ABSTRACT
An increasing number of elderly patients are presenting to the emergency department. Numerous studies have observed that emergency physicians often fail to identify and diagnose delirium in the elderly. These studies also suggest that even when emergency physicians recognized delirium, they still may not have fully appreciated the import of the diagnosis. Delirium is not a normal manifestation of aging and, often, is the only sign of a serious underlying medical condition. This article will review the significance, definition, and principal features of delirium so that emergency physicians may better appreciate, recognize, evaluate, and manage delirium in the elderly.
Subject(s)
Anti-Anxiety Agents , Substance-Related Disorders , Triazolam , Adult , Diazepam , Humans , Male , Substance Withdrawal SyndromeABSTRACT
The historical uniqueness of the Vietnam War produced an unusually high rate of psychiatric dysfunction among veterans, particularly in the form of posttraumatic stress disorder (PTSD). Now, in the wake of unprecedented media coverage of PTSD and the growth of veteran outreach centers documenting and publicizing the difficulties of some veterans, a heretofore unrecognized variant of PTSD-factitious PTSD--has arisen. The authors present seven cases of factitious PTSD, a classic example of clinical deception found among veterans who were never in combat and, in some cases, were never in Vietnam. The authors discuss the etiologies of the disorder and the underlying psychopathology, which suggests either factitious syndromes, such as Munchausen's, or malingering. They conclude with recommendations for diagnosis and treatment.
Subject(s)
Combat Disorders/diagnosis , Factitious Disorders/diagnosis , Stress Disorders, Post-Traumatic/diagnosis , Veterans/psychology , Adult , Combat Disorders/psychology , Diagnosis, Differential , Factitious Disorders/psychology , Humans , Male , VietnamSubject(s)
Alcoholism/therapy , Psychotherapy , Attitude of Health Personnel , Denial, Psychological , Family , Grief , Humans , Motivation , Self ConceptABSTRACT
The authors describe one phase of a four-step procedure designed to more fully evaluate candidates for psychotherapist positions. All applicants must conduct an interview with a patient, which is observed and evaluated by a team of staff members to assess diagnostic skills. This procedure has not only proved valuable in the program for which it was designed but has been extended to other programs and proposed for use in peer review.
