- Title
- Psychiatric issues in the critically poisoned patient
- Creator
- Rasimas, J. J.; Carter, Gregory L.
- Relation
- Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient p. 117-157
- Publisher Link
- http://dx.doi.org/10.1007/978-3-319-17900-1_44
- Publisher
- Springer
- Resource Type
- book chapter
- Date
- 2017
- Description
- Clinical care of the seriously poisoned patient is usually multidisciplinary, commonly involving various medical specialists, including emergency physicians, anesthesiologists, intensivists, and toxicologists. The role of a psychiatrist is sometimes overlooked, especially in texts that focus on the ABCs (airway, breathing, circulation) of toxicologic management. Reviews of the topic often make little or no mention of the psychiatric management of these patients [1]. Yet patients who deliberately overdose have a high prevalence of suicidal ideation and pre-existing psychiatric disorders that may impact medical management [2], and it is also common for patients admitted to intensive care units (ICUs) to develop a psychiatric disturbance (e.g., delirium) during their admission, regardless of their premorbid psychiatric state [3]. Delirium is now being recognized as a condition to be prevented when possible and managed aggressively to minimize short- and long-term sequelae; therefore, psychobehavioral expertise is becoming vital in the critical care setting. Furthermore, drug misadventures in patients with addictive disorders comprise a growing percentage of acutely poisoned patients. Many toxicology patients have intentionally exposed themselves to their poisons, and a portion of those carry an elevated risk of subsequent suicide with a rate of 1.6% (CI 1.2–2.4) after 12 months and 3.9% (CI 3.2–4.8) after 5 years; and repetition of nonfatal self-harm or self-poisoning of 16.3% (CI 15.1–17.7) after 12 months [4], so attention to the psychosocial determinants of self-poisoning and to underlying mental health needs is essential. This chapter outlines the psychiatric aspects of critical care toxicology and describes the potentially useful role of a psychiatric service in the multidisciplinary management of seriously poisoned patients. It is organized to mirror the temporal course of patient care and mental health issues that arise, from the precipitants of toxicologic exposure through the course of critical illness to post-recovery intervention.
- Description
- 2nd ed.
- Subject
- delirium; deliberate self-poisoning; borderline personality disorder; Munchausen syndrome; post-traumatic stress disorder; PTSD; Memorial Delirium Assessment Scale; Delirium Rating Scale; benzodiazepines; haloperidol; flumazenil; physostigmine; substance misuse; butyrophenones; ziprasidone; olanzapine; aripiprazole; psychosis; lorazepam; droperidol; ketamine; alpha-2 receptor agonists; dexmedetomidine; deliberate self-harm; analgosedation; morphine; atypical antipsychotic medications; suicide; parasuicide; methylenedioxymethamphetamine; MDMA; neuroleptic malignant syndrome; serotonin syndrome
- Identifier
- http://hdl.handle.net/1959.13/1397358
- Identifier
- uon:34254
- Identifier
- ISBN:9783319178998
- Language
- eng
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