ABSTRACT
BACKGROUND: The risk of depression and the fear of reinjury were documented in recent investigations of patients after anterior cruciate ligament (ACL) ruptures. The extent of psychological trauma accompanying these injuries among young athletes, however, has never been assessed. HYPOTHESIS: Posttraumatic stress disorder (PTSD) symptoms after ACL injury are present among young athletes with high athletic identities. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Patients ≤21 years of age who had suffered an acute ACL rupture were consecutively recruited at a tertiary care center. Patients completed the Horowitz Impact of Event Scale - Revised (IES-R) to analyze for PTSD symptomatology, the Athletic Identity Measurement Scale, and an athlete specialization instrument created at the authors' institution. RESULTS: A total of 24 patients were consecutively recruited. The mean patient age was 14.5 ± 2.7 years, and 50% of patients were male. More than 87.5% of patients experienced avoidance symptoms, 83.3% acknowledged symptoms of intrusion, and 75% had symptoms of hyperarousal. Patients aged 15 to 21 years incurred a higher severity of PTSD symptoms than younger patients (P = .033). Female patients experienced greater emotional trauma than male patients (P = .017). Finally, patients with high athletic identities experienced greater emotional trauma than those with lesser athletic identities, but this finding was not statistically significant (P = .14). CONCLUSION: Following ACL rupture, young athletes experience significant emotional trauma, including symptoms of avoidance, intrusion, and hyperarousal. High school and college athletes, female athletes, and patients with high athletic identities may be most susceptible.
Subject(s)
Anti-Bacterial Agents/adverse effects , Antifungal Agents/adverse effects , Anxiety Disorders/etiology , Depressive Disorder/etiology , Drug-Related Side Effects and Adverse Reactions/epidemiology , Penicillins/adverse effects , Psychotic Disorders/etiology , Quinolones/adverse effects , Sulfonamides/adverse effects , Female , Humans , MaleABSTRACT
OBJECTIVE: Given the limited literature reporting on the medical comorbidity of patients attending psychiatric day treatment, we studied the medical status and care of a cohort of 100 patients for 1 year following enrollment in a day treatment program at a public sector hospital. METHODS: Data were abstracted from electronic medical records retrospectively for the year following day treatment enrollment. Study variables included lifetime medical and psychiatric diagnoses documented in the medical record, patient measures performed during the study year (including laboratory, diagnostic, and physical measures), current medication, and encounters within the hospital system. RESULTS: Despite an average age of only 41 years for the cohort, 80% had 1 or more major medical diagnoses. For the 57 subjects with laboratory studies performed during the 1-year study interval, more than half had abnormal results. Forty-three subjects had no laboratory studies during the study interval. Forty-four were seen in the emergency room and an equal number in the medicine clinic. CONCLUSIONS: The occurrence of medical co-morbidity in this population was alarmingly high. The vigor of medical care provided was greater than one would expect for a psychiatric population averaging 41 years of age, although there were inadequacies reflecting a lack of standardized medical assessment at entry to day treatment. We propose a reconceptualization for day treatment, incorporating full medical screening as a standard component of entrance into day treatment.
Subject(s)
Health Status Indicators , Mental Disorders/therapy , Adult , Ambulatory Care , Comorbidity , Female , Humans , Male , Mental Disorders/diagnosis , Retrospective StudiesSubject(s)
Delivery of Health Care, Integrated/organization & administration , Mental Disorders/therapy , Mental Health Services/organization & administration , Delivery of Health Care, Integrated/standards , Hospitalization , Humans , Life Expectancy , Mental Disorders/mortality , Mental Health Services/standards , Minnesota/epidemiology , Models, Organizational , Needs Assessment , Outpatient Clinics, Hospital/organization & administration , Program Evaluation/methods , Quality ImprovementSubject(s)
Benzazepines/adverse effects , Depressive Disorder, Major/chemically induced , Nicotinic Agonists/adverse effects , Quinoxalines/adverse effects , Receptors, Nicotinic/drug effects , Smoking Cessation , Aged , Benzazepines/therapeutic use , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/psychology , Dose-Response Relationship, Drug , Drug Administration Schedule , Humans , Male , Nicotinic Agonists/therapeutic use , Quinoxalines/therapeutic use , Recurrence , VareniclineABSTRACT
Psychiatric consultations to evaluate a patient's suitability to receive organ transplantation can require the integration of multiple types and sources of information. A patient's social support network, history of treatment compliance, ongoing Axis I and Axis II disorders, and understanding of the procedure and follow-up required must all be evaluated during such a consultation. This article presents the case of a woman with borderline personality disorder who developed hepatic failure following a drug overdose, and discusses her evaluation for liver transplantation. The discussion frames the pertinent issues in the transplant evaluation and describes the perioperative (transplant) management of the borderline patient.
