Dynamic Evolution of Catatonia in the Context of Cerebral Venous Sinus Thrombosis.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.Prim Care Companion CNS Disord 2023;25(4):22f03471. Author affiliations are listed at the end of this article.

"Bath salt" ingestion leading to severe intoxication delirium: two cases and a brief review of the emergence of mephedrone use.

BACKGROUND: Recreational use of designer substances containing synthetic cathinones such as mephedrone, commonly sold as "bath salts," has recently been increasing in the United States (National Institute on Drug Abuse. Available at: http://www.nida.nih.gov/about/welcome/MessageBathSalts211.html. Accessed March 25, 2011; The Washington Post. Available at: http://www.washingtonpost.com/national/officials-fear-bath-salts-becoming-the-next-big-drug-menace/2011/01/22/ABybyRJ_story.html. Accessed March 25, 2011). "Bath salt" ingestion can generate an intense stimulant toxidrome and has been associated with significant morbidity. OBJECTIVES: The authors seek to alert clinicians to the potential for profound delirium, psychosis, and other medical and behavioral sequelae of "bath salt" use. METHODS: Case series. RESULTS: We describe our recent experience with two highly agitated and delirious patients following "bath salt" ingestion and offer a brief review of the emergence of this phenomenon. CONCLUSIONS: Challenges and strategies surrounding diagnosis and treatment are described, which may be useful as "bath salt" use becomes more widespread. SCIENTIFIC SIGNIFICANCE: As an emerging trend, bath salt intoxication delirium appears to cause intense psychosis that can be managed with antipsychotic medications. Clinicians should be aware of this phenomenon until more precise detection methods are available.

Factitious disorders and cardiothoracic surgery: the ongoing multidisciplinary challenges of a complex case.

Chronic factitious disorder, Munchausen's syndrome, can be challenging to manage-particularly when complaints and symptoms suggest medical or surgical emergencies. We present a patient whose problems have spanned many years and a great distance. Hopefully, with a greater awareness of this disease, as this patient continues to seek health care in many different hospitals, the implications of timely access to information, good histories and physical exams, and an index of suspicion can assist in potentially avoiding unnecessary, expensive, and invasive evaluations.