Physically III and Mentally III

1986 ◽  
Vol 31 (3) ◽  
pp. 197-201 ◽  
Author(s):  
Robert Johnson ◽  
Jambur Ananth
Keyword(s):  
Physical Examination ◽  
Psychiatric Patients ◽  
Case Reports ◽  
Physical Examinations ◽  
Atypical Presentations ◽  
Do So

Undetected physical illnesses in psychiatric patients are common. Why do so many physical illnesses go undetected? These disorders are difficult to detect and need an elaborate consultatory process. Some of the problems may be related to the fact that psychiatrists do not do physical examinations. Clues suggesting an organic etiology may be attributed to psychodynamic issues by many physicians. In this paper, seven case reports are presented to illustrate the following: perform your own physical examination; do not attribute physical signs to dynamic issues; all physical signs should be explained; be alert to atypical presentations; conduct relevant laboratory workup; avoid bias against unattractive patients; and pose specific questions to consultants.

scholarly journals 2019 novel coronavirus disease with secondary ischemic stroke: two case reports

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bin Fu ◽  
Yun Chen ◽  
Ping Li
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Laboratory ◽  
Case Reports ◽  
Small Vessel ◽  
Vessel Occlusion ◽  
Aged Patients ◽  
Health Crisis ◽  
Physical Examinations ◽  
Novel Coronavirus

Abstract Background The COVID-19 pandemic, which broke out in Wuhan in 2019, has become the global health crisis of our time. Elderly patients with certain fundamental diseases are more likely to develop severe cases. The secondary lesion following viral infection have only rarely been reported. Case presentation We here report two cases of coronavirus-infected pneumonia with acute ischemic stroke in middle-aged patients. In both COVID-19 cases, neurological physical examinations showed normal results before infection. Lymphocytopenia, accompanied by elevated cytokines and D-dimers, were found from serum clinical laboratory examination at admission. Dysarthria and limb muscle weakness are initial manifestations, occurring one week after infect-causative pathogen, SARS-CoV-2. The head CT and head/neck arterial CTA showed small-vessel occlusion. The patients were diagnosed with coronavirus diseases with secondary acute ischemic stroke. They were treated with tirofiban and followed up with daily aspirin and atorvastatin. Conclusions These cases suggested that secondary ischemic stroke, mainly manifested as small-vessel occlusion, should be considered for COVID-19 patients and diagnosed and treated promptly.

scholarly journals Intestinal Obstruction following Ingestion of Metallic Instruments in a Psychiatric Patient

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Oscar Kivike ◽  
Israel Soko ◽  
David Mgaya ◽  
Frank Sandi
Keyword(s):  
Physical Examination ◽  
Intestinal Obstruction ◽  
Female Patient ◽  
Psychiatric Patient ◽  
Psychiatric Patients ◽  
Abdominal Distension ◽  
History Taking ◽  
Proximal Intestine ◽  
Psychotic Features

Pica among psychiatric patients has been well documented. We report a 25-year-old female patient who presented with abdominal distension for one week. She is a known psychiatric patient for 5 years. Through history taking, physical examination, and investigations, the patient was found to have psychotic features and features of intestinal obstruction. Surgery was done by opening the abdomen and then the stomach. The stomach, together with the proximal intestine, was found to be filled with metallic instruments weighing 780 mg. The diagnosis of a metalophagia type of pica was reached. All instruments were removed and the patient did well postoperatively.

Pallor Sign: An Indicator of Hemangioma in Evolution

2012 ◽  
Vol 16 (6) ◽  
pp. 451-452
Author(s):  
Muzamil Chisti ◽  
Nusrat Banka ◽  
Abdullah Alfadley
Keyword(s):  
Case Reports ◽  
Infantile Hemangioma ◽  
Clinical Implications ◽  
Atypical Presentations

Background: The typical presentation of infantile hemangioma is well known and is easily recognizable. However, it may have many atypical presentations, as reported in the literature. Most of the hemangiomas are not visible at birth and become apparent at about 3 to 4 weeks of age. There are very few case reports of hemangioma presenting as a pale patch in the dermatology literature, and none of them describe the etiopathogenesis of this presentation and its clinical implications. Objective and Conclusion: We report a case of an infantile hemangioma with a trichrome presentation: an erythematous oval patch with a dark red macule at the periphery enclosed by a hypopigmented halo. A brief description of the etiopathogenesis of the pallor sign is also given. Renseignements de base: La présentation typique d'un hémangiome infantile est bien connue et facilement reconnaissable. Toutefois, comme l'indique la documentation, il peut avoir de nombreuses présentations atypiques. La plupart des hémangiomes ne sont pas visibles à la naissance et deviennent apparents à environ 3 à 4 semaines. La documentation dermatologique ne compte que très peu d'observations d'hémangiome se présentant sous forme de plaque pâle, et aucune d'entre elles ne décrit l'étiopathogénie de cette présentation et ses conséquences cliniques. Objectif et conclusion: Nous signalons un cas d'hémangiome infantile avec présentation trichrome: plaque érythémateuse ovale avec une macule rouge foncée en périphérie, entourée d'un halo hypopigmenté. Une brève description de l'étiopathogénie de la pâleur est également donnée.

scholarly journals Annual physical health checks within a forensic inpatient service

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S72-S72
Author(s):  
Michael Cooper ◽  
Partha Gangopadhyay
Keyword(s):  
Blood Pressure ◽  
Physical Examination ◽  
Physical Health ◽  
Local System ◽  
Health Examination ◽  
Inclusion Criteria ◽  
The Past ◽  
Health Checks ◽  
Blood Monitoring ◽  
Physical Examinations

AimsPatients prescribed antipsychotics are at risk of ill effects to their physical health. Our aims were to assess whether inpatients within a forensic service, on antipsychotic medications, were receiving annual physical health monitoring in accordance with current NICE and SIGN Guidelines. Based on these Guidelines the following objectives were identified: 1: Physical examination, BMI and blood pressure recorded within the past year2: FBC recorded within the past year3: U&Es recorded within past year4: LFTs recorded within the past year5: HbA1C / random glucose / fasting glucose recorded within the past year6: Random lipids / fasting lipids recorded within the past yearMethodInclusion Criteria: Patients admitted for longer than a year currently prescribed an antipsychotic.Data were collected cross-sectionally on 24/7/20 for all inpatients meeting the inclusion criteria. Medical notes and the blood results system were reviewed for results of any annual physical examinations and blood monitoring over the past year.Anonymized data were analysed using Excel.Result13 out of 17 inpatients fulfilled the inclusion criteria. Of these 13 inpatients, 9 (69.2%) were prescribed clozapine, 1 (7.7%) zuclopenthixol, 1 (7.7%) paliperidone and 1 (7.7%) amisulpride.All patients had BMI and blood pressures recorded within the preceding month. Only 1 patient (7.7%) had an annual physical health examination within the past year.Findings for bloods taken within the past year were as follows:12 patients (92.3%) had an FBC recorded9 patients (69.2%) had U + Es recorded9 patients (69.2%) had LFTs recorded11 patients (84.6%) had HBA1c recorded7 patients (53.8%) had lipids recordedConclusionThere is scope for improvement with both annual physical examinations and blood monitoring.All patients had regular BMIs and blood pressure recorded which is largely attributable to nursing staff protocols. Low compliance with full annual physical examination could be explained by there being no local system in place for annual physical health checks and also frequent changes in junior doctor ward cover.Blood monitoring showed variable compliance with established standards. FBC monitoring had the best compliance, likely because the vast majority of our patients are prescribed clozapine, which necessitates minimal monthly FBC monitoring.This audit was presented to the Forensic Team and thereafter it was agreed for a local system to be put in place for annual physical health checks in the summer each year. This will improve oportunities to optimise our patients health. We plan to re-audit at this time.

scholarly journals Painless Livedoid Vasculopathy in a Patient with G20210A Prothrombin Gene Mutation

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Aibek E. Mirrakhimov ◽  
Erwin Velasquez Kho ◽  
Alaa Ali
Keyword(s):  
Physical Examination ◽  
Gene Mutation ◽  
Case Reports ◽  
Arterial Disease ◽  
Skin Lesions ◽  
Livedoid Vasculopathy ◽  
Prothrombin Gene Mutation ◽  
Prothrombin Gene ◽  
Work Up ◽  
Caucasian Female

87 year old Caucasian female with chronic painless non-healing ulcers over malleoli was admitted to the hospital. On a physical examination, there were two bilateral and laterally located malleoli ulcers with no discharge. A thorough work up was done: lower extremities venous and arterial Doppler ultrasound did not show any evidence of venous and arterial disease respectively. Heterozygous G20210A Prothrombin gene mutation was found, and the patient was started on anticoagulation. This case reports highlights a possibility of a painless livedoid vasculopathy presentation in a patient without significant past thrombotic events. Therefore, it is important to consider livedoid vasculopathy in the differential in a patient with painless ulcerative, atrophic and/or nodular skin lesions over the shins and malleoli.

scholarly journals Group B Streptococcus Meningitis Following Elective Termination of Pregnancy: Two Case Reports

1995 ◽  
Vol 2 (6) ◽  
pp. 275-278 ◽  
Author(s):  
Mark A. Walker ◽  
S. Gene McNeeley
Keyword(s):  
Case Reports ◽  
Group B Streptococcus ◽  
Altered Mental Status ◽  
Csf Analysis ◽  
Elective Abortion ◽  
Serious Infections ◽  
Physical Examinations ◽  
Group B ◽  
Elective Termination ◽  
Prompt Diagnosis

Background: Although maternal group B streptococcus (GBS) infections are common, serious infections are rare with prompt diagnosis and treatment. We present 2 cases of GBS meningitis occurring 3 and 10 days after elective abortion. In the first patient, GBS meningitis was definitely related to the elective termination. In the second patient, however, no evidence for a causal relationship could be established and can only be presumed.Case: The patients presented to the emergency department with headache, altered mental status, and fever. Their physical examinations were consistent with meningitis and confirmed by cerebrospinal fluid (CSF) analysis. One patient recovered completely and the other developed severe bilateral hearing loss.Conclusion: GBS meningitis is rare, occurring in men and women. When associated with pregnancy, most cases present within 48–72 h of delivery or abortion.

Pain processing in Schizophrenia

2011 ◽  
Vol 26 (S2) ◽  
pp. 2130-2130
Author(s):  
O. Bonnot ◽  
S. Tordjman
Keyword(s):  
Clinical Studies ◽  
Pain Sensitivity ◽  
Pain Threshold ◽  
Pain Perception ◽  
Psychiatric Patients ◽  
Case Reports ◽  
Experimental Studies ◽  
Self Report ◽  
Pain Expression ◽  
Endogenous Analgesia

We will propose a critical review of the scientific literature regarding pain and schizophrenia, examine the empirical basis for the reported pain insensitivity of schizophrenia, and emphasize the distinction between behavioral responses to pain or self-reported pain and physiological response to painful stimuli. Litterature is scarse and could be classified in 4 groups: case reports (n = 9), clinical studies (n = 23), experimental research (n = 20) and review articles (n = 5).The analysis of Case reports and clinical studies show reduced pain reactivity in patients with schizophrenia compared to healthy controls or other psychiatric patients. In the same vein, experimental studies using self-report measures of pain reactivity generally reported higher pain perception thresholds in patients with schizophrenia. However, the only experimental study using a neurophysiological measure of pain reactivity (the nociceptive RIII reflex) demonstrated a normal pain threshold in schizophrenia.Review of clinical and experimental data indicates that in most situations behavioral pain reactivity and self-reported responses to pain are reduced in schizophrenia. However, there is little or no physiological evidence supporting pain insensitivity in schizophrenia. It can be suggested that the widely accepted notion of reduced pain sensitivity in schizophrenia is related more to a different mode of pain expression than to a real endogenous analgesia. We will also present preliminary data on pain sensitivity associating behavioural pain reactivity measurements, "objective" electrophysiological assessments and neurovegetative function recordings. Our results are in the line of the literature and strongly suggest that there is no analgesia in schizophrenia but a different mode of pain expression.

Psychotropic Drug-Related Rhabdomyolysis

1992 ◽  
Vol 26 (7-8) ◽  
pp. 948-954 ◽  
Author(s):  
Donna M. Jermain ◽  
M. Lynn Crismon
Keyword(s):  
Adverse Effect ◽  
Psychotropic Drug ◽  
English Language ◽  
Psychiatric Patients ◽  
Case Reports ◽  
Data Extraction ◽  
Drug Induced ◽  
Individual Factor ◽  
Intramuscular Injections ◽  
Muscle Necrosis

OBJECTIVE: The objective of this review is to discuss the pathophysiology and potential etiologies of rhabdomyolysis in psychiatric patients, with an emphasis on psychotropic drug-induced rhabdomyolysis. DATA SOURCES: References were obtained through an on-line search of MEDLINE, using English-language and human literature only. STUDY SELECTION: Because the topic is a potential drug-induced adverse effect, no controlled studies are available. Most of the literature are case reports and series of case reports. DATA EXTRACTION: The quality of case reports was assessed using the Food and Drug Administration guidelines for assessing the causality of a potential adverse drug reaction. DATA SYNTHESIS: The results of this review are based on qualitative data and indicate that rhabdomyolysis in psychiatric patients can be from multiple etiologies, including agitation, dehydration, and intramuscular injections, as well as an adverse effect of psychotropic medications. Although the deficiencies of this type of data are recognized, it is the only type of data often available to assess the etiology and causality of an uncommon adverse event. CONCLUSIONS: Rhabdomyolysis in psychiatric patients can be caused by many factors, both drug- and non—drug-related. Rhabdomyolysis is more likely to occur when patients are faced with a combination of risk factors. When combinations of factors are present (e.g., aggression and restraints, intramuscular injections, and extrapyramidal effects), or when muscle trauma from an individual factor is sufficiently traumatic, muscle necrosis may occur to the point that rhabdomyolysis ensues.

Slipped capital femoral epiphysis and associated hypothyroidism. A review of the literature with two classic case examples

2016 ◽  
Vol 29 (4) ◽  
Author(s):  
James Moyer ◽  
Laura Jacks ◽  
Janel Darcy Hunter ◽  
Gilbert Chan
Keyword(s):  
Short Stature ◽  
Thyroid Dysfunction ◽  
Case Reports ◽  
Hormone Replacement ◽  
Slipped Capital Femoral Epiphysis ◽  
Cost Effective ◽  
Operative Management ◽  
Review Of The Literature ◽  
Case Examples ◽  
Atypical Presentations

AbstractSlipped capital femoral epiphysis (SCFE) is a relatively common hip disorder often seen in overweight, peripubertal children. Although the exact etiology is uncertain, it is generally accepted that underlying endocrinopathies play a role in the pathogenesis. Hypothyroidism is the endocrine disorder cited most commonly in association with SCFE, and patients often have no history of thyroid dysfunction at the time of presentation. Despite being a well-recognized risk factor, recommendations for screening thyroid function in patients with typical presentations of SCFE have not been deemed cost-effective; however, there is data to support screening for hypothyroidism in patients with atypical presentations of SCFE or short stature. Hypothyroidism may have a significant impact on healing and bone union after surgical management of SCFE and there is a paucity of case reports in the literature describing potential peri- and postoperative complications. We performed a systematic review of the literature of all reported cases of SCFE with associated hypothyroidism using the search terms, which demonstrated a physiologic relationship between hypothyroidism and SCFE. Two case reports of SCFE in patients with hypothyroidism and associated complications are presented with the literature review. There is a physiologic relationship between thyroid dysfunction and SCFE, and we postulate that profound hypothyroidism may contribute to delayed healing or nonunion in patients undergoing operative management. We support the recommendation to screen patients with short stature, atypical presentation of SCFE, or perisistent nonunion after surgery. In cases of hypothyroidism, we recommend thyroid hormone replacement and laboratory confirmation of return to euthyroid state prior to operative intervention.

scholarly journals Atypical presentations of malignant otitis externa

2010 ◽  
Vol 124 (11) ◽  
pp. 1205-1208 ◽  
Author(s):  
Z Vourexakis ◽  
M-I Kos ◽  
J-P Guyot
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Skull Base ◽  
Diagnostic Criteria ◽  
Otitis Externa ◽  
Case Reports ◽  
Clinical Manifestations ◽  
Diabetic Patients ◽  
Malignant Otitis Externa ◽  
Life Threatening ◽  
Atypical Presentations

AbstractIntroduction:Malignant otitis externa is a life-threatening infection of the skull base. Its presentation is not always typical.Case reports:We report three cases of malignant otitis externa which illustrate the diversity of its clinical manifestations and the difficulties in its diagnosis.Discussion:The perception of malignant otitis externa as an infection caused by Pseudomonas aeruginosa in diabetic patients is not always correct. The adoption of diagnostic criteria could be helpful in identifying atypical cases.

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