BackgroundIn Japan, many carbon monoxide (CO) poisoning cases are transported to emergency settings, making treatment and prognostic assessment an urgent task. However, there is currently no reliable means to predict whether “delayed neuropsychiatric sequelae (DNS)” will develop after acute CO poisoning. This study is intended to find out risk factors for the development of DNS and to characterize the clinical course following the development of DNS in acute CO poisoning cases.MethodsThis is a retrospective cohort study of 79 consecutive patients treated at a single institution for CO poisoning. This study included 79 cases of acute CO poisoning admitted to our emergency department after attempted suicide, who were divided into two groups consisting of 13 cases who developed DNS and 66 cases who did not. The two groups were compared and analyzed in terms of clinical symptoms, laboratory findings, etc.ResultsPredictors for the development of DNS following acute CO poisoning included: serious consciousness disturbance at emergency admission; head CT findings indicating hypoxic encephalopathy; hematology findings including high creatine kinase, creatine kinase-MB and lactate dehydrogenase levels; and low Global Assessment Scale scores. The clinical course of the DNS-developing cases was characterized by prolonged hospital stay and a larger number of hyperbaric oxygen (HBO) therapy sessions.ConclusionIn patients with the characteristics identified in this study, administration of HBO therapy should be proactively considered after informing their family, at initial stage, of the risk of developing DNS, and at least 5 weeks’ follow-up to watch for the development of DNS is considered necessary.
The Circadian rhythm sleep disorder of the dementia is apt to cause night wandering, delirium and even sundowning syndrome. And these behaviors put a major burden on the patients themselves and their caregivers. The ratio of complication of Circadian rhythm sleep disorder in Alzheimer's disease, the major figure of dementia, is considerably high. Circadian rhythm sleep disorder in Alzheimer's disease is supposed to be caused by physiological change of the internal secretion rhythm, physical disorder and/or environmental factors. Furthermore, in recent years, in addition to the high rate of coexistence, it has been reported that there may be essential relation between circadian rhythm sleep disorder and Alzheimer's disease. In the present study, we summarized the role of neuropathological and neuroendocrinal alternation in Circadian rhythm sleep disorder of Alzheimer's disease.
Background: The purpose of this study is to determine, by classifying emergently admitted suicide attempter patients according to their Global Assessment Scale (GAS) scores, the characteristics of and factors associated with each group of patients. Methods: The subjects of this study were 1,317 suicide attempters who were seen at the primary/secondary emergency department of the Iwate Medical University Hospital and at the Iwate Advanced Critical Care and Emergency Center, during the period of 7 years from April 1, 2006. These subjects were classified into three groups, consisting of the low, middle and high score groups, and were analyzed by comparing these groups with each other in terms of background factors and psychiatric assessment of emergency psychiatry case cards. Comparison examination was performed among 3 groups, and multiple logistic regression analysis was performed by using investigation items and the three GAS score groups as explanatory and dependent variables, respectively Results: Factors associated with the low score group included being male, advanced age and unemployed, and high life event values. The odds of completed suicide in this group were more than 5-fold higher than in the other two groups. Past history of suicide attempts was extracted as a factor associated with the middle score group. Factors associated with the high score group included: being female; young age; having no history of regular psychiatric visits; having history of advice seeking prior to the attempted suicide; and complex motives. Conclusions: This paper determined characteristics of emergently admitted suicide attempters according to their GAS score levels, and proposed specific measures to be taken according to individual patients' GAS scores. It was suggested that in an emergency setting involving a suicide attempter, a global assessment of the patient and treatment given according to the assessment results may lead to the prevention of further suicide attempts. Keywords Suicide attempt; Global assessment scale (GAS); Emergency psychiatry; Suicide prevention; Suicide on this scale having already analyzed its reliability and validity using a variety of setups, producing good results [3-5]. Our previous studies on suicide attempts have revealed a tendency that, regardless of gender or age group, suicide attempters with lower GAS scores more often use dangerous methods of suicide in their attempts, indicating that GAS scores may be a predictor for dangerous suicide attempts not only across gender or age groups but also across disease entities [6,7]. However, there is not sufficient evidence that the GAS, a comprehensive indicator, is clearly related to the level of risk of suicide in patients. The purpose of this study is to clarify the characteristics and related factors associate with GAS of each group were classified into three groups in the GAS score a suicide attempters. Methods We hypothesized that the lead to the prevention of re-suicide attempt by taking action appropriate to the score to understand the char...
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