Poster Example 1

Total Page：16

File Type：pdf, Size：1020Kb

Difficulties in Managing Alcohol Withdrawal Delirium in a Patient With a History of Schizophrenia Commented [p1]: Title describes the key points of the case. Abstract Mr. M., a 55-year-old African-American male with a past psychiatric history of schizophrenia and alcohol use disorder, presents to the psychiatric consult service with recent onset of altered mental status, incoherent speech and picking movements. The patient had stopped drinking alcohol two days prior, and his family could only provide a limited history. He was admitted to the inpatient medicine service. The medical team considered the differential diagnosis of alcohol withdrawal delirium, toxic metabolic encephalopathy and medication toxicity. The patient's condition initially worsened. He was continually monitored on the regular floor instead of a critical care setting, with uncertainty whether his symptoms were a result of alcohol withdrawal delirium or schizophrenia. This led to the concern of suboptimal management of his alcohol withdrawal as a result of the stigma of his previous psychiatric diagnosis of schizophrenia, compared to a patient with no prior psychiatric history. Being that alcohol withdrawal is a medical emergency, patients with psychiatric histories presenting with this symptom constellation need to be treated in the same manner as any other patient would be. A thorough medical workup and history gathering can help elucidate the source of the presenting picture in this patient population. In this poster, we discuss the challenges and importance of differentiating psychotic symptom etiology during the treatment of alcohol withdrawal delirium in patients with a previous psychiatric disorder. Commented [p2]: Abstract is concise and effectively describes the case being studied and the lessons learned. .

Copy Link

Recommended publications

The Clinical Presentation of Psychotic Disorders Bob Boland MD Slide 1
The Clinical Presentation of Psychotic Disorders Bob Boland MD Slide 1 Psychotic Disorders Slide 2 As with all the disorders, it is preferable to pick Archetype one “archetypal” disorder for the category of • Schizophrenia disorder, understand it well, and then know the others as they compare. For the psychotic disorders, the diagnosis we will concentrate on will be Schizophrenia. Slide 3 A good way to organize discussions of Phenomenology phenomenology is by using the same structure • The mental status exam as the mental status examination. – Appearance –Mood – Thought – Cognition – Judgment and Insight Clinical Presentation of Psychotic Disorders. Slide 4 Motor disturbances include disorders of Appearance mobility, activity and volition. Catatonic – Motor disturbances • Catatonia stupor is a state in which patients are •Stereotypy • Mannerisms immobile, mute, yet conscious. They exhibit – Behavioral problems •Hygiene waxy flexibility, or assumption of bizarre • Social functioning – “Soft signs” postures as most dramatic example. Catatonic excitement is uncontrolled and aimless motor activity. It is important to differentiate from substance-induced movement disorders, such as extrapyramidal symptoms and tardive dyskinesia. Slide 5 Disorders of behavior may involve Appearance deterioration of social functioning-- social • Behavioral Problems • Social functioning withdrawal, self neglect, neglect of • Other – Ex. Neuro soft signs environment (deterioration of housing, etc.), or socially inappropriate behaviors (talking to themselves in
[Show full text]
Schizophrenia
Schizophrenia The upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) makes several key changes to the category of schizophrenia and highlights for future study an area that could be critical for early detection of this often debilitating condition. Changes to the Diagnosis Schizophrenia is characterized by delusions, hallucinations, disorganized speech and behavior, and other symptoms that cause social or occupational dysfunction. For a diagnosis, symptoms must have been present for six months and include at least one month of active symptoms. DSM-5 raises the symptom threshold, requiring that an individual exhibit at least two of the specified symptoms. (In the manual’s previous editions, that threshold was one.) Additionally, the diagnostic criteria no longer identify subtypes. Subtypes had been defined by the predominant symptom at the time of evaluation. But these were not helpful to clinicians because patients’ symptoms often changed from one subtype to another and presented overlapping subtype symptoms, which blurred distinc- tions among the five subtypes and decreased their validity. Some of the subtypes are now specifiers to help provide further detail in diagnosis. For example, catatonia (marked by motor immobility and stupor) will be used as a specifier for schizophrenia and other psychotic conditions such as schizoaffec- tive disorder. This specifier can also be used in other disorder areas such as bipolar disorders and major depressive disorder. Area for Further Study Attenuated psychosis syndrome is included in Section III of the new manual; conditions listed there require further research before their consideration as formal disorders. This potential category would identify a person who does not have a full-blown psychotic disorder but exhibits minor versions of relevant symptoms.
[Show full text]
Association Between Schizophrenia Polygenic Score and Psychotic Symptoms In
bioRxiv preprint doi: https://doi.org/10.1101/528802; this version posted January 26, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. Association between schizophrenia polygenic score and psychotic symptoms in Alzheimer’s disease: meta-analysis of 11 cohort studies. Byron Creese1,2*, Evangelos Vassos3*, Sverre Bergh2,4,5*, Lavinia Athanasiu6,7, Iskandar Johar8,2, Arvid Rongve9,10,,2, Ingrid Tøndel Medbøen5,11, Miguel Vasconcelos Da Silva1,8,2, Eivind Aakhus4, Fred Andersen12, Francesco Bettella6,7 , Anne Braekhus5,11,13, Srdjan Djurovic10,14, Giulia Paroni16, Petroula Proitsi17, Ingvild Saltvedt18,19, Davide Seripa16, Eystein Stordal20,21, Tormod Fladby22,23, Dag Aarsland2,8,24, Ole A. Andreassen6,7, Clive Ballard1,2*, Geir Selbaek4,5,25*, on behalf of the AddNeuroMed consortium and the Alzheimer's Disease Neuroimaging Initiative** 1. University of Exeter Medical School, Exeter, UK 2. Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia 3. Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London 4. Research centre of Age-related Functional Decline and Disease, Innlandet Hospital Trust, Pb 68, Ottestad 2312, Norway 5. Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway 6. NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 7. NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway 8. Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London 9.
[Show full text]
Psychotic Symptoms in Post Traumatic Stress Disorder: a Case Illustration and Literature Review
CASE REPORT SA Psych Rev 2003;6: 21-24 Psychotic symptoms in post traumatic stress disorder: a case illustration and literature review Adekola O Alao, Laura Leso, Mantosh J Dewan, Erika B Johnson Department of Psychiatry, State University of New York, Syracuse, NY, USA ABSTRACT Posttraumatic stress disorder (PTSD) is a condition being increasingly recognized. The diagnosis is based on the re-experiencing of a traumatic event. There have been reports of the presence of psychotic symptoms in some cases of PTSD. This may represent in- creased severity or a different diagnostic clinical entity. It has also been suggested that psychotic symptoms may be over-represented in the Hispanic population. In this manuscript, we describe a case to illustrate this relationship and we review the current literature on the relationship of psychotic symptoms among PTSD patients. The implications regarding diagnosis, treatment, and prognosis are discussed. Keywords: Psychosis; PTSD; Trauma; Hallucinations; Delusions; Posttraumatic stress disorder. INTRODUCTION the best of our knowledge is the first report of psychotic symp- Posttraumatic stress disorder (PTSD) is a psychiatric illness for- toms in a non-veteran adult with PTSD. mally recognized with the publication of the third edition of the Diagnostic and Statistical Manual of the American Psychiatric CASE ILLUSTRATION Association in 1980.1 Re-experiencing of traumatic events as A 37 year-old gentleman was admitted to a state university hos- recurrent unpleasant images, nightmares, and intrusive feelings pital inpatient setting after alerting his wife of his suicidal is a core characteristic of PTSD.2 Most PTSD research has oc- thoughts and intent to slit his throat with a kitchen knife.
[Show full text]
A Postmortem Neuropathologic Study of 100 Cases
ORIGINAL ARTICLE Alzheimer Disease and Related Neurodegenerative Diseases in Elderly Patients With Schizophrenia A Postmortem Neuropathologic Study of 100 Cases Dushyant P. Purohit, MD; Daniel P. Perl, MD; Vahram Haroutunian, PhD; Peter Powchik, MD; Michael Davidson, MD; Kenneth L. Davis, MD Background: Clinical studies suggest that severe cognitive im- nile plaques or neurofibrillary tangles was not different pairment is common among elderly patients with schizophrenia in the group with schizophrenia compared with the age- who reside in long-stay psychiatric institutions; however, previ- matched controls or the group with nonschizophrenic ous autopsy-based neuropathologic investigations have provided psychiatric disorders. The higher Clinical Dementia Rat- conflicting results about the occurrence of Alzheimer disease (AD) ing Scale scores lacked correlation with neuropatho- in elderly patients with schizophrenia. We report the results of a logic evidence of dementing disorders. In the 87 cases comprehensive neuropathologic study performed to identify AD lacking a neuropathologic diagnosis of AD or other de- and other dementing neurodegenerative diseases in elderly pa- menting disorders, the mean (±SD) Clinical Dementia Rat- tients with schizophrenia. ing Scale score was 2.21 (±1.14), with 43 of the cases scor- ing 3 or higher (indicating severe, profound, or terminal Methods: A neuropathologic examination was per- cognitive impairment). formed on 100 consecutive autopsy brain specimens of patients aged 52 to 101 years (mean, 76.5 years). A cog- Conclusions: This study provides evidence that el- nitive assessment of these cases was also done by em- derly patients with schizophrenia are not inordinately ploying the Clinical Dementia Rating Scale. For com- prone to the development of AD or to increased senile parison, we included 47 patients with nonschizophrenic plaques or neurofibrillary tangle formation in the brain.
[Show full text]
Early Identification of Psychosis a Primer
Early Identification of Psychosis A Primer Mental Health Evaluation & Community Consultation Unit TABLE OF CONTENTS Introduction...............................................................................................................3 Psychosis and Early Intervention........................................................................4 Why is Early Intervention Needed?...................................................................5 Risk and Onset..........................................................................................................6 Course of First-Episode Psychosis 1. Prodrome........................................................................................................7 2. Acute Phase....................................................................................................8 3. Recovery Phase..............................................................................................9 Summary of First-Episode Psychosis...............................................................11 Tips for Helpers......................................................................................................12 More Resources......................................................................................................15 Acknowledgements...............................................................................................16 2 INTRODUCTION Psychosis is a condition characterized by loss of contact with reality and may involve severe disturbances in perception, cognition, behavior,
[Show full text]
Fact Sheet: Schizophrenia At-A-Glance (PDF)
Oﬃce of Communications www.broadinstitute.org T 617-714-8600 [email protected] 415 Main Street, Cambridge, MA 02142 SCHIZOPHRENIA: AT-A-GLANCE ABOUT THE DISORDER Schizophrenia is a severe, chronic, and debilitating mental illness. It affects more than 2 million Americans over the age of 18, and roughly 1 out of every 100 people worldwide. Schizophrenia significantly affects a person’s ability to think, feel, and act. Symptoms vary widely, and are generally classified as positive, negative, or cognitive: • Positive symptoms include psychotic behaviors typically not seen in healthy people, such as delusions, hallucinations, and disorganized thoughts and speech. • Negative symptoms include loss of normal functions, resulting in symptoms such as impoverished thought and speech, emotional blunting, and loss of motivation. • Cognitive symptoms are highly disabling and include deficits in attention, memory, verbal fluency, and executive function (notably the ability to regulate thought, emotion, and behavior in accordance with goals). DIAGNOSIS Schizophrenia typically begins in the teens and early twenties with a “prodrome” that may be difficult to distinguish from other psychiatric problems. Typically the prodrome involves a drop in grades, social withdrawal, sleep problems, irritability, and when measured, a decline in multiple cognitive functions. Later, mild psychotic symptoms begin to manifest — the person may become suspicious and begin to experience hallucinations. The diagnosis is often not made, however, until a florid psychotic episode develops. There is no simple diagnostic test for schizophrenia, and thus clinicians must consider other causes of psychosis, including severe mood disorders and substance abuse disorders. TREATMENT The underlying causes of schizophrenia remain unknown, so current treatments focus on reducing or eliminating symptoms.
[Show full text]
Cognitive-Behavioral Treatment of Social Anxiety Disorder and Comorbid Paranoid Schizophrenia Monnica T
University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln Faculty Publications, Department of Psychology Psychology, Department of 2015 Cognitive-Behavioral Treatment of Social Anxiety Disorder and Comorbid Paranoid Schizophrenia Monnica T. Williams University of Louisville, [email protected] Michelle C. Capozzoli University of Nebraska–Lincoln, [email protected] Erica V. Buckner University of Louisville David Yuska University of Pennsylvania Follow this and additional works at: https://digitalcommons.unl.edu/psychfacpub Part of the Clinical Psychology Commons, and the Personality and Social Contexts Commons Williams, Monnica T.; Capozzoli, Michelle C.; Buckner, Erica V.; and Yuska, David, "Cognitive-Behavioral Treatment of Social Anxiety Disorder and Comorbid Paranoid Schizophrenia" (2015). Faculty Publications, Department of Psychology. 711. https://digitalcommons.unl.edu/psychfacpub/711 This Article is brought to you for free and open access by the Psychology, Department of at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in Faculty Publications, Department of Psychology by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. Published in Clinical Case Studies 14:5 (2015), pp. 323– 341. doi 10.1177/1534650114559717 Copyright © 2014 Monnica T. Williams, Michelle C. Capozzoli, Erica V. Buckner, and David Yusko; published by SAGE Publications. Used by permission. digitalcommons.unl.edu Cognitive-Behavioral Treatment of Social Anxiety Disorder
[Show full text]
Abnormal Diffusion Across the Brain in Schizophrenia
Neuropsychologia 135 (2019) 107233 Contents lists available at ScienceDirect Neuropsychologia journal homepage: http://www.elsevier.com/locate/neuropsychologia White matter structure in schizophrenia and autism: Abnormal diffusion across the brain in schizophrenia Sarah M. Haigh a,b,c,*, Shaun M. Eack d,f, Timothy Keller a, Nancy J. Minshew d,e, Marlene Behrmann a,b a Department of Psychology, Carnegie Mellon University, USA b Center for the Neural Basis of Cognition, Carnegie Mellon University, USA c Department of Psychology and Center for Integrative Neuroscience, University of Nevada, Reno, USA d Department of Psychiatry, University of Pittsburgh School of Medicine, USA e Department of Neurology, University of Pittsburgh, USA f School of Social Work, University of Pittsburgh, USA ARTICLE INFO ABSTRACT Keywords: Background: Schizophrenia and autism share many behavioral and neurological similarities, including altered Autism white matter tract structure. However, because schizophrenia and autism are rarely compared directly, it is Schizophrenia difficult to establish whether white matter abnormalities are disorder-specific or are common across these dis DTI orders that share some symptomatology. White matter Methods: In the current study, we compared white matter water diffusion using tensor imaging in 25 adults with Mean diffusivity TBSS autism, 15 adults with schizophrenia, all with IQ scores above 88, and 19 neurotypical adults. Results: Although the three groups evinced no statistically significant differences in measures of fractional anisotropy (FA), the schizophrenia group showed significantly greater mean diffusivity (MD; Cohen’s d > 0.77), due to greater radial diffusivity (RD; Cohen’s d > 0.92), compared to both the autism and control groups. This effect was evident across the brain rather than specific to a particular tract.
[Show full text]
Children with Schizophrenia-Spectrum Disorders: Thought Disorder and Communication Problems in a Family Interactional Context Martha Tompson Boston University
Digital Commons @ George Fox University Faculty Publications - Grad School of Clinical Graduate School of Clinical Psychology Psychology 1997 Children with Schizophrenia-spectrum Disorders: Thought Disorder and Communication Problems in a Family Interactional Context Martha Tompson Boston University Joan Asarnow University of California, Los Angeles Elizabeth Burney Hamilton George Fox University, [email protected] LaRisa E. Newell University of California, Los Angeles Michael J. Goldstein University of California, Los Angeles Follow this and additional works at: http://digitalcommons.georgefox.edu/gscp_fac Part of the Psychology Commons Recommended Citation Tompson, Martha; Asarnow, Joan; Hamilton, Elizabeth Burney; Newell, LaRisa E.; and Goldstein, Michael J., "Children with Schizophrenia-spectrum Disorders: Thought Disorder and Communication Problems in a Family Interactional Context" (1997). Faculty Publications - Grad School of Clinical Psychology. Paper 237. http://digitalcommons.georgefox.edu/gscp_fac/237 This Article is brought to you for free and open access by the Graduate School of Clinical Psychology at Digital Commons @ George Fox University. It has been accepted for inclusion in Faculty Publications - Grad School of Clinical Psychology by an authorized administrator of Digital Commons @ George Fox University. For more information, please contact [email protected]. Children with Schizophrenia-spectrum Disorders: Thought Disorder and Communication Problems in a Family Interactional Context Martha C. Tompson, Joan R. Asarnow, Elizabeth Burney Hamilton, LaRisa E. Newell, and Michael J. Goldstein UCLA Family Project, University of California at Los Angeles, U.S.A. Thought disorder and communication patterns during an interactional task were examined in families of children with schizophrenia-spectrum disorders (schizophrenia and schizo typal personality disorder), depressed children, and normal controls.
[Show full text]
Introduction to Agitation, Delirium, and Psychosis Curriculum for Physicians
PARTICIPANT HANDBOOK ENGLISH-HAITI Introduction to Agitation, Delirium, and Psychosis Curriculum for Physicians Introduction to Agitation, Delirium, and Psychosis Curriculum for Physicians Partners In Health (PIH) is an independent, non-profit organization founded over twenty years ago in Haiti with a mission to provide the very best medical care in places that had none, to accompany patients through their care and treatment and to address the root causes of their illnesses. Today, PIH works in fourteen countries with a comprehensive approach to breaking the cycle of poverty and disease — through direct health-care delivery as well as community-based interventions in agriculture and nutrition, housing, clean water, and income generation. PIH’s work begins with caring for and treating patients, but it extends far beyond; to the transformation of communities, health systems, and global health policy. PIH has built and sustained this integrated approach in the midst of tragedies like the devastating earthquake in Haiti. Through collaboration with leading medical and academic institutions like Harvard Medical School and the Brigham & Women’s Hospital, PIH works to disseminate this model to others. Through advocacy efforts aimed at global health funders and policymakers, PIH seeks to raise the standard for what is possible in the delivery of health care in the poorest corners of the world. PIH works in Haiti, Russia, Peru, Rwanda, Sierra Leone, Liberia, Lesotho, Malawi, Kazakhstan, Mexico and the United States. For more information about PIH, please visit www.pih.org. Many PIH and Zanmi Lasante staff members and external partners contributed to the development of this training. We would like to thank Giuseppe Raviola, MD, MPH; Rupinder Legha, MD ; Père Eddy Eustache, MA; Tatiana Therosme; Wilder Dubuisson; Shin Daimyo, MPH; Leigh Forbush, MPH; Emily Dally, MPH; Ketnie Aristide, and Jenny Lee Utech.
[Show full text]
Identifying Schizophrenia and Bipolar Disorder from a Sea of Mimics
Identifying Schizophrenia and Bipolar Disorder from a Sea of Mimics Michael Sean Stanley, MD Assistant Professor OHSU Department of Psychiatry Identifying Schizophrenia and Bipolar Disorder from a Sea of Mimics No Disclosures. • Objectives: – Understand the clinical presentation and approach to treatment of Schizophrenia and Bipolar Disorder Psychotic disorders are: Mood Disorders are: • primarily problems of • Primarily problems of sensory processing prolonged extreme and association, not emotional tone (mood). emotion • Exhibit excessive high or • Exhibit profound low mood/motivation disconnection from from normal state sensory reality Psychosis Schizophrenia • a neurodevelopmental syndrome • associated with functional impairments Schizophrenia • no single unifying cause • emerges when environmental accelerants act upon genetic predisposition • May be at the more severely impairing end of a spectrum of disorders. + - C Positive Symptoms Negative Symptoms Cognitive Symptoms New abnormal sx Loss of normal fxn Accompany and likely - Hallucinations - Affective flattening precede +/- sx (auditory most - Anhedonia - Attentional problems commonly) - Asociality - Slower processing - Delusions - Alogia - Difficulty with - Significant planning/prob disorganization of solving thought/behavior - Memory problems May come and go A stable loss, do not Prodromal sx? fluctuate significantly once lost. May decrease to some May be responsive to Minimally responsive to degree with tx of pos sx, antipsychotic meds antipsychotic meds if at but rarely completely.
[Show full text]