Subject(s)
Catatonia/therapy , Depressive Disorder/therapy , Electroconvulsive Therapy/adverse effects , Selective Serotonin Reuptake Inhibitors/adverse effects , Serotonin Syndrome/etiology , Serotonin and Noradrenaline Reuptake Inhibitors/adverse effects , Adult , Combined Modality Therapy/adverse effects , Female , Humans , Male , Serotonin Syndrome/chemically induced , Stupor/therapy , Young AdultSubject(s)
Acidosis, Respiratory/etiology , Atrial Fibrillation/surgery , Bundle-Branch Block/etiology , Carbon Dioxide/blood , Catheter Ablation , Conscious Sedation/adverse effects , Stupor/etiology , Acidosis, Respiratory/blood , Acidosis, Respiratory/diagnosis , Acidosis, Respiratory/therapy , Action Potentials , Adult , Atrial Fibrillation/diagnosis , Atrial Fibrillation/physiopathology , Bundle-Branch Block/diagnosis , Bundle-Branch Block/physiopathology , Electrocardiography , Heart Rate , Humans , Male , Risk Factors , Severity of Illness Index , Stupor/blood , Stupor/diagnosis , Stupor/therapy , Treatment OutcomeABSTRACT
Psychiatric emergencies present a frequent and interdisciplinary challenge. Clinical diagnosis and management are complicated by the acuity, and the patient's compliance is often limited by the illness. Psychiatric emergencies include states of acute agitation, suicidality, delirium, stupor, and drug-induced emergencies. Sometimes interventions such as conversational contact, responding empathically to patients, or "talking down" are sufficient. If pharmacotherapy is necessary, benzodiazepines and antipsychotic drugs are the primary agents of choice.
Subject(s)
Emergency Services, Psychiatric/methods , Interdisciplinary Communication , Intersectoral Collaboration , Mental Disorders/diagnosis , Mental Disorders/therapy , Acute Disease , Alcoholic Intoxication/diagnosis , Alcoholic Intoxication/psychology , Alcoholic Intoxication/therapy , Dangerous Behavior , Delirium/diagnosis , Delirium/psychology , Delirium/therapy , Disease Progression , Humans , Illicit Drugs/toxicity , Mental Disorders/psychology , Psychomotor Agitation/diagnosis , Psychomotor Agitation/psychology , Psychomotor Agitation/therapy , Psychotropic Drugs/toxicity , Stupor/diagnosis , Stupor/psychology , Stupor/therapy , Substance-Related Disorders/diagnosis , Substance-Related Disorders/psychology , Substance-Related Disorders/therapy , Suicidal IdeationABSTRACT
Stupor and coma are clinical states in which patients have impaired responsiveness or are unresponsive to external stimulation and are either difficult to arouse or are unarousable. The term stupor refer to states between alertness and coma. An alteration in arousal represents an acute life-threatening emergency, requiring prompt intervention for preservation of life and brain function.
Subject(s)
Consciousness Disorders/diagnosis , Consciousness Disorders/therapy , Emergencies , Arousal , Coma/classification , Coma/diagnosis , Coma/etiology , Coma/therapy , Consciousness Disorders/classification , Consciousness Disorders/etiology , Diagnosis, Differential , Disorders of Excessive Somnolence/classification , Disorders of Excessive Somnolence/diagnosis , Disorders of Excessive Somnolence/etiology , Glasgow Coma Scale , Humans , Interdisciplinary Communication , Intersectoral Collaboration , Neurologic Examination , Prognosis , Stupor/classification , Stupor/diagnosis , Stupor/etiology , Stupor/therapy , Unconsciousness/classification , Unconsciousness/diagnosis , Unconsciousness/etiology , Unconsciousness/therapyABSTRACT
Neurological complications of haemolytic uraemic syndrome (HUS) include altered states of consciousness, seizures, ischaemic stroke and encephalopathy. Adult-onset HUS is uncommon, and there is only a limited literature reporting neurological complications in this population. We report an adult with Shiga toxin-associated HUS complicated by focal-onset non-convulsive status epilepticus, who made a full neurological recovery.
Subject(s)
Escherichia coli Infections/diagnosis , Foodborne Diseases/diagnosis , Hemolytic-Uremic Syndrome/diagnosis , Meat/microbiology , Seizures/diagnosis , Stupor/diagnosis , Animals , Escherichia coli/isolation & purification , Escherichia coli Infections/complications , Escherichia coli Infections/therapy , Female , Foodborne Diseases/etiology , Foodborne Diseases/therapy , Hemolytic-Uremic Syndrome/etiology , Hemolytic-Uremic Syndrome/therapy , Humans , Meat/adverse effects , Middle Aged , Seizures/etiology , Seizures/therapy , Shiga Toxin/isolation & purification , Stupor/etiology , Stupor/therapy , SwineSubject(s)
Clinical Competence , Mental Disorders/therapy , Psychotherapy/education , Depressive Disorder/psychology , Depressive Disorder/therapy , Diagnosis, Differential , Echolalia/psychology , Echolalia/therapy , Hallucinations/etiology , Hallucinations/psychology , Humans , Mental Disorders/diagnosis , Mental Disorders/psychology , Munchausen Syndrome/psychology , Munchausen Syndrome/therapy , Munchausen Syndrome by Proxy/psychology , Munchausen Syndrome by Proxy/therapy , Psychotherapy/standards , Schizophrenic Psychology , Stereotyped Behavior , Stupor/psychology , Stupor/therapy , Suicidal IdeationSubject(s)
Actigraphy , Immunotherapy , Stupor/physiopathology , Stupor/therapy , Syringomyelia/physiopathology , Syringomyelia/therapy , Administration, Intravenous , Aged , Humans , Immunoglobulins/administration & dosage , Immunologic Factors/administration & dosage , Male , Polysomnography , Sleep/physiology , Video Recording , Wakefulness/physiologyABSTRACT
OBJECTIVE: The objective of this study is to provide appropriate treatment of patients who showed decreased mentality but did not suffer cardiac arrest (CA) from hanging injury, from reviewing the characteristics and analyzing the outcomes in such patients. METHODS: A retrospective review of victims with decreased mentality but without CA due to hanging presenting to 2 tertiary general hospitals between January 2005 and August 2011 was performed. Treatments and examinations were evaluated, and the outcomes were assessed by cerebral performance category at hospital discharge. RESULTS: A total of 21 patients were included, and their initial Glasgow Coma Scale scores were between 3 and 11. No one received therapeutic hypothermia, but all regained consciousness spontaneously and were discharged with cerebral performance category 1. They received only conservative treatment such as respiratory care, fever control, and inotropic use. Computed tomography and magnetic resonance imaging studies revealed no definite abnormality if the patient did not show abnormal symptom and sign. CONCLUSION: Unconscious patients without CA from hanging could recover consciousness through conservative treatment.
Subject(s)
Asphyxia/therapy , Hypoxia, Brain/therapy , Unconsciousness/therapy , Adult , Aged , Aged, 80 and over , Asphyxia/complications , Emergency Service, Hospital , Female , Glasgow Coma Scale , Humans , Hypothermia, Induced , Hypoxia, Brain/etiology , Male , Middle Aged , Recovery of Function , Respiration, Artificial , Retrospective Studies , Stupor/etiology , Stupor/therapy , Suicide, Attempted , Treatment Outcome , Unconsciousness/etiology , Young AdultABSTRACT
Pervasive refusal syndrome (PRS) has been proposed as a new diagnostic entity among child and adolescent psychiatric disorders. It is characterized by a cluster of life-threatening symptoms including refusal of hood intake, decreased or complete lack of mobilization, and lack of communication as well as retreat from normal life activities. Active refusal to accept help as well as neglect of personal care have been core features of PRS in the limited number of cases reported in the last decade. There have, however; been cases with predominantly passive resistance, indicating the possibility that there may be a continuum from active refusal to passive resistance within PRS. Postulating this continuum allows for the integration of "depressive devitalization" -- a refusal syndrome mainly characterized by passive resistance -- into the concept of PRS. Here, three case vignettes of adolescent patients with PRS are presented. The patients' symptomatology can be allocated on this continuum of PRS. PRS and dissociative disorders are compared in greater detail and contrasted within this discussion of differential diagnoses at the poles of such a continuum. PRS is a useful diagnosis for cases involving symptoms of predominating refusal and retreat which cannot satisfactorily be classified by existing diagnostic categories, and which can mostly clearly be separated from dissociative disorder.
Subject(s)
Feeding and Eating Disorders of Childhood/diagnosis , Mutism/diagnosis , Social Isolation , Stupor/diagnosis , Adolescent , Anorexia Nervosa/classification , Anorexia Nervosa/diagnosis , Anorexia Nervosa/psychology , Anorexia Nervosa/therapy , Body Mass Index , Child , Combined Modality Therapy , Diagnostic and Statistical Manual of Mental Disorders , Dissociative Disorders/classification , Dissociative Disorders/diagnosis , Dissociative Disorders/psychology , Dissociative Disorders/therapy , Feeding and Eating Disorders of Childhood/classification , Feeding and Eating Disorders of Childhood/psychology , Feeding and Eating Disorders of Childhood/therapy , Female , Follow-Up Studies , Humans , International Classification of Diseases , Male , Mutism/classification , Mutism/psychology , Mutism/therapy , Patient Admission , Stupor/classification , Stupor/psychology , Stupor/therapyABSTRACT
Electroconvulsive therapy (ECT) is primarily indicated for mood disorders and schizophrenia. Clinicians may encounter cases in which ECT is administered to patients with various kinds of complications. However, to our knowledge, no detailed medical guideline is available about the indications for ECT in psychiatric illness complicated with a concomitant brain tumor, which is one of the most likely physical complications that can directly affect ECT. We report a case in which 3 courses of modified ECT (m-ECT) were successfully administered without any neurological deterioration to a patient, who was frequently hospitalized for recurrent depressive disorder with stupor. We did not undertake any additional measures for reducing adverse events derived from the meningioma during m-ECT. In this report, we discuss the relation between brain tumor and depression.
Subject(s)
Depressive Disorder, Major/therapy , Electroconvulsive Therapy/methods , Meningeal Neoplasms/complications , Meningioma/complications , Aged , Depressive Disorder, Major/etiology , Female , Humans , Meningeal Neoplasms/pathology , Meningioma/pathology , Recurrence , Stupor/etiology , Stupor/therapy , Treatment OutcomeABSTRACT
BACKGROUND: Decreased consciousness is a common reason for presentation to the emergency department (ED) and admission to acute hospital beds. In trauma, a Glasgow Coma Scale score (GCS) of 8 or less indicates a need for endotracheal intubation. Some advocate a similar approach for other causes of decreased consciousness, however, the loss of airway reflexes and risk of aspiration cannot be reliably predicted using the GCS alone. STUDY OBJECTIVE: A survey of all poisoned patients with a decreased GCS who were admitted to an ED short-stay ward staffed by experienced emergency physicians, to establish the incidence of clinically significant aspiration or other morbidities and endotracheal intubation. METHODS: A prospective, observational study was conducted of all patients admitted to the ED short-stay ward with a decreased level of consciousness (GCS < 15). RESULTS: The study included 73 patients with decreased consciousness as a result of drug or alcohol intoxication. The GCS ranged from 3 to 14, and 12 patients had a GCS of 8 or less. No patient with a GCS of 8 or less aspirated or required intubation. There was one patient who required intubation; this patient had a GCS of 12 on admission to the ward. CONCLUSIONS: This study suggests that it can be safe to observe poisoned patients with decreased consciousness, even if they have a GCS of 8 or less, in the ED.
