & Espelage, 2011). The purpose of this article is to review the research on bullying and students with disabilities and to propose an inclusive narrative: when differences are celebrated rather than used as fuel for maltreatment, a world will be created where bullying is not tolerated. This will be a better world for everyone.

scholarly journals Abortion and mental health disorders: evidence from a 30-year longitudinal study

2008 ◽  
Vol 193 (6) ◽  
pp. 444-451 ◽  
Author(s):  
David M. Fergusson ◽  
L. John Horwood ◽  
Joseph M. Boden
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Pregnancy Outcomes ◽  
Mental Health Problems ◽  
Design Problems ◽  
Health History ◽  
Weak Evidence ◽  
Increased Risk ◽  
Mental Health History ◽  
History Of

BackgroundResearch on the links between abortion and mental health has been limited by design problems and relatively weak evidence.AimsTo examine the links between pregnancy outcomes and mental health outcomes.MethodData were gathered on the pregnancy and mental health history of a birth cohort of over 500 women studied to the age of 30.ResultsAfter adjustment for confounding, abortion was associated with a small increase in the risk of mental disorders; women who had had abortions had rates of mental disorder that were about 30% higher. There were no consistent associations between other pregnancy outcomes and mental health. Estimates of attributable risk indicated that exposure to abortion accounted for 1.5% to 5.5% of the overall rate of mental disorders.ConclusionsThe evidence is consistent with the view that abortion may be associated with a small increase in risk of mental disorders. Other pregnancy outcomes were not related to increased risk of mental health problems.

Delirium Secondary to Lamotrigine Toxicity

2020 ◽  
Vol 15 (2) ◽  
pp. 156-159 ◽  
Author(s):  
Deborah L. Sanchez ◽  
Adam J. Fusick ◽  
Steven R. Gunther ◽  
Michael J. Hernandez ◽  
Gregory A. Sullivan ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Valproic Acid ◽  
Mental Status ◽  
The United States ◽  
Clinical Correlation ◽  
Medication Regimen ◽  
Medication Effects ◽  
United States Food ◽  
States Food ◽  
Rule Out

Background: Lamotrigine is a phenyltriazine medication that has been approved by the United States Food and Drug Administration as monotherapy and as an adjunctive agent for the treatment of seizure disorder. It was later approved by the FDA for the treatment of bipolar disorder. Lamotrigine is generally well tolerated by patients, but some serious symptoms can occur during treatment. These severe side effects include rashes and multi-organ failure. Lamotrigine has also been associated with the development of mental status changes, frequently when used concurrently with other medications that may impact the metabolism of lamotrigine. Objective: To present the case of a 65-year-old man being treated with lamotrigine and valproic acid who developed mental status changes after the addition of sertraline to his medication regimen, and to compare this case to existing cases reported in the literature. Discussion: Our case adds to the existing literature by demonstrating that patients may experience adverse medication effects despite lamotrigine levels that are normally considered to be in the therapeutic range, highlighting the importance of clinical correlation when obtaining medication levels. Conclusion: Clinicians should use caution interpreting lamotrigine levels when working up delirium, as normal levels may not rule out the development of lamotrigine toxicity.

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