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Serotonin Syndrome: a Concise Review of a Toxic State Dwayne R RHODE ISLAND M EDICAL J OURNAL THE CORNER brown’s new DRUGSTORE ARONSON FUND PAGES 10–12 PAGE 75 SPECIAL SECTION IDENTIFYING and MANAGING PSYCHIATRIC EMERGENCIES COLIN J. HARRINGTON, MD; ROBERT BOLAND, MD; GUEST EDITORS JUNE 2014 VOLUME 97• NUMBER 6 ISSN 2327-2228 Some things have changed in 25 years. Some things have not. Since 1988, physicians have trusted us to understand their professional liability, property, and personal insurance needs. Working with multiple insurers allows us to offer you choice and the convenience of one-stop shopping. Call us. 800-559-6711 rims I B C RIMS-INSURANCE BROKERAGE CORPORATION Medical/Professional Liability Property/Casualty Life/Health/Disability RHODE ISLAND M EDICAL J OURNAL 16 Identifying and Managing Psychiatric Emergencies COLIN J. HARRINGTON, MD; ROBERT BOLAND, MD GUEST EDITORS Colin J. Harrington, MD Robert Boland, MD 18 Delirium: Presentation, Epidemiology, and Diagnostic Evaluation (Part 1) COLIN J. HARRINGTON, MD; KALYA VARDI, MD 24 Delirium: Treatment and Prevention (Part 2) KALYA VARDI, MD; COLIN J. HARRINGTON, MD Kalya Vardi, MD 29 The ‘Problem Patient’: Modest Advice for Frustrated Clinicians ROBERT BOLAND, MD 33 Serotonin Syndrome: A Concise Review of a Toxic State DWAYNE R. HEITMILLER, MD Jeffrey Burock, MD 36 Practical Management of Alzheimer’s Dementia JEFFREY BUROCK, MD; LILLY NAQVI, BS 41 Emerging Drugs of Abuse: Clinical and Legal Considerations ELIE G. AOUN, MD; PAUL P. CHRISTOPHER, MD; Elie G. Aoun, MD JAMES W. INGRAHAM, MD RHODE ISLAND M EDICAL J OURNAL 7 COMMENTARY Retirement: For Better or Worse? JOSEPH H. FRIEDMAN, MD The Moral Heritage of the Corner Drugstore STANLEY M. ARONSON, MD Working on the Family ‘Pharm’ MARY KORR 14 RIMJ AROUND THE WORLD Belgium, Portugal, Israel, France 68 RIMS NEWS TarWars, Helmet Distribution, Eleventh Hour Education Event Working for You Why You Should Join RIMS 86 SPOTLIGHT Pitch Perfect: Piyush Gupta, MD, Wins at Google Glass Challenge MARY KORR 96 PHYSICIan’s LEXICON The Esoteric Prefixes of Medicine (Part II) STANLEY M. ARONSON, MD 98 HERITAGE 100 Years Ago: Dr. Blumer Calls for Experts to Assess Mental Health of ‘Insane Aliens’ 1914: Hats Off to The Way We Were MARY KORR RHODE ISLAND M EDICAL J OURNAL IN THE NEWS JWU PA SCHOOL 71 79 HEALTH DEPT. REPORT: has ribbon cutting drug-dependent babies LIFESPan Lab’s 73 80 KENT/MEMORIAL automated equipment use germ-zapping robots BROWN 75 81 BRADLEY/HASBRO STUDY: endows Aronson Fund asthma in Latino students BROWN ONCOLOGy’s 76 82 BRADLEY/HASBRO STUDY: 20th anniversary CBT benefits youngsters with OCD RIC/URI NURSING CENTER 77 82 RI HOSPITAL STUDY: approved by Board of Ed increased readmission rates for Medicare patients with dementia CVS MINUTECLINICS 78 given terms by Health Dept. 83 CHARTERCARE/PROSPECT receive state approval NEW LAW 79 expands Prescription 84 WOMEN AND INFANTS Monitoring Program opens oncology facilities PEOPLE JAMES PADBURY, MD 88 92 JOSEPH A. DIAZ, MD honored by named Physician-in-Chief pediatric society of Medicine at Memorial ESTHER CHOO, MD 88 94 LISA J. GOULD, MD receives Young named president of Investigator Award Wound Healing Society JOSEPH SWEENEY, MD 89 95 JENNIFER GASS, MD receives Milton Hamolsky elected president Lifetime Achievement Award of RI ACS LYNN E. TAYLOR, MD 90 95 MARGARET HOWARD, PhD RIMWA Woman Physician named W&I director of of the Year Women’s Behavioral Health ROBERT S. CRAUSMAN, MD 91 95 KAREN L. FURIE, MD CLYDE S. FISH, DPM installed as Inaugural honored by RI Podiatric Kennison Professor Medical Society JUNE 2014 VOLUME 97 • NUMBER 6 RHODE ISLAND Rhode Island Medical Society R I Med J (2013) 2327-2228 M EDICAL OURNAL PUBLISHER J 97 RHODE ISLAND MEDICAL SOCIETY 6 WITH SUPPORT FROM RI DEPT. OF HEALTH 2014 PRESIDENT June ELAINE C. JONES, MD 2 PRESIDENT-ELECT PETER KARCZMAR, MD VICE PRESIDENT CONTRIBUTION RUSSELL A. SETTIPANE, MD 47 Outpatient, Awake, Ultra-Minimally Invasive Endoscopic Treatment SECRETARY ELIZABETH B. LANGE, MD of Lumbar Disc Herniations TREASURER GABRIELE P. JASPER, MD; GINA M. FRANCISCO, BSC; ALBERT E. TELFEIAN, MD, PhD JOSE R. POLANCO, MD 50 Promoting Medical Student Research Productivity: IMMEDIATE PAST PRESIDENT ALYN L. ADRAIN, MD The Student Perspective EXECUTIVE DIRECTOR BENJAMIN K. YOUNG, MS; FEI CAI, AB; VICKRAM J. TANDON, BS; NEWELL E. WARDE, PhD PAUL GEORGE, MD, MHPE; PAUL B. GREENBERG, MD EDITOR-IN-CHIEF JOSEPH H. FRIEDMAN, MD CASE REPORT ASSOCIATE EDITOR 53 Gastrointestinal CMV in an Elderly, Immunocompetent Patient SUN HO AHN, MD CHRISTOPHER FYOCK, MD; MELISSA GAITANIS, MD; JOHN GAO, MD; EDITOR EMERITUS MURRAY RESNICK, MD, PHD; SAMIR SHAH, MD STANLEY M. ARONSON, MD PUBLICATION STAFF 56 An Unusual Case of Pulmonary Embolism in MANAGING EDITOR a Young Healthy Female Competitive Rower MARY KORR KATHERINE M. RAND, CHARLES B. SHERMAN, MD [email protected] GRAPHIC DESIGNER MARIANNE MIGLIORI PUBLIC HEALTH ADVERTISING STEVEN DETOY 60 Health by Numbers: Rhode Island Clostridium difficile Infection SARAH STEVENS Trends and Laboratory ID Events Ranking [email protected] YONGWEN JIANG, PHD; ROSA BAIER, MPH; BLAKE MORPHIS, BS, CPEHR; EDITORIAL BOARD LEONARD A. MERMEL, DO, SCM; SAMARA VINER-BROWN, MS STANLEY M. ARONSON, MD, MPH JOHN J. CRONAN, MD 64 Using the Rhode Island Prescription Drug Monitoring Program (PMP) JAMES P. CROWLEY, MD JAMES V. MCDONALD, MD, MPH EDWARD R. FELLER, MD JOHN P. FULTON, PhD 66 Enhanced Surveillance for Opioid Overdose in Rhode Island PETER A. HOLLMANN, MD KENNETH S. KORR, MD [REPORTED BY STAFF OF THE RHODE ISLAND DEPARTMENT OF HEALTH MARGUERITE A. NEILL, MD FRANK J. SCHABERG, JR., MD 67 Vital Statistics LAWRENCE W. VERNAGLIA, JD, MPH COLLEEN A. FONTANA, STATE REGISTRAR NEWELL E. WARDE, PhD RHODE ISLAND MEDICAL JOURNAL Erratum (USPS 464-820), a monthly publication, is R I Med J (2013). 2014 May 1;97(5):22-6. owned and published by the Rhode Island The Brown university traumatic brain injury research consortium and the Norman Medical Society, 235 Promenade Street, Suite Prince Neurosciences Institute. 500, Providence RI 02908, 401-331-3207. Rogg J, Lafrance WC Jr, Wilcox E, Correira S, Chodobski A, Szmydynger-Chodobska J, All rights reserved. ISSN 2327-2228. Published Raukar N, Ellermeier A, Spader H, Machan JT. articles represent opinions of the authors and Erratum in: R I Med J (2013). 2014 June 2; 97(6):6. do not necessarily reflect the official policy Corrected to: Rogg J, Lafrance WC Jr, Wilcox BJ, Correira S, Chodobski A, Szmydyn- of the Rhode Island Medical Society, unless clearly specified. Advertisements do not im- ger-Chodobska J, Raukar N, Ellermeier A, Spader H, Machan JT, Crisco JJ ply sponsorship or endorsement by the Rhode This article provides an overview of the Brown University Traumatic Brain Injury Re- Island Medical Society. search Consortium (TBIRC) and summarizes the multidisciplinary basic and clinical neuroscience work being conducted by investigators at Brown University and the affil- Advertisers contact: Sarah Stevens, RI Medical Society, 401-331-3207, fax 401-751-8050, iate hospitals in association with the Norman Prince Neurosciences Institute (NPNI). [email protected]. PMID: 24791263 [PubMed - in process] COMMENTARY Retirement: For Better or Worse? JOSEPH H. FRIEDMAN, MD [email protected] 7 8 EN “THE DOCTOR TOLD HIM enjoyed much more than needs “work hardening” therapy to live not to retire. He said that work. “I’m so busy I don’t with the pain and restore meaning and retirement would kill him.” know how I had time to financial support in their lives, PD is a I’m often amazed by work!” Others are adrift. progressive disorder. Work now takes what doctors tell patients One of my physician col- longer, is harder, and may not be per- and what patients be- leagues, recently retired formed at the same level as before, and lieve. Usually the quote is due to illness, and still therefore less rewarding. Furthermore more like, “if you waited adjusting, reported that the most disabling aspects of PD for another 10 minutes he’d he met another retired many are the “non-motor” symptoms, have been dead.” As if we doctor, who summed up problems such as fatigue, sleepiness, can forecast the future. his retirement this way: loss of ability to perform two tasks at This quote came from the “I used to be important.” wife of a patient of mine, a 72-year-old Retirement and disability are quite One of my physician colleagues, man with Parkinson’s disease who was different but may overlap. The person recently retired due to illness, continuing to work three days a week who retires because of a disability is in in his family business, and rather am- a very different mindset than the one and still adjusting, reported that bivalent about giving it up. He mostly who has looked forward to stopping he met another retired doctor, wanted to give it up but his friend, a work for years in order to do something who summed up his retirement man of about the same age, had recently prized more highly than their vocation. gotten the advice quoted above. I told Sometimes disability provides the im- this way: “I used to be important.” the patient and his wife, who apparent- petus for a long-considered retirement, ly believe that the doctor really does a little, or not so little, nudge over the the same time. This complements the know best, that, “I never said anything line. Since I deal only with patients with difficulties induced by physical slow- like that to you. In fact, I’ve never said movement disorders I mostly see people ness, reduced dexterity, tremor and im- anything like that to any of my patients. with Parkinson’s disease. For those who balance. These problems are impossible My patients tell me what they want to begin their illness during their working to assess from the outside.
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