scholarly journals Routine pre admission laboratory screening investigations in aggressive patients who require sedation in the emergency department – necessary or unnecessary

2009 ◽  
Vol 15 (3) ◽  
pp. 5
Author(s):  
Shamima Saloojee
Keyword(s):  
Emergency Department ◽  
Mental Illness ◽  
Physical Examination ◽  
Psychiatric Illness ◽  
Past History ◽  
Behavioural Control ◽  
Full Blood Count ◽  
Laboratory Screening ◽  
History Of ◽  
Laboratory Investigations

<p><strong>Background</strong>: The triage of aggressive patients who require sedation for behavioural control in the emergency department (ED) at our hospitals is delayed because the results of mandatory screening laboratory investigations to exclude a general medical condition (GMC) must be available prior to a psychiatric referral. The monitoring of these sedated patients in the ED is the problem.</p><p><strong>Objective</strong>: The primary objective of this study was to determine the value of the results of routine pre-admission laboratory screening investigations in the differentiation of a medical from a psychiatric cause of aggression in consecutive aggressive patients who required sedation in the EDs at King Edward V111 and Addington Hospitals. Specific objectives were to determine if there was an association between a history of past psychiatric illness, the physical examination, the results of laboratory screening investigations and the cause of the aggression.</p><p><strong>Methods</strong>: a retrospective chart review of 339 consecutive aggressive patients who required intravenous or intramuscular sedation for behavioural control in the EDs of Addington and King Edward V111 Hospitals in Kwa Zulu Natal (KZN) was conducted from 01 January 2006 to 31 December 2006. Patients who required oral or no sedation were excluded from the study. <strong></strong></p><p><strong>Results:</strong> 82 (24.2%) of the 339 patients in the study had a medical cause for the aggression .40 (11.7%) of these had no previous medical history. Overall the yield of clinically significant results from laboratory investigations was 9.6%. No past history of psychiatric illness, physical examination, the Full Blood Count (FBC), Urea and Electroloyte estimation (U&amp;E) and Random Blood Glucose (RBG) had sensitivities of 28%, 63%, 57%, 40% and 21% respectively for the identification of a GMC causing the aggression. The variables that remained significantly associated with a causal GMC were an abnormal physical examination only (OR 42.151), an abnormal FBC (OR 2.363),an abnormal U &amp; E (OR 3.531) and no past history of mental illness combined with an abnormal physical examination (OR 277.442). A previous history of a mental illness only was not significantly associated with the cause of aggression. These are adjusted odds ratios, ie they are independent of the effects of the other variables.</p><p><strong> Conclusion:</strong> The high rate of a medical cause for the aggressive behaviour and the overall yield from screening laboratory investigations emphasize the need for mandatory screening to exclude a GMC in the EDs of our hospitals. Aggressive patients with a documented past psychiatric history and a normal physical examination can be referred for a psychiatric assessment prior to the results of routine laboratory investigations becoming available.</p>

Quality of parenting and vulnerability to depression: results from a family study

1998 ◽  
Vol 28 (1) ◽  
pp. 185-191 ◽  
Author(s):  
C. DUGGAN ◽  
P. SHAM ◽  
C. MINNE ◽  
A. LEE ◽  
R. MURRAY
Keyword(s):  
Mental Illness ◽  
Family Study ◽  
Past History ◽  
Familial Risk ◽  
Self Report ◽  
History Of ◽  
Quality Of Parenting ◽  
Independent Effects ◽  
The Relationship ◽  
History Of Depression

Background. We examined a group of subjects at familial risk of depression and explored the relationship between the perceptions of parents and a history of depression. We also investigated: (a) whether any difference in perceived parenting found between those with and without a past history of depression was an artefact of the depression; and (b) whether the relationship between parenting and depression was explained by neuroticism.Method. We took a sample of first-degree relatives selected from a family study in depression and subdivided them by their history of mental illness on the SADS-L, into those: (a) without a history of mental illness (N=43); and (b) those who had fully recovered from an episode of RDC major depression (N=34). We compared the perceptions of parenting, as measured by the Parental Bonding Instrument (PBI), in these two groups having adjusted for the effect of neuroticism and subsyndromal depressive symptoms. We also had informants report on parenting of their siblings, the latter being subdivided into those with and without a past history of depression.Results. Relatives with a past history of depression showed lower care scores for both mother and father combined compared with the never ill relatives. The presence of a history of depression was associated with a non-significant reduction in the self-report care scores compared to the siblings report. Vulnerable personality (as measured by high neuroticism) and low perceived care were both found to exert independent effects in discriminating between the scores of relatives with and without a history of depression and there was no interaction between them.Conclusion. This study confirmed that low perceived parental care was associated with a past history of depression, that it was not entirely an artefact of having been depressed, and suggested that this association was partially independent of neuroticism.

scholarly journals Perichondritis: inspect the lobule

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Eli Bress ◽  
Jason E. Cohn
Keyword(s):  
Emergency Department ◽  
Physical Examination ◽  
Marked Improvement ◽  
Otitis Externa ◽  
Left Auricle ◽  
Case Presentation ◽  
Physical Examination Finding ◽  
Examination Finding ◽  
History Of ◽  
Caucasian Female

Abstract Case presentation This is a brief report of a 57-year-old Caucasian female presented with a 4-day history of worsening left ear pain. Her symptoms began with left otalgia and otorrhea which progressed to helical erythema, prompting a visit to the emergency department. She was noted to have erythema of the left auricle and swelling of the left auditory meatus. Our otolaryngology service observed erythema of the auricle with sparing of the lobule. Diagnosis The diagnosis to be otitis externa with perichondritis was established, and we recommended otic ciprofloxacin-hydrocortisone, IV vancomycin, and ciprofloxacin. The patient had marked improvement and was discharged on an oral and otic fluoroquinolone. In this case, the diagnosis of perichondritis was made by a classic physical examination finding: erythema and edema with sparing of the fatty lobule. This key finding helps to distinguish perichondritis from otitis externa.

Predictors of ICU admission and long-term outcomes in overdose presentations to Emergency Department

2020 ◽  
Vol 28 (1) ◽  
pp. 75-79
Author(s):  
Mark Savage ◽  
Ross Kung ◽  
Cameron Green ◽  
Brandon Thia ◽  
Dinushka Perera ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Emergency Department ◽  
Psychiatric Illness ◽  
Atypical Antipsychotics ◽  
Long Term Outcomes ◽  
Icu Admission ◽  
History Of

Objective: To describe the characteristics of patients presenting to an Emergency Department (ED) following overdoses; to identify risk factors for intensive care unit (ICU) admission among these patients; and to identify the rate of mortality and repeat overdose presentations over four years. Methods: Adult patients presenting to ED following drug overdose during 2014 were included. Data were collected from medical notes and hospital databases. Results: During the study period, 654 patients presented to ED 800 times following overdose. Seventy-eight (9.8%) resulted in ICU admission, and 59 (7.4%) required intubation; 57.2% had no history of overdose presentations, and 72.9% involved patients with known psychiatric illness. Overdose of atypical antipsychotics (AAP), age and history of prior overdose independently predicted ICU admission. A third of patients ( n = 196, 30%) had subsequent presentations to ED following overdose, in the four years from their index presentation, with an all-cause four-year mortality of 3.4% ( n = 22). Conclusion: A history of overdose, use of AAP and older age were risk factors for ICU admission following ED presentations. Over a third of patients had repeat overdose presentation in the four-year follow-up with a mortality of 3.4%.

scholarly journals Risk of puerperal and non-puerperal recurrence of illness following bipolar affective puerperal (post-partum) psychosis

2005 ◽  
Vol 186 (3) ◽  
pp. 258-259 ◽  
Author(s):  
Emma Robertson ◽  
Ian Jones ◽  
Sayeed Haque ◽  
Roger Holder ◽  
Nick Craddock
Keyword(s):  
Mental Illness ◽  
Value Of Information ◽  
Psychiatric Illness ◽  
Post Partum ◽  
Positive Family History ◽  
Psychotic Episode ◽  
Clinical Value ◽  
Puerperal Psychosis ◽  
History Of

SummaryThe clinical value of information on the risk of future psychiatric illness in women who have experienced puerperal (post-partum) psychosis has been limited by inconsistencies in terminology and nosology. Here we report rates of subsequent puerperal and non-puerperal episodes, in a well-characterised sample of women diagnosed with clearly defined bipolar affective puerperal psychosis (n=103). Out of 54 women having further children, 31 (57%; 95% Cl 44–69) experienced an additional puerperal psychotic episode, and 64 of 103 women (62%; 95%Cl 52–71) experienced a non-puerperal affective episode during the follow-up period (mean duration 9 years). A history of bipolar episodes prior to the puerperal psychosis did not predict risk following subsequent pregnancies, but positive family history of mental illness predicted shorter time to non-puerperal relapse.

scholarly journals AMYGDALECTOMY AND SCHIZOPHRENIA: A CASE PERSPECTIVE

2020 ◽  
pp. 89-91
Author(s):  
Sail D.B. ◽  
Thorat N.M. ◽  
Phutane P.V.
Keyword(s):  
Marked Improvement ◽  
Psychiatric Illness ◽  
Past History ◽  
Mental Illnesses ◽  
Treatment Modalities ◽  
Past Century ◽  
Variable Degree ◽  
The Past ◽  
History Of ◽  
Mental Status Examination

Introduction: In the past century patients with mental illnesses were treated by invasive brain surgeries which clinically resulted in a variable degree of effectiveness. We report a case of stereotactic amygdalectomy performed in a case of schizophrenia which later required medical management due to failure of the surgical procedure. Case: A 24 years old unmarried male with a past history of psychiatric illness was brought and admitted for behavioural disturbances. He recently had undergone bilateral amygdalectomy for his illness. A detailed history and mental status examination revealed diagnosis of schizophrenia. He was treated with ECTs and Clozapine on which he showed marked improvement without any side effects. Conclusion: In patients of schizophrenia psychosurgery shall be an option only after an adequate trial of pharmacotherapy and other treatment modalities.

scholarly journals Problem-Based Review: Paracetamol Overdose

2011 ◽  
Vol 10 (4) ◽  
pp. 212-215
Author(s):  
Tom Heaps ◽  
Keyword(s):  
Emergency Department ◽  
Glasgow Coma Scale ◽  
Past History ◽  
Previous History ◽  
Past Medical History ◽  
Minute Period ◽  
Normal Diameter ◽  
History Of ◽  
Self Harm ◽  
History Of Depression

A 29-year old male presents to the emergency department 1h after an overdose of cocodamol. He admits to taking approximately 60 x 8/500mg tablets, with alcohol, over a 20 minute period. He has a past history of depression, treated by his GP with citalopram 20mg OD. He has no previous history of deliberate self-harm. His past medical history is otherwise unremarkable and he is not on any additional medications. He drinks approximately 40 units of alcohol per week. Physical examination is unremarkable, his pupils are normal diameter and his Glasgow Coma Scale is 15. He weighs 82kg.

The Madness of Fear

2018 ◽  
Author(s):  
Edward Shorter ◽  
Max Fink
Keyword(s):  
Emergency Department ◽  
Psychiatric Illness ◽  
Fatal Outcome ◽  
Psychiatric Emergency ◽  
Food Refusal ◽  
Dementia Praecox ◽  
Convulsive Therapy ◽  
Single Term ◽  
History Of ◽  
Medical Historian

This is the first history of the psychiatric illness called catatonia, virtually forgotten by medicine yet often present in severely ill patients. The main symptoms of catatonia affect movement and thought, including staring, stupor, mutism, food refusal, negativism, and even psychosis. These symptoms are age-old, but they were brought together in the single term “catatonia” by German psychiatrist Karl Kahlbaum in 1874. Yet, 30 years later, catatonia disappeared from view as an independent illness, turned into a “subtype” of dementia praecox (schizophrenia). There, catatonia remained submerged from view for almost a century, rediscovered again as a disease of its own in the 1990s. Today, catatonic symptoms are seen in around one in ten admissions to a psychiatric emergency department. Untreated, catatonia may have a fatal outcome. Interest today has been increasing because of the discovery that, unlike schizophrenia, catatonia responds readily to therapy, with the symptoms vanishing without a trace. The authors argue that catatonia may be a response to fear and alarm triggered by trauma; during a stupor, patients often experience terrifying images and thoughts. Edward Shorter is a medical historian who has written widely about psychiatry. Max Fink is a clinician whose writings on melancholia, catatonia, and convulsive therapy have been internationally recognized.

A case of Fournier’s gangrene diagnosed with POCUS

POCUS Journal ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 3
Author(s):  
Marco Badinella Martini, MD ◽  
Antonello Iacobucci, MD
Keyword(s):  
Type 2 Diabetes ◽  
Emergency Department ◽  
Alzheimer Disease ◽  
Physical Examination ◽  
Subcutaneous Emphysema ◽  
Vital Signs ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
History Of

An 87-year-old man with a history of type 2 diabetes and severe Alzheimer disease was admitted to the emergency department with a lesion of the perineum for two days. The patient appeared agitated and not collaborating on the visit. His vital signs were normal. Physical examination revealed an edematous, suppurative, and foul-smelling perineal-scrotal lesion, with possible subcutaneous emphysema.

Hand-foot lesion in old age asthmatic women

2015 ◽  
Vol 3 (1) ◽  
pp. 314-317
Keyword(s):  
Oral Cavity ◽  
Physical Examination ◽  
Old Age ◽  
Past History ◽  
Laboratory Findings ◽  
Normal Limits ◽  
History Of ◽  
Complete Blood Counts

papulovesicular eruption on the hands which had begun to appear on the palms of her hands 2 days previously and which progressed to the soles, and dorsum of the feet. He had past history of asthma for more than 30-years and was taking bronchodilator and steroid medications. Physical examination revealed multiple erythematous papules on the palms, soles. The oral cavity and other areas such as face and trunk were spared. Laboratory findings, including complete blood counts and blood chemistries, were within normal limits. After 3 1/2 weeks he was commenced on oral aciclovir 200 mg five times daily, with subsequent resolution of all lesions within 5 days.

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