Injection-related necrosis is a common pattern in the arterial injuries. But the acute embolization that led to extremity necrosis is very rare. Here we described a case of 43-year male patient with arm necrosis due to intra-arterial drug injection. The patient has addicted drug for 24 years and has injected opium for 18 years with dose of 2 ml self-prepared opium solution, 3-4 times daily. On April 2000, after second injection of a day, the patient felt burn and pain in his left hand. Then watery purples and necrotic papules appeared on the skin of left arm. He was treated by antibiotics, analgesics, and vasodilators, but the condition was not improved. The patients had to be amputated his left arm after 3 days of admission.
Substance Withdrawal Syndrome ; Alcohol Withdrawal Delirium ; diagnosis

Delirium is not uncommon and is a devastating clinical syndrome. Elderly patients are vulnerable to delirium, especially demented or/and medically-surgically ill patients. Old age, comorbid psychiatric, medical and/or neurological diseases, medications, changed pharmacodynamics, sensory impairment and psychosocial stresses contribute to the development of delirium. Delirium in elderly patients is somewhat different from delirium in younger patients, sometimes under detected and/or poorly managed. This review discusses the diagnosis, classification, etiology and treatment, and presents 3 clinical cases of delirium in elderly patients. This review also focuses on a practical approach in assessing and managing delirium in elderly patients. The management of delirium consists of identifying and correcting the underlying problems, including prescribing suitable medication.
Aged* ; Classification ; Delirium* ; Diagnosis ; Geriatric Psychiatry ; Humans

OBJECTIVES: The misdiagnosis of delirium may result in a delay of correct diagnosis and appropriate treatment of the delirium. Additionally, aggravation of physical illnesses can occur. The objective of this study was to investigate patient characteristics in cases of misdiagnosed delirium upon psychiatric consultation in a university hospital. METHODS: Subjects included patients with delirium among all who we had consulted over a 12 week span. Psychiatric diagnosis was made by two well-trained psychiatrists by means of the DSM-IV-TR. Cognitive function, level of delirium, and physical function were evaluated by the Korean version of Mini Mental Status Examination (MMSE-K), the Delirium Rating Scale-Revised-98 (DRS-R-98), the Clinical Global Impression-Severity (CGI-S), the Eastern Cooperative Oncology Group Performance Status (ECOG-PS), and the Global Assessment of Functioning Scale (GAF). In addition, we collected socio-demographic information, date of admission and consultation, present causes of consultation, and speculated psychiatric diagnoses made by referring physicians. RESULTS: Among 45 subjects with delirium, only 28 patients (62%) were diagnosed with delirium by referring physicians at the time of consultation. The remaining 17 patients (38%) had been diagnosed with other illnesses. The group of misdiagnosed patients tended to have a longer duration of formal education than those that had been correctly diagnosed. CONCLUSION: Early diagnosis and intervention of delirium can minimize subsequent problems related to delayed diagnosis. Therefore, it is vital to identify the factors related to misdiagnoses by referring physicians. This study showed that a longer duration of formal education is a contributing factor for the misdiagnosis of delirium. Longer education may cover up the typical symptoms of delirium. This can keep referring physicians from making a correct diagnosis. This study was a pilot study investigating diagnostic accuracy of delirium by referring physicians. Additional, well-controlled studies are warranted.
Delayed Diagnosis ; Delirium ; Diagnostic Errors ; Early Diagnosis ; Humans ; Mental Disorders ; Pilot Projects ; Psychiatry

Delirium tremens is a severe state of alcohol-related withdrawal syndrome, which is precipitated in the chronic alcoholic who are suddenly deprived of alcohol because of traumatic injury or other diseases. About 5 % of alcoholics show evidence of severe withdrawal symptoms. Symptoms begin within 1 to 3 days after stopping ethanol intake. These include a state of confusion sometimes accompanied by visual, tactile, or auditory hallucinations. The diagnosis is made when the course progresses beyond the usual symptoms of withdrawal to include confusion, severe agitation, and generalized seizures. The likelihood of developing severe withdrawal symptoms increases with concomitant infections or medical problems, a prior history of withdrawal seizures of DTs, and higher quantity and frequency of drinking. Most periods of severe withdrawal begin and end abruptly, rarely lasting longer than 3 to 5 days. The mortality risk for DTs is quite low but increases with preexisting medical illnesses or organ system failure. We experienced a case of DTs associated with fracture of mandible. The patient was a 36-years-old male who was admitted to our hospital via emergency room after suffering from a traffic accident. He developed DTs 3 days after admission and eventually expired. The report of a case and review of literatures are as follows.
Accidents, Traffic ; Alcohol Withdrawal Delirium* ; Alcoholics ; Delirium* ; Diagnosis ; Dihydroergotamine ; Drinking ; Emergency Service, Hospital ; Ethanol ; Hallucinations ; Humans ; Male ; Mandible* ; Mortality ; Seizures ; Substance Withdrawal Syndrome

Korea is rapidly aging society and psychiatric disorders of the elderly increasing Korea is rapidly becoming an aging society and psychiatric disorders of the elderly are increasing significantly in importance. Interviewing the elderly requires special skills because of their physical weakness and cognitive impairments such as difficulty concentrating. There are various diagnostic tools for them, for more accurate diagnosis. Representative scales include the Mini-Mental Status Examination for dementia, the Geriatric Depression Scale for depression, and the Confusional Assessment Method for delirium. Differential diagnosis of psychiatric disorders from cerebral and physical disorders is important.
Aged ; Aging ; Delirium ; Dementia ; Depression ; Diagnosis, Differential ; Geriatric Psychiatry ; Humans ; Korea ; Weights and Measures

BACKGROUND: Recent therapeutic advances to delay the progression of dementia have renewed calls to improve early detection and management of individuals with dementia. A new computerized neuropsychological interview and clinical examination, the Cognitive Assessment and Reference Diagnosis System (CARDS) was developed to incorporate in a single instrument all the information required to make an accurate clinical diagnosis of dementia, its subtype, depression and delirium, to present reference diagnoses just after completion of tests, and to detect early dementia. This study aims to verify the diagnostic capability of the CARDS. METHODS: The CARDS was administered to 56 dementia patients (38 Alzheimer's disease, 18 vascular dementia) as well as 40 nondemented subjects. To evaluate the sensitivity and specificity of the CARDS, we compared the CARDS diagnosis with the clinician's diagnosis on dementia, Alzheimer's disease, vascular dementia and depression. To test diagnostic capability of the CARDS in the diagnosis of early dementia, we compared mean scores of total and subscales in the CARDS of GDS stage 3 group with those of GDS stage 4 group. RESULTS: The CARDS demonstrated high levels of sensitivity and specificity in the diagnosis of dementia, AD, VaD and depression. Mean CARDS scores for total and 3 subscales (amnesia, aphasia, agnosia) in GDS stage 3 group were significantly different from those of GDS stage 4 group (p<0.001). CONCLUSION: We demonstrated that CARDS is valid instrument not only for dementia diagnosis but also for detection of early dementia.
Alzheimer Disease ; Aphasia ; Delirium ; Dementia ; Dementia, Vascular ; Depression ; Diagnosis* ; Humans ; Sensitivity and Specificity

OBJECTIVES: This study investigated the prescribing patterns of atypical antipsychotics for the various psychiatric disorders in the psychiatric ward of a University hospital. METHODS: We reviewed the medical records of patients who were discharged from an open psychiatric ward from May, 2003 through April, 2014. The association between psychiatric disorders and prescription pattern of atypical antipsychotics was analyzed. RESULTS: The study included 3091 patients' prescription of psychiatric medication. 60% of prescription included antipsychotics; quetiapine was the most frequently prescribed antipsychotics, but the average dosage was the lowest among all the atypical antipsychotics. According to the diagnoses, prescription rates and dosage of antipsychotics were different. Prescription rates of antipsychotics were the lowest in patients with anxiety disorders, and the mean dosage were the lowest in those with delirium, dementia, and amnestic and other cognitive disorders. CONCLUSION: This observational study shows prescription patterns of atypical antipsychotics for the treatment of psychiatric disorders in a University hospital; atypical antipsychotics were widely used for the treatment of the various disorders, and there were differences in prescription patterns for each disorders. The results of this study may be used to identify the proper atypical antipsychotics effective on certain psychiatric disorders and to propose expanding the indications of each atypical antipsychotics in the future.
Antipsychotic Agents* ; Anxiety Disorders ; Delirium ; Dementia ; Diagnosis ; Humans ; Medical Records ; Observational Study* ; Prescriptions* ; Quetiapine Fumarate

We report a case of delayed diagnosed pneumonia due to an aspirated metallic crown, which had been detached from a molar tooth. Dental prosthesis should be checked and a careful review of the chest radiograph is mandatory when an elderly patient with delirium after hip fracture surgery develops pneumonia postoperatively.
Aged ; Crowns ; Delayed Diagnosis ; Delirium ; Dental Prosthesis ; Hip ; Humans ; Molar ; Pneumonia ; Thorax ; Tooth

OBJECTIVES: The aim of this study was to know differences of characteristics between presenile and senile patients who were consulted to the department of psychiatry during medical-surgical admission. METHODS: The demographic and clinical data obtained from the medical records of psychiatric consultation in the presenile inpatients with age 50 to 64 years(N=162) and those of the senile inpatients with age over 65 years(N=171) were reviewed and compared. RESULTS: 1) The most common chief complaints for psychiatric consultation in presenile patients were somatic symptoms, anxiety and sleep disturbance in order, while cognitive decline, clouded consciousness and depressed mood were most common in senile patients with statistical significance. 2) The most frequent psychiatric diagnoses after consultation in presenile patients were delirium, mood disorder and substance use disorder in order, while delirium, mood disorder and major neurocognitive disorder were most frequent in senile patients with statistical significance. 3) There were no significant difference in numbers of physical illnesses, while numbers of therapeutic drugs for them were more in senile patients. CONCLUSIONS: Our study found significant differences between presenile and senile patients on psychiatric symptoms and diagnoses in geropsychiatric consultation. Therefore, more subdivided age-specific approach seems to be needed for the geropsychiatric consultation activities.
Anxiety ; Consciousness ; Delirium ; Diagnosis ; Humans ; Inpatients* ; Medical Records ; Mood Disorders ; Substance-Related Disorders

OBJECTIVETo assess the medical community's awareness and practice regarding delirium in the intensive care unit (ICU).

METHODSOne hundred and ten predesigned questionnaires were distributed to ICU practitioners in the affiliated hospitals of Zhejiang University.

RESULTSA total of 105 valid questionnaires were collected. Totally, 55.3% of the clinicians considered that delirium was common in the ICU. Delirium was believed to be a significant or serious problem by 70.5% of respondents, and under-diagnosis was acknowledged by 56.2% of the respondents. The incidence of ICU delirium is even more under-estimated by the pediatric doctors compared with their counterparts in adult ICU (P less than 0.05). Primary disease of the brain (agreed by 82.1% of the respondents) was believed to be the most common risk factor for delirium. None of the ICU professionals screened delirium or used a specific tool for delirium assessment routinely. The vast majority (92.4%) of respondents had little knowledge on the diagnosis and the standard treatment of delirium.

CONCLUSIONSAlthough delirium is considered as a serious problem by a majority of the surveyed ICU professionals, it is still under-recognized in routine critical care practice. Data from this survey show a disconnection between the perceived significance of delirium and the current practices of monitoring and treatment in ICU in China.

Attitude of Health Personnel ; Delirium ; diagnosis ; epidemiology ; therapy ; Humans ; Incidence ; Intensive Care Units ; Risk Factors ; Surveys and Questionnaires