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P-745 - Excited Delirium: A Clinical Case
- G. DaPonte, M. Lobo, S. Fernandes, V. VilaNova, A. Paiva
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- Journal:
- European Psychiatry / Volume 27 / Issue S1 / 2012
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction:
Delirium involves an acute, transient disturbance in consciousness and cognition. When the delirium involves aggressive behavior it's termed excited delirium; when this is followed by sudden death, it's termed excited delirium syndrome. Typically, patients presented fever, a rapid pulse, agitation and anxiety, with increasing confusion, and a progressive deterioration over a course of weeks before dying.
Objectives and AimsAlert to the poor prognosis of excited delirium syndrome.
Methods:Review of relevant literature after the description of a clinical case.
Results:Description of a clinical case:
A.R. is a man of 69 years, without psychiatric background, under neoadjuvant chemotherapy for metastatic bone disease. He has multiple comorbidity: chronic obstructive pulmonary disease, hypertension, diabetes and stomach cancer treated 15 years ago.
Three days before the hospitalization the patient began incoherent speech, and physically he was dehydrated; it was requested observation liaison psychiatry for psychomotor agitation. in the course of the interview, the patient was aggressive, very anxious, with jealousy and paranoid delusions, visual and auditory hallucinations, disoriented and with dispersed attention. It's placed the hypothesis of delirium by multiple etiologies and he was medicated with neuroleptics. It was necessary increased doses and physical restraint to control of agitation, which was not complete and lasted two weeks; meanwhile, he developed a respiratory infection. the patient eventually died of cardiopulmonary arrest.
Conclusions:It's described a typical case of excited delirium syndrome in a patient with psychomotor agitation that was difficult to control and lasted weeks, which culminated in cardiopulmonary arrest.
P-1020 - Delirium in old Age
- G. DaPonte, M. Lobo, S. Fernandes, V. VilaNova, A. Paiva
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- Journal:
- European Psychiatry / Volume 27 / Issue S1 / 2012
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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- Article
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Introduction
The concept of delirium has developed historically from the prototype of acute confusion with psychomotor agitation. While the modern view of delirium recognizes four core features (disturbance of consciousness, disturbance of cognition, limited course and external causation), their operationalization can produce a misleading picture of the most common manifestations of delirium in elderly people.
Objectives and AimsAlert to the diagnosis of delirium in elderly patients.
MethodsReview of relevant literature.
ResultsDelirium is a multifactorial syndrome, involving the interrelationship between patient vulnerability, predisposing factors at admission, and the noxious insults and aggravating factors during hospitalization. A significant proportion of elderly patients are either delirious on admission to hospital, or develop delirium at some point during their hospital stay. The clinic needs to be alert to the predisposing and precipitating factors, which have the potential to identify those at risk of delirium and to prevent it occurring, like age, sex, dementia, psychiatric disorders and physical illness. Another important phase of assessment is the differential diagnosis that includes most other organic and functional psychiatric disorders (but it's necessary to remember that their presence does not exclude the possibility that the subject is delirious as well), especially depression, dementia or dysphasia due to a cerebrovascular accident.
ConclusionsComplications arising from the delirious state in elderly patients prolong hospital admission and contribute to adverse functional outcomes, notably increased dependency and higher rates of institutionalization.
P-618 - the Place of Subjectivity in Psychiatric Research: Addressing Stigma
- A. Neto, G. Daponte, S. Xavier, C. Klut, J. Melo, G. Cardoso
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- Journal:
- European Psychiatry / Volume 27 / Issue S1 / 2012
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction:
Qualitative methodology as a tool to understand the subjective meaning of individual's experience, is becoming more popular in health sciences' research. Understanding Stigma, which represents a major source of disability of people with mental illness, is a challenge that conventional research methods can not properly address.
Objective and aims:To explore major features of qualitative methods and their relationship with quantitative research, and to point out how Stigma about mental illness can benefit from this epistemology and methodology.
Methods:Review of relevant literature.
Results:Qualitative research seeks to know “what, how and why?” instead of “how much and what frequency?”. the researcher tries to shorten the distance to what's being researched, through close participation and interpretation of the study participants' experiences, considering its subjectivity and multiplicity. This accounts for a solid internal validity, but does not allow for external validity, replication and generalization, which is the goal of post positivism paradigm through quantitative methods.
Because of its considerable strength in disclosing cultural issues, values, judgments, behaviors and social contexts, the use of qualitative methods on Stigma experience has allowed a better understanding of its meaning.
Conclusions:There is now widespread evidence and acceptance that addressing subjective experience is of great importance in substantial mental health research. Despite fundamental differences from quantitative methods, qualitative methodology has gained considerable relevance, and became an essential tool to better address challenges in mental health, taking a bio-psycho-social model into account, such as in Stigma experience
P-744 - “Organic” Mania in Latter Life
- G. DaPonte, M. Lobo, S. Fernandes, V. VilaNova, A. Paiva
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- Journal:
- European Psychiatry / Volume 27 / Issue S1 / 2012
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction:
Bipolar disorder is commonly associated with early adulthood, although a substantial proportion of patients develops the condition in later life. the results of early investigations suggested that cases of bipolar disorder with onset in later life were more often associated with 'organic causes', and could potentially justify the distinction between early and late onset bipolar disorder.
Objectives and AimsAlert for organic causes of mania.
Methods:Review of relevant literature after the description of a clinical case.
Results:Description of clinical case:
J.C. is a man of 80 years without psychiatric history that is admitted in a Oncology Service for dehydration. He has breast cancer since 2005, treated with neoadjuvant-chemotherapy, mastectomy and hormone-therapy with remission. in 2010 there was progression of the disease and he restart chemotherapy. He started odd behaviors and refusal to take medication and it was made the request for observation of liaison psychiatry. in the psychopathological observation is notorious a psychomotor agitation with sexual deshinibition, grandiosity ideas and dysphoric mood. It was placed the diagnostic hypothesis of mood disturbance due to cancer progression with manic characteristics that was supported by evidence in neuroimaging of metastization in frontal-parietal-occipital cranial bones. He started medication with halopheridol with remission of the psychiatric symptoms.
Conclusions:It is described a case of an old-age patient, without psychiatric background, with progression of his cancer disease, that suddenly starts manic symptoms. the manic states due to organic causes are more rare then other affective disorders and the clinician has to be alert.