RESUMEN
BACKGROUND: Postmortem toxicology can be useful for reconstructing some clinically important events occurring before a suicide. Its utility may be improved by examining patterns of detected substances in a population over time. METHODS: Toxicology was performed for 333 (96%) of the 346 suicides occurring in Mobile County, Alabama, between October 1990 and September 1998. Detected psychoactive substances were grouped in three categories: alcohol, cocaine, and cannabis; abusable prescription medications; and non-abused psychotropic medications. The overlap between these three categories was assessed. RESULTS: Psychoactive substances were detected in 227 (68%) of 333 suicides. Of the cases positive for any prescription psychoactive medication, 2/3 were positive for an abusable medication. An abusable substance was found in 56% of cases positive for non-abused psychotropic medication. Alcohol, cocaine and/or cannabis were found in 34% of cases with abusable prescription medications and in 33% with non-abused psychotropics. LIMITATIONS: Clinicians must be aware of a number of methodological realities when interpreting routine postmortem toxicology results. CONCLUSIONS: Routine surveillance of psychoactive substances among suicides can provide useful data for directing and monitoring strategies for suicide prevention in clinical practice.
Asunto(s)
Psicotrópicos/análisis , Detección de Abuso de Sustancias/métodos , Trastornos Relacionados con Sustancias/epidemiología , Suicidio/estadística & datos numéricos , Toxicología/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Alabama/epidemiología , Áreas de Influencia de Salud , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Trastornos Relacionados con Sustancias/diagnósticoRESUMEN
We report an unusual case of thrombocytopenia associated with neuroleptic malignant syndrome (NMS). A 31-year-old Black male with a history of hypertension, partial seizures, and schizophrenia developed acute rigidity closely followed by severe hyperpyrexia (temperature 102 degree F), tachypnea, and tachycardia. His home medications at the time of presentation included propanolol 10 mg tid, haloperidol 10 mg bid, sodium valproate 500 mg bid, benztropine 1 mg bid, and haloperidol decanoate 100 mg i.m. every 3 weeks, from another psychiatric facility. Despite vigorous therapy for the hyperthermia, he rapidly developed significant hypoxia requiring mechanical ventilation. A diagnosis of neuroleptic malignant syndrome was made and the patient continued to receive aggressive supportive care. On hospital day 2 his platelet count dropped to 47,000/microl and bottomed out at 36,000/microl by day 3 with other blood cell counts remaining within normal limits. Over the next few days he showed rapid clinical improvement with normalization of his blood chemistries and he was discharged home after 5 days of hospitalization in good condition.
Asunto(s)
Antipsicóticos/efectos adversos , Síndrome Neuroléptico Maligno/complicaciones , Síndrome Neuroléptico Maligno/terapia , Trombocitopenia/complicaciones , Adulto , Quimioterapia Combinada , Haloperidol/efectos adversos , Humanos , Masculino , Esquizofrenia/tratamiento farmacológico , Ácido Valproico/efectos adversosRESUMEN
In a sample of 311 consecutive psychiatric emergency room patients, 133 (43%) were accompanied by relatives, friends, or others, 113 (36%) came with the police, and 65 (21%) came by themselves. There were more males in the group brought in by police or who came by themselves than in the group accompanied by family or others. Aggression was the presenting problem in about 40% of police referrals. Half the aggressive patients who were brought in by the police were diagnosed with psychotic disorders. Poor social functioning was found in patients who came with police and by themselves, this finding was more pronounced in males. High rates of substance abuse, as suggested by positive toxicology, were found in police referrals and patients who came by themselves. This was mostly due to alcohol in males and cocaine in females. Findings indicate that gender, diagnosis, and psychosocial status contribute independently to who brings patients to the psychiatric emergency room. It is suggested that this information is clinically useful for diagnostic assessment and management. Clinical and research implications are discussed.
Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Servicios de Urgencia Psiquiátrica/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Adulto , Agresión , Distribución de Chi-Cuadrado , Femenino , Encuestas de Atención de la Salud , Hospitales Universitarios , Humanos , Masculino , Ciudad de Nueva York/epidemiología , Policia/estadística & datos numéricos , Trastornos Psicóticos/epidemiología , Análisis de Regresión , Estudios Retrospectivos , Distribución por Sexo , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
Our goal in this retrospective study was to assess empirical risk factors for repeat visits to the psychiatric emergency room. This information may be useful for targeted prevention and cost-effective service planning. Over a 7-month period, 400 (18%) of 2212 patients were repeat visitors, accounting for 36% of all visits. A diagnosis of a psychotic disorder at the first visit was a risk factor for a repeat visit, especially in young patients. Substance abuse, as suggested by positive urine toxicology, decreased the likelihood of recidivism, but positive toxicology screens in young schizophrenic patients increased the chances of a repeat visit. In a 1-month consecutive sample of 311 patients, unemployment and homelessness were stronger correlates than a clinical diagnosis of schizophrenia. These findings support previous evidence that psychiatric emergency services are often used by underprivileged patients. We suggest that a rational preventive approach to reduce recidivism in psychiatric emergency services may include substance abuse treatment and case management for young schizophrenics and community outreach projects for socially disadvantaged patients. Compliance of recidivist patients poses a difficult task for case managers and community psychiatrists. More studies are needed to assess the efficacy of these interventions.
Asunto(s)
Servicios de Urgencia Psiquiátrica/estadística & datos numéricos , Episodio de Atención , Trastornos Mentales/terapia , Adulto , Factores de Edad , Distribución de Chi-Cuadrado , Grupos Diagnósticos Relacionados , Empleo , Femenino , Personas con Mala Vivienda/estadística & datos numéricos , Humanos , Modelos Logísticos , Masculino , Trastornos Mentales/complicaciones , Trastornos Mentales/diagnóstico , Ciudad de Nueva York , Readmisión del Paciente/estadística & datos numéricos , Pronóstico , Modelos de Riesgos Proporcionales , Recurrencia , Factores de Riesgo , Detección de Abuso de Sustancias/estadística & datos numéricos , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/terapia , Análisis de Supervivencia , Factores de TiempoRESUMEN
Diagnoses obtained from the hospital computer system were compared at two consecutive visits in 286 psychiatric emergency room patients within a 7-month period. Diagnostic agreement of schizophrenia and changes from and to schizophrenia were examined. There was moderate stability for a schizophrenic diagnosis in patients at two consecutive visits (kappa 0.5). schizophrenia was a more stable diagnosis in males (kappa 0.6) than females (0.4). Underdiagnosis of schizophrenia in females may be due to initial diagnostic confusion with affective illnesses. Further studies are needed in other settings to assess if underdiagnosis is associated with undertreatment of schizophrenia in females.