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1.
Acute Med Surg ; 3(3): 230-236, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-29123790

RESUMO

Aim: Reporting of the analytical and clinical findings of synthetic cannabinoids and cathinones is essential in carrying out a complete clinical assessment of new psychoactive substances. Methods: From 2012 to 2014, we examined synthetic cathinone and cannabinoid poisoning in six patients aged 22-42 years old. Analyses of these compounds were carried out using liquid chromatography-tandem mass spectrometry. Results: The observed clinical symptoms were similar to those reported for intoxication with synthetic cathinones and cannabinoids. In cases of intoxication with synthetic cathinones, the psychiatric and neurological symptoms were long-lasting, and these compounds were detected in serum for 15-48 h after use. Although the clinical symptoms induced by the synthetic cannabinoids disappeared within several hours after use, the range of serum concentrations of these compounds was ≤5 ng/mL for 1-3 h after use. In one fatal case, in which high serum concentrations of synthetic cathinones and cannabinoids were detected, the most plausible cause of death was heart failure due to overdose with these drugs. The long-lasting symptoms induced by synthetic cathinones correlated with the long detection window in serum, whereas the early disappearance of symptoms induced by synthetic cannabinoids corresponded to the short detection window in serum. Conclusions: This study shows that the profiles of synthetic cathinones and cannabinoids in serum are closely related to the duration of the toxic symptoms and that concomitant use of two psychoactive drugs with different pharmacological actions may have the potential for fatal cardiotoxicity.

2.
BMC Emerg Med ; 14: 3, 2014 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-24484081

RESUMO

BACKGROUND: In Japan, many carbon monoxide (CO) poisoning cases are transported to emergency settings, making treatment and prognostic assessment an urgent task. However, there is currently no reliable means to predict whether "delayed neuropsychiatric sequelae (DNS)" will develop after acute CO poisoning. This study is intended to find out risk factors for the development of DNS and to characterize the clinical course following the development of DNS in acute CO poisoning cases. METHODS: This is a retrospective cohort study of 79 consecutive patients treated at a single institution for CO poisoning. This study included 79 cases of acute CO poisoning admitted to our emergency department after attempted suicide, who were divided into two groups consisting of 13 cases who developed DNS and 66 cases who did not. The two groups were compared and analyzed in terms of clinical symptoms, laboratory findings, etc. RESULTS: Predictors for the development of DNS following acute CO poisoning included: serious consciousness disturbance at emergency admission; head CT findings indicating hypoxic encephalopathy; hematology findings including high creatine kinase, creatine kinase-MB and lactate dehydrogenase levels; and low Global Assessment Scale scores. The clinical course of the DNS-developing cases was characterized by prolonged hospital stay and a larger number of hyperbaric oxygen (HBO) therapy sessions. CONCLUSION: In patients with the characteristics identified in this study, administration of HBO therapy should be proactively considered after informing their family, at initial stage, of the risk of developing DNS, and at least 5 weeks' follow-up to watch for the development of DNS is considered necessary.


Assuntos
Intoxicação por Monóxido de Carbono/complicações , Hipóxia Encefálica/induzido quimicamente , Transtornos Mentais/induzido quimicamente , Doenças do Sistema Nervoso/induzido quimicamente , Adulto , Intoxicação por Monóxido de Carbono/sangue , Intoxicação por Monóxido de Carbono/terapia , Creatina Quinase Forma MB/sangue , Serviço Hospitalar de Emergência , Feminino , Humanos , Oxigenoterapia Hiperbárica , Hipóxia Encefálica/diagnóstico por imagem , Lactato Desidrogenases/sangue , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Radiografia , Estudos Retrospectivos , Fatores de Risco , Tentativa de Suicídio , Fatores de Tempo , Adulto Jovem
3.
Schizophr Res ; 142(1-3): 31-9, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23127379

RESUMO

We worked on characterizing suicide attempts in patients with schizophrenia in comparison with mood disorders. This study population comprised 260 patients with F2 disorders (ICD-10), i.e., "schizophrenic group" and 705 patients with F3 disorders, i.e., "depressive group" who presented at the psychiatric emergency department of our hospital for 8 years. They were compared in three age groups: young (≤24 years), middle-aged (25-44 years), and elderly (≥45 years). Multivariate logistic regression analysis identified factors associated with the seriousness of the suicide attempt method. The schizophrenic group (≥25 years) had a younger mean age and higher prevalences of "within-1-year suicide attempts" and "past suicide attempts" than the depressive group. The Schizophrenic group tended to use serious methods, such as "jumping from high places," "throwing oneself in front of an oncoming train," and "burning oneself," in their suicide attempts, with "hallucination-delusion" accounting for an overwhelmingly large percentage of suicide attempt motives, irrespective of the age group. In the elderly group, the ratio of "no-housemate" patients was high. In all age groups, jobless individuals were prevalent, and the schizophrenic group had lower LCU (Life Change Unit) scores than did the depressive group. The middle-aged cases of schizophrenic group had higher BPRS (Brief Psychiatric Rating Scale) scores and lower GAS (Global Assessment Scale) scores. Regarding factors influencing the seriousness of the methods, a history of within-1-year suicide attempts increased the method seriousness in the schizophrenic group. Years of education correlated with the method seriousness in the schizophrenic group. Low scores of overall health on the GAS increased the method seriousness in both groups.


Assuntos
Transtorno Depressivo/psicologia , Esquizofrenia , Psicologia do Esquizofrênico , Tentativa de Suicídio/psicologia , Adolescente , Adulto , Fatores Etários , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Japão/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Adulto Jovem
6.
J Neurol ; 259(8): 1698-705, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22258479

RESUMO

Carbon monoxide (CO) poisoning leads to demyelination of cerebral white matter (CWM) fibers, causing chronic neuropsychiatric symptoms. To clarify whether fractional anisotropy (FA) from diffusion tensor imaging in the centrum semiovale can depict demyelination in the CWM during the subacute phase after CO inhalation, we examined correlations between FA in the centrum semiovale and myelin basic protein (MBP) in cerebrospinal fluid. Subjects comprised 26 adult CO-poisoned patients ≤60 years old. MBP concentration was examined for all patients at 2 weeks after CO inhalation. The mean FA of the centrum semiovale bilaterally at 2 weeks was also examined for all patients and 21 age-matched healthy volunteers as controls. After these examinations, the presence of chronic symptoms was checked at 6 weeks after CO poisoning. Seven patients displayed chronic symptoms, of whom six showed abnormal MBP concentrations. The remaining 19 patients presented no chronic symptoms and no abnormal MBP concentrations, with MBP concentrations undetectable in 16 patients. The MBP concentration differed significantly between patients with and without chronic symptoms. The mean FA was significantly lower in patients displaying chronic symptoms than in either patients without chronic symptoms or controls. After excluding the 16 patients with undetectable MBP concentrations, a significant correlation was identified between MBP concentration and FA in ten patients. The present results suggest that FA in the centrum semiovale offers a quantitative indicator of the extent of demyelination in damaged CWM during the subacute phase in CO-poisoned patients.


Assuntos
Intoxicação por Monóxido de Carbono/líquido cefalorraquidiano , Intoxicação por Monóxido de Carbono/diagnóstico , Cérebro/patologia , Imagem de Tensor de Difusão , Proteína Básica da Mielina/líquido cefalorraquidiano , Fibras Nervosas Mielinizadas/patologia , Adulto , Anisotropia , Biomarcadores/líquido cefalorraquidiano , Intoxicação por Monóxido de Carbono/metabolismo , Cérebro/metabolismo , Imagem de Tensor de Difusão/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas Mielinizadas/metabolismo , Tratos Piramidais/metabolismo , Tratos Piramidais/patologia , Adulto Jovem
7.
Neuroradiology ; 54(7): 681-9, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21918850

RESUMO

INTRODUCTION: The present study aimed to detect the main regions of cerebral white matter (CWM) showing damage in the subacute phase for CO-poisoned patients with chronic neurological symptoms using voxel-based analysis (VBA) with diffusion tensor imaging (DTI). METHODS: Subjects comprised 22 adult CO-poisoned patients and 16 age-matched healthy volunteers as controls. Patients were classified into patients with transient acute symptoms only (group A) and patients with chronic neurological symptoms (group S). In all patients, DTI covering the whole brain was performed with a 3.0-T magnetic resonance imaging system at 2 weeks after CO exposure. As procedures for VBA, all fractional anisotropy (FA) maps obtained from DTI were spatially normalized, and FA values for all voxels in the whole CWM on normalized FA maps were statistically compared among the two patient groups and controls. RESULTS: Voxels with significant differences in FA were detected at various regions in comparisons between groups S and A and between group S and controls. In these comparisons, more voxels were detected in deep CWM, including the centrum semiovale, than in other regions. A few voxels were detected between group A and controls. Absolute FA values in the centrum semiovale were significantly lower in group S than in group A or controls. CONCLUSIONS: VBA demonstrated that CO-poisoned patients with chronic neurological symptoms had already suffered damage to various CWM regions in the subacute phase. In these regions, the centrum semiovale was suggested to be the main region damaged in the subacute phase after CO inhalation.


Assuntos
Intoxicação por Monóxido de Carbono/patologia , Córtex Cerebral/patologia , Imagem de Tensor de Difusão/métodos , Adulto , Anisotropia , Estudos de Casos e Controles , Feminino , Escala de Coma de Glasgow , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Proteína Básica da Mielina/líquido cefalorraquidiano , Estatísticas não Paramétricas
8.
BMC Psychiatry ; 11: 38, 2011 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-21385448

RESUMO

BACKGROUND: The nurses working in psychiatric hospitals and wards are prone to encounter completed suicides. The research was conducted to examine post-suicide stress in nurses and the availability of suicide-related mental health care services and education. METHODS: Experiences with inpatient suicide were investigated using an anonymous, self-reported questionnaire, which was, along with the Impact of Event Scale-Revised, administered to 531 psychiatric nurses. RESULTS: The rate of nurses who had encountered patient suicide was 55.0%. The mean Impact of Event Scale-Revised (IES-R) score was 11.4. The proportion of respondents at a high risk (≥ 25 on the 88-point IES-R score) for post-traumatic stress disorder (PTSD) was 13.7%. However, only 15.8% of respondents indicated that they had access to post-suicide mental health care programmes. The survey also revealed a low rate of nurses who reported attending in-hospital seminars on suicide prevention or mental health care for nurses (26.4% and 12.8%, respectively). CONCLUSIONS: These results indicated that nurses exposed to inpatient suicide suffer significant mental distress. However, the low availability of systematic post-suicide mental health care programmes for such nurses and the lack of suicide-related education initiatives and mental health care for nurses are problematic. The situation is likely related to the fact that there are no formal systems in place for identifying and evaluating the psychological effects of patient suicide in nurses and to the pressures stemming from the public perception of nurses as suppliers rather than recipients of health care.


Assuntos
Adaptação Psicológica , Transtornos Mentais/enfermagem , Enfermeiras e Enfermeiros/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Suicídio/psicologia , Necessidades e Demandas de Serviços de Saúde , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Pacientes Internados/psicologia , Pacientes Internados/estatística & dados numéricos , Transtornos Mentais/psicologia , Enfermagem Psiquiátrica , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Suicídio/estatística & dados numéricos , Inquéritos e Questionários
9.
BMC Psychiatry ; 10: 4, 2010 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-20064269

RESUMO

BACKGROUND: The allocation of outcome of suicide attempters is extremely important in emergency situations. Following categorization of suicidal attempters who visited the emergency room by outcome, we aimed to identify the characteristics and potential needs of each group. METHODS: The outcomes of 1348 individuals who attempted suicide and visited the critical care center or the psychiatry emergency department of the hospital were categorized into 3 groups, "hospitalization in the critical care center (HICCC)", "hospitalization in the psychiatry ward (HIPW)", or "non-hospitalization (NH)", and the physical, mental, and social characteristics of these groups were compared. In addition, multiple logistic analysis was used to extract factors related to outcome. RESULTS: The male-to-female ratio was 1:2. The hospitalized groups, particularly the HICCC group, were found to have biopsychosocially serious findings with regard to disturbance of consciousness (JCS), general health performance (GAS), psychiatric symptoms (BPRS), and life events (LCU), while most subjects in the NH group were women who tended to repeat suicide-related behaviors induced by relatively light stress. The HIPW group had the highest number of cases, and their symptoms were psychologically serious but physically mild. On multiple logistic analysis, outcome was found to be closely correlated with physical severity, risk factor of suicide, assessment of emergent medical intervention, and overall care. CONCLUSION: There are different potential needs for each group. The HICCC group needs psychiatrists on a full-time basis and also social workers and clinical psychotherapists to immediately initiate comprehensive care by a medical team composed of multiple professionals. The HIPW group needs psychological education to prevent repetition of suicide attempts, and high-quality physical treatment and management skill of the staff in the psychiatric ward. The NH group subjects need a support system to convince them of the risks of attempting suicide and to take a problem-solving approach to specific issues.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Hospitalização , Transtornos Mentais/psicologia , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Tentativa de Suicídio/psicologia , Adulto , Serviços Comunitários de Saúde Mental , Assistência Integral à Saúde , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitais Psiquiátricos , Humanos , Japão , Acontecimentos que Mudam a Vida , Modelos Logísticos , Masculino , Transtornos Mentais/diagnóstico , Avaliação de Resultados em Cuidados de Saúde , Equipe de Assistência ao Paciente , Medição de Risco , Fatores de Risco , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/estatística & dados numéricos , Prevenção do Suicídio
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