Diagnosing Late-Onset Psychosis in a Medically Complex Patient: A Diagnostic Challenge.

This case report explores various possible causes of late-onset psychosis and highlights the importance of follow-up care. We report the case of a 65-year-old female with minimal available medical history or contacts, who presented to the hospital after being found unconscious after three weeks of strange behaviors, including partition delusions, multiple phone calls and texts to her friend, and lack of sleep. In the following days, she had various symptoms consistent with delirium, psychosis, and mania. However, she was also found to have a dural calcification and urinary tract infection on imaging and laboratories, respectively. We attempted to distinguish these possible etiologies and understand the best course of action for such a patient with a limited medical history who was subsequently lost to medical follow-up. Utilizing the psychiatric interview, mental status examination, laboratory work, imaging, and available medical and psychiatric history can all help narrow down the most likely etiologies. However, the lack of data given during follow-up visits, regarding patient response to treatment, their full medical and psychiatry history, as well as their understanding of their diagnosis, poses a significant challenge in reaching a definitive diagnosis in such a patient. This underscores the critical need for follow-up care, especially for patients treated for psychosis in acute settings.

Small Hemothoraces Not Drained on Admission: Initial Volume Predicts Need for Intervention.

BACKGROUND: Unlike large hemothoraces (HTX), small HTX after blunt trauma may be observed without drainage. We aimed to study if there were risk factors that would predict the need for intervention in initially observed small HTX. METHODS: A retrospective review of patients with blunt traumatic HTX from 2016 to 2022 was performed. Patients with small HTX (pleural fluid volume <400 mL on admission chest computerized tomography [CT]) were included. Patients were considered as being "initially observed" if there was no intervention for the HTX within 48 hours after admission. Primary outcome was any HTX-related intervention (open, thoracoscopic or percutaneous procedures) occurring after 48 hours and up to 6 months after injury. Univariable and multivariable statistical analyses were employed. A P-value of <.05 was considered significant. RESULTS: Of 335 patients with HTX, 188 (59.6%) met inclusion criteria. Median (interquartile range) HTX volume was 90 (36-134) ml. One hundred and twenty-seven (68%) were initially observed. Of these, 31 (24%) had the primary outcome. These patients had a larger HTX volume (median, 129 vs 68 mL, P = .0001), and number of rib fractures (median, 7 vs 4, P = .0002) compared to those without the primary outcome. Chest-related readmission occurred in 8 (6%) with a median of 20 days from injury. Of these, 7 required an HTX-related intervention. Logistic regression analysis found that both the number of rib fractures and HTX volume independently predicted the primary outcome. CONCLUSION: For small HTX initially observed, number of rib fractures and initial volume predicted delayed HTX-related intervention.