General hospital psychiatry
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Gen Hosp Psychiatry · Jul 1997
Case ReportsUse of high dose benzodiazepines in alcohol and sedative withdrawal delirium.
The authors describe two patients who required massive doses of benzodiazepines to treat complicated alcohol and sedative withdrawal delirium. Some of the factors that contribute to difficulties in management are discussed. Finally, we describe the advantages and disadvantages of high dose pharmacologic management and controversies regarding psychopharmacologic management of such complex patients.
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Gen Hosp Psychiatry · Mar 1997
Letter Case ReportsAcute psychosis associated with acetaminophen overdose.
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Gen Hosp Psychiatry · Jan 1997
Case ReportsProfiles and treatment of attempted suicide by self-immolation.
Self-immolation represented 3.9% of patients (N = 7) at this burn unit over the last 18 months. Charts of these patients were retrospectively reviewed for demographics, hospital course, and discharge plan. All had a major psychiatric diagnosis, although no clear patient profile emerged. ⋯ Physical sequelae of the burns raised problems in arranging subsequent psychiatric treatment. Follow-up information was obtained by brief telephone interviews. The survivors appeared to be functioning well given their psychopathology and physical sequelae.
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Gen Hosp Psychiatry · Jan 1997
Case ReportsConcurrent factitious disorder and factitious disorder by proxy. Double jeopardy.
Two forms of medical dissimulation-factitious disorder and factitious disorder by proxy-present enormous challenges to clinicians accustomed to receiving valid symptom reports from their patients. The consequences of such "disease forgery" are heightened when a patient simultaneously engages in both forms of deception. We discuss a 34-year-old nurse who simulated or induced a panoply of physical and psychological ailments in both herself and her daughter. The staff's insistence on access to outside information sources proved indispensible in establishing both diagnoses, facilitating ongoing treatment for the patient and ensuring appropriate protection of the child.
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In order to detect patients who become delirious after cardiac surgery in an early postoperative stage, an observational checklist was used. Fifteen patients were constantly observed during their 48-hour stay at the intensive care unit for postoperative care. Two (13%) male patients developed postoperative delirium according to DSM-III-R criteria. It was possible to detect these patients in an early postoperative stage (within 48 hours) by means of systematic observations of their behavior.