scholarly journals Managing Acute Agitation and Psychotic Symptoms in the Emergency Department

2020 ◽  
Vol 9 (2) ◽  
pp. 118-128
Author(s):  
Nidal Moukaddam ◽  
Raymond Choi ◽  
Veronica Tucci
Keyword(s):  
Physical Activity ◽  
Emergency Department ◽  
Differential Diagnosis ◽  
Psychotic Disorders ◽  
Psychotic Symptoms ◽  
Optimal Management ◽  
Emergency Physicians ◽  
Pharmacological Treatments ◽  
Antipsychotic Medications ◽  
Acute Agitation

Background and goals: It is fairly common for adolescents with a presenting problem of acute agitation to present to the Emergency Department. These patients present challenges with respect to both differential diagnosis and management. Furthermore, with many adolescents having extended stays in emergency departments, it is important for ED physicians to have a basic familiarity with diagnosis and treatment. Method: In this paper, we present a primer on the conditions underlying acute agitation and review approaches to management in the emergency department. Discussion: Psychotic disorders, such as schizophrenia, are distinct from other conditions presenting with psychotic symptoms, which can range from depression to substance use to non-psychiatric medical conditions. Agitation, a state of excessive verbal and physical activity, can accompany any of these conditions. Unlike the case for adults, practice guidelines do not exist, and there is no fully agreed upon expert consensus yet. Emergency physicians should have a working knowledge of antipsychotic medications and need to consider pharmacological as well as non-pharmacological treatments for optimal management.

scholarly journals Accidental transdermal methanol poisoning presenting to a regional emergency department

CJEM ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. 435-437
Author(s):  
Chelsea R. Beaton ◽  
Clinton Meyer
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Metabolic Acidosis ◽  
Laboratory Testing ◽  
Clinical Findings ◽  
Anion Gap ◽  
List Type ◽  
Emergency Physicians ◽  
Clinical Presentations ◽  
Learning Points

Learning Points:•Know and identify clinical presentations of toxic alcohols.•Understand the differential diagnosis of high anion gap metabolic acidosis.•Appreciate the importance of history and clinical findings in establishing methanol toxicity diagnoses, especially in centres where laboratory testing is unavailable.•Recognize the value of provincial poison centres in supporting emergency physicians in the diagnosis and management of poisonings and overdoses.

Audit of Antipsychotic Prescribing in a Private Psychiatric Hospital

2004 ◽  
Vol 12 (3) ◽  
pp. 227-233
Author(s):  
Lev Botvinik ◽  
Chee Ng ◽  
Isaac Schweitzer
Keyword(s):  
Psychiatric Hospital ◽  
Psychotic Disorders ◽  
Psychiatric Inpatient ◽  
Prescribing Patterns ◽  
Psychotic Symptoms ◽  
Inpatient Setting ◽  
Antipsychotic Medications ◽  
Published Evidence ◽  
Utility Cost ◽  
And Control

Objectives: There exists a substantial and growing body of evidence suggesting that antipsychotic medications are efficacious in the treatment of many non-psychotic psychiatric disorders. Although indications for the use of antipsychotics (particularly the atypicals) remain relatively narrow in Australia, psychiatrists seem to be using them for an expanding range of disorders in a variety of clinical settings. This has raised issues of costeffectiveness and methods of funding of these medications. The present study aimed to quantify and describe the patterns of prescribing of antipsychotic medications in a large private psychiatric hospital. Another aim was to compare the findings with other published evidence, and consider the implications of antipsychotic use for current clinical practice in Australia. Methods: A retrospective review of the medical records of 100 consecutive patients admitted to a private psychiatric hospital was conducted. The data collected included demographic details, major psychiatric diagnoses, all medications prescribed during the admission and their doses and, in the case of antipsychotics, the target symptoms/conditions for which they were prescribed. Results: Fifty-nine per cent of inpatients received at least one dose of an antipsychotic during their admission. While all patients with psychotic illnesses were treated with antipsychotics, 57% of patients with primary mood disorders and 40% of patients with a primary anxiety disorder also received an antipsychotic. The most common indications for use of antipsychotics included the treatment of psychotic symptoms, augmentation of antidepressants, relief of anxiety symptoms and lessening of agitation, and control of difficult behaviours (including self-harm and aggression) associated with personality disorders. The most frequently used antipsychotic was olanzapine (22%), followed by chlorpromazine (20%), and quetiapine (14%). Eleven per cent of patients received a combination of two antipsychotics. Conclusions: Antipsychotic medications were widely used in a private psychiatric inpatient setting for the treatment of non-psychotic disorders. This finding parallels those from other Australian studies of psychotropic prescribing patterns. The issues of clinical utility, cost-effectiveness and benefits of funding of these medications for such wider indications require further study and evaluation.

Assessing Diagnosis and Symptoms Profiles of Late-Life Psychosis

GeroPsych ◽  
2013 ◽  
Vol 26 (4) ◽  
pp. 205-209 ◽  
Author(s):  
Ali Javadpour ◽  
Maryam Sehatpour ◽  
Arash Mani ◽  
Ali Sahraian
Keyword(s):  
Differential Diagnosis ◽  
Mood Disorders ◽  
Psychotic Disorders ◽  
Late Onset ◽  
Late Life ◽  
Psychotic Symptoms ◽  
Elderly Persons ◽  
Visual Hallucinations ◽  
Symptom Profiles ◽  
Symptom Profile

Background: There are many controversies with regard to the nosology and conditions causing psychosis in old age people. This study defines a symptom profile and differential diagnosis of late-onset psychosis. Method: 201 elderly persons with psychotic symptoms were recruited. All patients were interviewed based on SCID-1 to confirm the possible diagnosis. Results: The most delusional symptom reported by the subjects was persecutory delusion, and visual hallucinations were the most common hallucination. The most repeated diagnosis was dementia, followed by psychosis due to mood disorders, primary psychotic disorders, delirium, and psychosis due to medical conditions. Conclusions: Results from the current study indicate that late-life psychoses form a heterogeneous group of disorders with varying symptom profiles and etiologies.

Substance-induced Psychotic Disorders in an Emergency Department

2017 ◽  
Vol 41 (S1) ◽  
pp. S203-S203
Author(s):  
A. Fernandez-Quintana ◽  
A. Novo-Ponte ◽  
C. Quiroga-Fernandez ◽  
M.D.C. Garcia-Mahia
Keyword(s):  
Emergency Department ◽  
Substance Abuse ◽  
Psychotic Disorders ◽  
Drug Misuse ◽  
Psychotic Symptoms ◽  
First Year ◽  
Time Interval ◽  
History Of ◽  
Competing Interest ◽  
Urine Testing

IntroductionSubstance abuse has been correlated with psychotic disorders albeit more accurate details on causality remain to be assessed. Furthermore, the prevalence and prognosis of substance-induced psychotic disorders have not been clearly established.MethodRetrospective study performed in 124 patients assessed in an Emergency Department (ED) due to psychotic symptoms over a 6-month period. Medical records were reviewed to obtain clinical and socio-demographic variables.Objectives(1) To analyse substance abuse patterns among ED psychotic patients; (2) to estimate the prevalence of substance-induced psychotic disorders in ED; (3) to underpin the socio-demographic and clinical variables associated.ResultsPersonal history of substance abuse: THC 31.5%, alcohol 29%, cocaine 18.5%, benzodiazepines 18.5%, opiates 6.5%, MDMA 4%, amphetamines 3.2%, hallucinogens 2.4%. Accumulated time interval of substance abuse prior to psychotic onset: 0–5 years 15% (3.9% developed psychosis during the first year of cannabis use), 5–10 years 9.2%, more than 10 years 20.8%. Urine testing for drug misuse undertaken in 80.6% of cases: positives 53%, negatives 47%. Among positive urine test results: THC 16.5%, benzodiazepines 16.5%, cocaine 6.1%, opiates 5.1%, alcohol 0.9%, amphetamines 0.8%, hallucinogens 0.8%. Substance-induced psychotic disorder (F19.15) was diagnosed among 20.4% of patients. This diagnosis was 1.5 times more prevalent among males. Forty-eight percent of patients were single, 36% married, 12% divorced, 4% widowers. Habitat: 68% urban, 34% rural. Highest prevalence group 36 – 50 year olds.ConclusionsBoth substance abuse and substance-induced psychotic disorders are highly prevalent in our sample. Their socio-demographic and clinical profile is similar to that found in schizophrenia. Further refinements of these findings are warranted.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Delusions and Hallucinations as First Symptoms of Frontotemporal Dementia: A Case Report of a 48-Year Old Male

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
R. Malta ◽  
C. Torres ◽  
T. Faria ◽  
S. Almeida
Keyword(s):  
Differential Diagnosis ◽  
Frontotemporal Dementia ◽  
Frontotemporal Lobar Degeneration ◽  
Psychotic Disorders ◽  
Functional Neuroimaging ◽  
Neuropsychiatric Symptoms ◽  
Psychotic Symptoms ◽  
Psychiatric Ward ◽  
Personality Changes ◽  
Behavior Impairment

Frontotemporal dementia (FTD) generally has a presenile onset, behavioral manifestations dominate the clinical picture during which cognitive functions are still relatively intact. Therefore, particularly in the early stages of FTD it is difficult to differentiate this type of dementia from other types of dementia and psychiatric disorders.Although most patients with frontotemporal dementia (FTD) present with neuropsychiatric symptoms, the frequency of psychotic symptoms, assumed to be rare, is still unclear possibly due to limited temporal-limbic involvement in this disorder. We report the case of a 48-year old man admitted in a psychiatric ward with delusions and hallucinations.Significant behavior impairment was present related to social isolation and personality changes. Structural and functional neuroimaging methods disclosed asymmetric frontal and bitemporal damage, mainly on the left. Differential diagnosis consisted of psychotic disorders as well as one of the subtypes of the frontotemporal lobar degeneration group.

scholarly journals P053: Mismatches in pre-injury activities and return-to-activity advice received by concussion patients presenting to the emergency department

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S82
Author(s):  
L. Gaudet ◽  
L. Eliyahu ◽  
M. Mrazik ◽  
J. Beach ◽  
G. Cummings ◽  
...  
Keyword(s):  
Physical Activity ◽  
Emergency Department ◽  
Return To Work ◽  
Activity Level ◽  
Future Research ◽  
Emergency Physicians ◽  
Physically Active ◽  
Physical Activity Advice ◽  
Patient Reported ◽  
Return To Activity

Introduction: Patients with concussion often present to the emergency department (ED). Current guidelines recommend graded return to work and physical activity (i.e., sport, recreation and exercise activities); however, whether emergency physicians target this advice based on patient-reported activities is unknown. This study aimed to assess mismatches between physicians’ rest and return-to-activity advice and self-reported pre-injury work and physical activity of adult concussion patients. Methods: Adults (>17 years) presenting with a concussion from April 2013 to April 2015 to a study ED with Glasgow coma scale score ≥13 were recruited by on-site research assistants. Data on patient characteristics (i.e., age, sex, employment, and physical activity level) and activity leading to injury were collected from structured patient interviews. A structured questionnaire collected data from the treating physician about discharge advice provided. “Working” was defined as employed or enrolled in any level of school at the time of injury. “Physically active” was defined by reporting regular exercise (≥2 times a week) or concussed during a sports-related activity. Proportions or medians (interquartile range [IQR]) are reported, as appropriate. Results: Physician questionnaires were completed for 198/248 enrolled patients (median age: 37 years [IQR: 23, 49]; 46% male). Overall, 89% (177/198) were working; 110/177 (62%) received return-to-work advice, while 10/21 (48%) patients also received return-to-work advice, despite not working. Mentally strenuous work/school duties were reported by 143 patients, of which 85 (60%) were recommended cognitive rest. Overall, 148 patients were physically active and 115 (78%) of these were recommended physical rest while 124 (82%) were advised on safe return to physical activity. On the other hand, 35/50 (70%) patients who were not physically active received advice on safe return to physical activity. Sustaining a sports-related injury significantly increased the likelihood of safe return to physical activity advice among physically active patients (Fisher's exact p = 0.001). Conclusion: There is a mismatch between concussed patients’ pre-injury activities, and the rest and return-to-activity (i.e., work and physical activity) advice provided by emergency physicians. The possible effect of this mismatch on patient outcomes should be assessed in future research, as should strategies to improve emergency physician-patient communications around concussion management.

scholarly journals Cognitive impairment in psychotic illness: prevalence, profile of impairment, developmental course, and treatment considerations

2019 ◽  
Vol 21 (3) ◽  
pp. 239-248 ◽  
Keyword(s):  
Cognitive Impairment ◽  
Functional Outcomes ◽  
Psychotic Disorders ◽  
Clinical Population ◽  
Psychotic Symptoms ◽  
Pharmacological Treatments ◽  
Psychotic Illness ◽  
Important Target ◽  
Treatment Considerations ◽  
Developmental Course

Despite effective pharmacological treatments for psychotic symptoms (eg, hallucinations, delusions), functional outcomes for people with psychotic disorders are often disappointing. Although it is not included in the diagnostic criteria for psychotic disorders, cognitive impairment is one of the strongest determinants of community functioning in this clinical population, and thus it is an important target for intervention. In this review, we discuss the major areas of research regarding impaired cognition in psychotic illness. The specific topics covered include: (i) the prevalence of cognitive impairment in psychotic disorders; (ii) the profile and magnitude of cognitive impairment in psychotic disorders; (iii) the developmental course of cognitive impairment; (iv) the longitudinal stability of cognitive impairment; and (v) treatment approaches to improve cognitive performance in people with psychotic disorders.

scholarly journals Management of sepsis and septic shock in the emergency department

2021 ◽  
Author(s):  
Francesco Gavelli ◽  
Luigi Mario Castello ◽  
Gian Carlo Avanzi
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Patient Management ◽  
Emergency Physicians ◽  
Surviving Sepsis Campaign ◽  
Sepsis Management ◽  
Early Management ◽  
New Information ◽  
Sepsis And Septic Shock ◽  
Early Phases

AbstractEarly management of sepsis and septic shock is crucial for patients’ prognosis. As the Emergency Department (ED) is the place where the first medical contact for septic patients is likely to occur, emergency physicians play an essential role in the early phases of patient management, which consists of accurate initial diagnosis, resuscitation, and early antibiotic treatment. Since the issuing of the Surviving Sepsis Campaign guidelines in 2016, several studies have been published on different aspects of sepsis management, adding a substantial amount of new information on the pathophysiology and treatment of sepsis and septic shock. In light of this emerging evidence, the present narrative review provides a comprehensive account of the recent advances in septic patient management in the ED.

Chronic mesenteric ischaemia presenting as possible large bowl malignancy: an easily overlooked differential diagnosis

2021 ◽  
Vol 14 (3) ◽  
pp. e240202
Author(s):  
Benjamin McDonald
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Weight Loss ◽  
Differential Diagnosis ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Mesenteric Ischaemia ◽  
Abdominal Symptoms ◽  
Chronic Mesenteric Ischaemia ◽  
Descending Colon

An 80-year-old woman presented to a regional emergency department with postprandial pain, weight loss and diarrhoea for 2 months and a Computed Tomography (CT) report suggestive of descending colon malignancy. Subsequent investigations revealed the patient to have chronic mesenteric ischaemia (CMI) with associated bowel changes. She developed an acute-on-chronic ischaemia that required emergency transfer, damage control surgery and revascularisation. While the patient survived, this case highlights the importance of considering CMI in elderly patients with vague abdominal symptoms and early intervention to avoid potentially catastrophic outcomes.

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