Psychosomatics
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Delirium occurs in approximately 1 in 5 general hospital admissions and up to 85% of patients with terminal illness, but can be difficult to differentiation from other disorders, such as depression. ⋯ Delirium should be considered in patients with altered mood states, and screening for depression should initially rule out delirium. Sustained alterations in mood may be more frequent in delirium than previously recognized.
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Delusional parasitosis is an uncommon psychiatric condition in which patients have the immutable conviction that small, living organisms, such as worms, insects, or larvae infest their skin or other organs. ⋯ The authors speculate that this specific type of delusion can be elicited by the disruption of the somatosensory pathway and that the subsequent cortical sensory deafferentiation and reorganization arising from this disruption may contribute to the development of delusional parasitosis.
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Low-molecular-weight heparins (LMWHs) have become ubiquitously used as anticoagulants because of their comparative safety and ease of use; however they may be fatal if taken in overdose, and lack of familiarity with their pharmacology may hinder appropriate care. ⋯ Feigned LMWH overdose is ideally suited to the purposes of malingering, since it represents a medical emergency that requires inpatient medical hospitalization and testing at outside laboratory facilities to verify the overdose.
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Delirium is an important problem especially in older medical inpatients. ⋯ Delirium and increased delirium durations are significantly associated with higher mortality.