This study reports a rare case of high-dose midazolam abuse and Munchausen Syndrome. A 48-year-old female physician was referred by a psychiatrist to the Toxicology Department of Imam Reza Hospital for abstaining from 300 mg/day of parenteral midazolam. She had mimicked the symptoms of Crohn’s disease; therefore, she had undergone 15 colonoscopies and 40 times MRI or CT scan, all of which were normal. Six months earlier, she had switched oral methadone to 30 mg/day of intravenous midazolam. She also had several skin lesions on injection sites that she considered pyoderma gangrenosum. When the total daily dose of intravenous midazolam was switched to oral bioequivalence of clonazepam, she could not tolerate withdrawal (Clinical Institute Withdrawal Assessment Scale-Benzodiazepines = 68). Therefore, she received midazolam again as a continuous intravenous infusion. Within 7 days, the whole dose was replaced by the bioequivalence oral dose of clonazepam. She was also treated with carbamazepine and cognitive behavior therapy. Afterward, she was transferred to the psychiatric ward for further psychiatric treatment. Dependency on a high dose of midazolam could be treated by tapering off the long-acting benzodiazepine.
Background Community Mental Health Centers (CMHCs) provide mental health services to patients at low cost, with less stigma, in a domiciliary. This is the first study to describe demographic characteristics, common mental disorders, referral status, and treatment discontinuation in patients at the only CMHC of Mashhad, northeastern Iran. Methods This cross-sectional study enrolled 662 patients who contacted this center between January 2014 and December 2021. We completed a checklist that included information on demographics, diagnosed mental disorders, referral status, and the number of psychiatric visits, all of which psychiatrists fully completed clinical records. The frequency distributions of all variables were carried out with SPSS11.5. In addition, the association between epidemiological findings and patient referral (referral system or self-referral) and the association between epidemiological findings and the number of psychiatric visits were examined by the Chi-square test. Results Of 662 patients, 472 (71%) women and 190 (29%) men were enrolled, and the mean age of all patients was 29 years. Among the 475 adult patients, 367 (77.3%) patients were married and had primary or secondary education (40.4%), and the majority of them were housewives (56.4%). Major Depression Disorder (32%), Generalized Anxiety Disorder (18.3%) were the two most common mental illnesses in patients. Large proportions of the patients (70.7%) were referred to this center via the referral system. Moreover, non-working patients (housewives and unemployed patients) and the female gender were associated with more referrals to this center through the referral system. 431 patients (65.1%) did not return for a second visit, and the higher number of psychiatric visits was associated with a lower level of education. Conclusions Based on the results of this study, most of the patients in this center had a low socioeconomic level. Most of them were referred through the referral system, and gender and employment significantly contributed to referral via the referral system. The majority of patients discontinued treatment after the first psychiatric visit, and this was associated with the level of education.
Background: We reported a case of gastric obstruction in a body packer who swallowed a large number of opium packets. Case Report: A 36-year-old man opium addict visited the emergency department with epigastric pain for three days. He swallowed nearly 90 packets of opium for smuggling purposes four days earlier. He self-administered laxatives. In contrast, many times vomiting, he defecated only four packets and vomited one packet. The abdominal X-rays showed some amounts of fluid-air levels and multiple cylindrical opacities with the double-condom sign, corresponding to the distended stomach. Due to the worsening of his abdominal symptoms, he underwent an urgent laparotomy and 84 packets (4-6 cm in size and 8-10 g/ packet of opium) with a total weight of 870 g. They were wrapped in some layers of plastic and tied at the ends. He was discharged in stable condition. Conclusion: A large number of ingested drug packets can induce gastrointestinal obstruction.
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