ABSTRACT
Background: At times, there is even a need for community involuntary treatment which may help in reducing the hospital admissions of patients with mentally illness. In India, there are very few State run psychiatric hospitals where patients get admitted and treated under section 20 of MHA 1987. There should be provisions for treating mentally ill in the community, if needed involuntarily. Detention of mentally ill for treatment during the time of florid psychosis is not a permanent solution for mental illness treatment. With the existing medicines these illnesses cannot be cured but can be controlled. So it leaves us with the option of using such detention only when no other method to treat is practicable. Such detention should best in the interest of the patient and the community. Aims: This study was an attempt to explore the practical problems in reintegrating the mentally ill back in to the community after their involuntary admission in comparison with the voluntary admission. Methods: This is a cross sectional study and data was collected from the medical records of 113 patients who were admitted in this hospital during the period of January 2010 to June 2010. Nearly 470 voluntary patients’ records were analysed during the above said period but by randomization they were limited to nearly 113 to equate with the involuntary admission. Results: Median duration of total hospitalization period in involuntary admission group of patients is 108 days with a minimum of 15 days and maximum of 460 days of admission. Median duration of involuntary stay at hospital is 91 days in some patients in whose reception orders there was a clear mention of what should be done after their treatment and recovery. In comparison to this group median duration of involuntary stay in others is 113 days as there was no clear mention in their reception orders about what should be done after their treatment and recovery. Conclusion: Most of the hospitals do not have any community social worker who can liaise with the family members to address their fears and to facilitate their early reintegration back in to home. There is a need for a review board consisting judiciary and medical personnel which can revoke the reception order at any point of time to minimize through duration of involuntary hospitalization in closed wards. Key message: Mentally ill patient rights need to be protected.
ABSTRACT
Background: Olanzapine is an atypical antipsychotic widely prescribed in schizophrenia patients because of its better tolerability. Clinical picture due to olanzapine over dosage can be confusing in the emergency department. Also often the patient would be drowsy to provide adequate information regarding the method of self harm attempt. Case description: We are reporting a case of olanzapine over dosage which presented to the emergency department with pin point pupils, lacrimation, and hypotension and semi conscious state. Discussion: Organophosphorous poison consumption is one of the common methods of suicide in rural south Indian setting which presents with miosis, respiratory depression and unconsciousness. Pontine hemorrhage is one more condition apart from opiod intoxication which presents with pin point pupils and altered mental status. Conclusion: We attributed olanzapine over dosage as the cause of pin point pupils, lacrimation and drowsiness in our case as other causes were excluded.