Tension Pneumoperitoneum after Cardiopulmonary Resuscitation

A 61-year-old chronic schizophrenic patient developed sudden cardiac arrest and ventricular fibrillation. Tension pneumoperitoneum was noted after cardiopulmonary resuscitation. The patient had hypotension, lower limbs cyanosis and priapism. The tension was relieved by insertion of a large bore IV catheter through the abdominal wall. Immediately after decompression, the blood pressure improved with the lower limbs cyanosis and priapism resolved.

Continuing Clozapine Despite Neutropenia

BackgroundA 40-year-old chronic schizophrenic patient whose psychosis and associated violent behaviour resolved on clozapine, required chemotherapy for a testicular teratoma with pulmonary metastases. His treatment was initially delayed due to refusal to consent.TreatmentThe patient finally agreed to orchidectomy and cytotoxic therapy, and following agreement by the CPMS, clozapine continued to be dispensed despite neutropenia and ‘red alert’ status on full blood count.DiscussionThis is the only patient to continue clozapine despite ‘red alert’ status, and as such is an exceptional case, but may open the way for such patients in the future.

Legally Untreatable — A New Category of Long Stay Patient?

The case is presented of a young and violent chronic schizophrenic patient whose symptoms respond to antipsychotic medication but who was recorded, at a time when he was deemed competent, as expressing a wish that he should not be given antipsychotic treatment. Under the present usage of the Ontario Mental Health Act, substitute consent givers are bound by such a “prior competent wish” and this patient must now be considered one of a growing group of “legally untreatable” psychotic patients.

Early Signs Monitoring Through a Period of Relapse in a Highly Symptomatic Chronic Schizophrenic Patient

The Early Signs Scale (Birchwood et al., 1989) for the monitoring of prodromal symptoms was used with a schizophrenic inpatient with severe residual psychotic symptoms. Marked changes in the scores were obtained in both self and observer reports during a period in which the patient was considered to “relapse”. The results suggest the possible wider applicability of the Early Signs Scale to patients who experience severe residual symptoms between relapse episodes.

A Misleading Case of Central Pontine Myelinolysis

Central pontine myelinolysis (CPM) is an uncommon disorder initially described in alcoholic or malnourished patients. Recent reports suggest an aetiological association with abnormalities of serum sodium. A physically unwell non-alcoholic chronic schizophrenic patient, whose symptoms led to psychiatric referral, died of CPM. A review of the literature reveals that psychiatric patients may indeed be at risk for CPM.British Journal of Psychiatry (1992), 160, 550–552