ABSTRACT
Neuroleptic Malignant Syndrome (NMS) is a life threatening complication of antipsychotic therapy. It is often assumed to be rare. Observations suggest that rather than overestimating its frequency, we are more likely to underestimate it (Pope et al., 1986). It is a rare but potentially fatal disorder characterized by four principal symptoms. These are mental status changes, muscle rigidity, hyperthermia, and autonomic dysfunction. The diagnosis of NMS often presents a challenge because several medical conditions generate similar symptoms. Although less common now than in the past, thanks to greater awareness, it remains a risk in susceptible patients receiving conventional or atypical neuroleptics. Reducing the risk factors, early recognition of suspected cases, and prompt management can significantly reduce morbidity and mortality of this dangerous condition. Collaboration between psychiatry and other medical specialities may be the key to a successful outcome.
Subject(s)
Autonomic Nervous System Diseases/diagnosis , Fever/diagnosis , Muscle Rigidity/diagnosis , Neuroleptic Malignant Syndrome/diagnosis , Autonomic Nervous System Diseases/etiology , Diagnosis, Differential , Fever/etiology , Humans , Muscle Rigidity/etiology , Neuroleptic Malignant Syndrome/complications , Neuroleptic Malignant Syndrome/prevention & control , Neuroleptic Malignant Syndrome/therapy , Risk FactorsABSTRACT
OBJECTIVE: A link between cancer and limbic encephalitis (LE) has been proposed. The aim of this case presentation is to further explore this association by literature review, inform clinicians of the investigations necessary to arrive at a diagnosis and to emphasize the clinical importance of liaison between psychiatry and other disciplines involved in management. METHOD: The case report of a 55 year old Niuean male school teacher with an acute onset of confusion and personality change is presented. The clinical data was obtained from various sources including the emergency room, medical ward, psychiatric ward as well as from discussions with other physicians involved in the management of this case. Family members and friends were also contacted to obtain corroborative historical information. RESULTS: LE was diagnosed in this case based on clinical presentation with psychiatric symptoms, ruling out delirium due to infections, metabolic and other toxins as well as magnetic resonance imaging findings confirming temporal lobe changes. CONCLUSION: LE is a known paraneoplastic syndrome (PNS) that may precede the diagnosis of an underlying malignancy. Recent advances in laboratory technology now allow for antibodies to be identified in specific malignancies. This behooves the clinicians to maintain a high level of diagnostic suspicion so that timely interventions with oncology can follow.
Subject(s)
Limbic Encephalitis/diagnosis , Acute Disease , Antipsychotic Agents/therapeutic use , Clonazepam/therapeutic use , Confusion/diagnosis , Confusion/psychology , Delirium/diagnosis , Delirium/psychology , Electroencephalography/statistics & numerical data , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunosuppression Therapy/methods , Limbic Encephalitis/psychology , Limbic Encephalitis/therapy , Magnetic Resonance Imaging/statistics & numerical data , Male , Middle Aged , Neoplasms/drug therapy , New Zealand , Patient Care Team , Plasma Exchange , Practice Patterns, Physicians' , Prednisone/therapeutic use , Psychiatric Status Rating Scales/statistics & numerical data , Steroids/therapeutic useABSTRACT
PURPOSE: To evaluate an emergency department's use of a mental health triage and mental health crisis counsellor for persons presenting with mental health concerns. METHOD: Mixed method (qualitative and quantitative), multiple measures. RESULTS: Significant pre- and post-intervention reductions for wait time, security incidents and hospital admissions were found. Follow ups with a community agency, medications and a psychiatrist increased post-intervention, while follow ups with detox decreased post-intervention. CONCLUSIONS: The qualitative and quantitative findings are congruent with other studies supporting the use of properly implemented mental health triage and crisis counsellors to improve the care of persons with mental health concerns.
