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.
Objectives: To examine the discharge prescription patterns of antipsychotics in patients with mental illness hospitalized compulsorily by prefectural governors in accordance with the provisions of Article 29 of the Japanese Mental Health Act. MethOds: This was a retrospective cohort study conducted on the Article 29 patients admitted during fiscal year 2010 to 79 Japanese mental hospitals. We analyzed patients who were diagnosed with psychotic disorders (ICD-10: F2) and prescribed at least one antipsychotic. Extracted data included gender, age, principal psychiatric diagnosis (based on ICD-10), treatment history, and types and doses of antipsychotics at discharge. Results: The cohort consisted of 440 males and 222 females, with an average age (standard deviation) of 43.6 years (13.3). The most frequent diagnostic subcategory was schizophrenia (F20; n= 542), followed by acute and transient psychotic disorders (F23; n= 33), schizoaffective disorders (F25; n= 29), and persistent delusional disorders (F22; n= 26). Of the 662 patients, 258 had never experienced psychiatric hospitalization before the index admission, and 133 of these had never undergone psychiatric treatment. Oral antipsychotics were prescribed for 651 patients; of these, 241 and 588 were prescribed first-generation and secondgeneration antipsychotics (SGAs), respectively. Among the SGAs, risperidone (39.7%; n= 263) had the highest prescription rate, followed by olanzapine (n= 223), aripiprazole (n= 70), quetiapine (n= 66), blonanserin (n= 42), perospirone (n= 8), paliperidone (n= 8), and clozapine (n= 2). Antipsychotic long-acting injections (LAIs) were administered in 84 (12.7%) patients; of these, haloperidol LAI (5.6%; n= 37) had the highest utilization rate, followed by risperidone LAI (4.4%; n= 29) and fluphenazine LAI (3.0%; n= 20). Antipsychotic polypharmacy was conducted in 297 (44.9%) patients; of these, 89 (13.4%) were prescribed three or more concurrent antipsychotics. cOnclusiOns: At discharge, about four ninths of the Article 29 patients in Japan are apparently treated with antipsychotic polypharmacy.
A 30-year-old female with lower abdominal pain was transported to our hospital by ambulance. She claimed to be a physician, but refused to produce identification. We requested that Iwate Prefecture Medical Association fax other medical facilities with information about this suspected addict. She requested immediate pentazocine administration. Based on her medical history, she had received intravenous injections of diazepam and pentazocine each time she presented with abdominal pain at other hospitals within the Kanto region of Japan. A psychiatrist recommended against administering pentazocine due to the potential dependency. The patient fled our hospital after it was noted that she had used a pseudonym and a counterfeit ID card. Thirty minutes later, a hospital approximately 20 km from our hospital reported that pentazocine had been administered to the patient; however, she fled because the hospital received the warning fax from the Iwate Prefecture Medical Association. The patient had also sought care for the same symptoms at medical facilities in Miyagi and Akita prefectures. This case suggests that pentazocine should not be administered to patients with a suspected addiction, and sharing information between police and medical associations is important. A response manual for psychiatric emergency patients is needed at emergency medical institutions.
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