Objectives:The purpose of this study is to determine the prevalence of methamphetamine-related diagnoses seen in the psychiatric emergency department (ED) of a large urban hospital, which serves an area with a known methamphetamine epidemic. This study also examines the characteristics and ED interventions of psychiatric patients with and without methamphetamine-related diagnoses. Methods:The records of 904 patients admitted to the psychiatric ED of the largest urban hospital in Hawaii between March and May 2002 were reviewed. Diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders IV. Patients were classified as having a methamphetaminerelated diagnosis if they were diagnosed with methamphetamine intoxication, dependency, abuse, withdrawal, methamphetamine-induced mood disorder or psychotic disorder. Results:One hundred sixty-six patients (18%) were diagnosed with a methamphetamine-related diagnosis. Patients with methamphetamine-related diagnoses were more likely to be male (70% vs. 57%), nonCaucasian (75% vs. 57%), and presented with suicidality (47% vs. 32%) and agitation (48% vs. 30%) more often than non-methamphetaminerelated diagnosis patients. Poly-drug use (14% vs. 3%) and dual diagnosis (37% vs. 17%) were more common among patients with methamphetaminerelated diagnoses. Patients with methamphetamine-related diagnoses were treated with sedating medications more frequently (37% vs. 25%), stayed longer in the ED (median 225 vs. 193 min), and were more likely to be admitted to the hospital (53% vs. 40%) than non-methamphetaminerelated diagnoses patients. Conclusions:Psychiatric ED patients with methamphetaminerelated diagnoses present more acutely and use more hospital resources.

In this article, the authors review current concepts in fibromyalgia. Findings regarding diagnosis, prevalence, comorbidities, and potential pathophysiologic links are discussed. Although fibromyalgia continues to be a complex disorder, there are specific criteria one must meet. Fibromyalgia questionnaires, along with commonalities of age, gender, menopause status, sleep disturbances, and mood symptoms, may aid in the diagnosis. Additionally, the close relationship between fibromyalgia and other chronic disorders should alert the physician to explore for comorbid illness. The relationship between fibromyalgia and irritable bowel syndrome, migraine headaches, and obesity are addressed. The roles of the hypothalamic-pituitary-axis, potential effects of neurotransmitters, and gender-specific hormones all substantiate this diagnosis and provide clues to causality, as well as venues for future treatment.