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To exemplify the role and relationship of Consultation Liaison Psychiatry with other areas of knowledge involved in the health-disease process, intending to propose solutions, under a biopsychosocial perspective, to clinical (care delivery) or institutional (service-related) problems.
The review of a patient record who represents an instance of this need for integration of approaches is reported.
The case of a patient who presented an unusual pathophysiological manifestation of Behçet's Syndrome (pseudo tumor neurological inflammation) and also developed psychiatric manic symptoms after the pharmacological treatment with corticosteroids is described. Despite both the remission of mental and behavioral symptoms with psychopharmacological treatment of short duration, her clinical outcome made it necessary to reintroduce corticotherapy, with recrudescence of psychiatric manifestations and the need for maintenance treatment to assure its management.
Besides illustrating a rare clinical condition, the described report exemplifies the benefits of joint and planned actions between psychiatrists and other professionals involved in integral assistance to inpatients at hospital wards.
To provide information about psychiatric comorbidity and suicidal behavior in people with epilepsy compared to those without epilepsy from a community sample in Brazil.
An attempt was made to evaluate all 174 subjects with epilepsy (cases) identified in a previous community survey. For every case identified, an individual without epilepsy (control) and matched by sex and age was selected in the same neighborhood. A structured interview with validated psychiatric scales was performed. 153 cases and 154 controls were enrolled in the study.
People with epilepsy had more frequently anxiety (39.4% versus 23.8%, OR 2.1 [95% CI 1.2 - 3.5]; p=0.006), depression (24.4% versus 14.7%, OR 1.9 [95% CI 1.01 - 3.5]; p=0.04) and anger (55.6% versus 39.7%, OR 1.9 [95% CI 1.2 - 3.1]; p=0.008). They also reported more suicidal thoughts (36.7% versus 23.8%, OR 1.8 [95% CI 1.1 - 3.1]; p=0.02), plans (18.2% versus 3.3%, OR 2.0 [95% CI 1.0 - 4.0]; p=0.04) and attempts (12.1% versus 5.3%, OR 2.4 [95% CI 1.1 - 3.2], p=0.04) during life than controls.
These findings call attention for psychiatric comorbidity and suicidal behavior associated with epilepsy. Suicide risk assessment, mental evaluation and treatment may improve quality of life in epilepsy and ultimately prevent suicide.
To analyze the clinical and demographic profile of psychiatric interconsultations in a pediatric ward of a Brazilian university hospital in 2008.
Review and statistical analysis, using SPSS, of the medical records of the 31 children/adolescents admitted to the Hospital from the University of Campinas-Brazil who required psychiatric assessment.
1,072 children/adolescents were hospitalized, with a total of 1,933 admissions. Psychiatric consultation was requested for 31(16 girls and 15 boys), 4(12.9%) were hospitalized more than once in 2008. Ages: 2 months-18 years old (mean: 9.9 ± 4.5). 19(61.3%) were white, 5(16.1%) mixed and 3(9.7%) black. Mothers were responsible for the children/adolescents in 23(74.5%) cases. 2(6.5%) children attended kindergarten and 19(61.3%), primary school. The permanence time varied between 1-199 days (mean: 24 ± 38.1). 8(25.8%) patients had psychiatric diagnoses at admission and were taking psychotropic drugs. 26(83.9%) had a positive clinical pediatric history. In 25(80.6%) patients the psychiatry diagnosed at least one mental disorder (more than one in 15-48.4% patients). Depressive mood disorders were the most prevalent. Psychiatric pharmacotherapy was used for 20(64.5%) patients and 17(54.8%) continued taking medication after discharge. Only 1 patient did not need referral after discharge. 1 patient died 7 months after the assessment.
The experience of being ill can have great emotional significance for children/adolescents and their families. The presence of a psychiatrist on staff can help the pediatrician in dealing with these situations, influencing therapy and prognosis.
To illustrate, with a case report, the risk of suicide in general hospitals among inpatients with acute confusion or delirious states.
The review of a patient record who represents an instance of this risk is reported.
A Brazilian farmer, with incomplete elementary education, was admitted to the General Infirmary of Adults, from the Clinical Hospital of the State University of Campinas-Brazil (Unicamp), diagnosed with a hypothyroidism mixedematous myopathy, which led to the following clinical sequence: rhabdomyolysis, myoglobinuria and acute renal failure. An accidental iatrogenic levothyroxine poisoning precipitated or exacerbated the confusion in this previously weakened patient, leading to psychiatric symptoms of delirium. When a bed was brought to the corridor by nurses, he considered it an ambush. Anxious, wanting to flee, he pitched himself from the 6th floor (8 meters). The fall was partly contained by a protection net. Following the episode, the psychiatric disorder was reversed, after temporary introduction of haloperidol, with no new episodes.
Physicians should recognize confused states to identify and treat the underlying causes and to prevent the development of its complications. Besides clinical and psychiatric care for patients with confused and agitated states, several other measures are recommended when aiming to prevent suicide in a general hospital, such as: restriction of access to means of suicide (windows and hazardous balconies); placement of protective nets; training of the care team for early detection and intervention in any mental disorders; assessment of suicide risks before hospital discharge.
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