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Example of alert and reporting system of scopolamine poisoning among Parisian cocaine users at regional, national and European levels
- A. Batisse, C. Chevallier, J. Azevedo Correia, M. Martinez, G. Hoizey, M. Chèze, S. Buscail, M. Deveaux, S. Djezzar, B. Sandrine, D. Samira
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. s858
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Introduction
In the literature, few intoxications are related to scopolamine due to its presence in cocaine, heroin or even in counterfeit rohypnol tablets. Nonetheless, during summer 2016, several cases of non-fatal intoxication appeared in the region of Paris.
ObjectivesDemonstrate how clinical detection of rare toxic events are fostered by exchanges in close collaboration with different territorial level.
AimsImprove the detection of short toxic epidemic.
MethodsSuspected cases of scopolamine poisoning notified to Parisian Addictovigilance centre were reported. Information shared through different levels of the alert process contributed to strengthen their assessment.
ResultsSeventeen cases of probable scopolamine poisoning among cocaine users were registered between the 6 and 24 of July. In the first 4 cases, toxicological analysis, of blood samples were scopolamine positive, with high concentration between 7 ng/mL and 25 ng/mL (usual therapeutic range: 0.1 to 1.1 ng/mL). A collected sample of this cocaine powder had a purity of 23.2%, with 15.2% of scopolamine. Half time of scopolamine is longer than half time of cocaine (3–8 hours versus 1–2 hours): this could explain why the observed effects lasted over 24 hours (8/17). Main clinical features were mydriasis (15/17), high blood pressure (12/17), tachycardia (13/17), behavioural disorder with agitation (13/17), hallucinations (5/17), and coma (8/17). Practitioner's responsiveness and the extensive information sharing [MM1] between regional and European level were congruent.
ConclusionsAdulterated street drugs can lead to short toxic epidemic which could be unnoticed. Emerging event should require careful assessment with linkage between risk assessors and risk managers.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Identifying Dementia in the Primary Care Practice
- Paul R. Solomon, Michael Brush, Vivian Calvo, Felicity Adams, Richard D. DeVeaux, William W. Pendlebury, Daniel M. Sullivan
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- Journal:
- International Psychogeriatrics / Volume 12 / Issue 4 / December 2000
- Published online by Cambridge University Press:
- 10 January 2005, pp. 483-493
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Background: The purpose of this study was to evaluate the utility (i.e., positive and negative predictive value) of the 7 Minute Screen in identifying patients with probable Alzheimer's disease (AD) in a primary care practice. A second objective was to estimate the number of undiagnosed AD patients in a typical primary care practice. Methods: One hundred thirty-seven successive admissions (96%) of patients over the age of 60 to a primary care practice over a 53-day period who completed informed consent documents were administered the 7 Minute Screen. All patients who screened positive (n = 13) and a random sample of those who screened negative (n = 26) returned for full diagnostic evaluation. Positive predictive value (PPV) and negative predictive value (NPV) of the 7 Minute Screen were determined using the criterion standard of clinical diagnosis established by examination, history, and laboratory studies. Test-retest reliability and time for administration were also determined. Results: Of the 137 patients evaluated, 13 screened positive and 124 screened negative. Eleven of the 13 patients who screened positive were willing to return to the primary care practice for follow-up evaluation. A random sample of 26 patients who screened negative all agreed to return for follow-up evaluation. Of the 11 patients who screened positive who returned for evaluation, 10 were subsequently diagnosed with probable AD. The remaining patient was diagnosed with mixed dementia. The caregivers of the two patients who refused to return were contacted and both indicated that the patients were having significant cognitive problems as verified by an activities of daily living scale. Of the 26 patients who screened negative, 25 were judged to be cognitively normal and the 26th was judged to have mild cognitive impairment. Discussion: In successive admissions of patients over the age of 60 in a primary care practice, the 7 Minute Screen showed a PPV of 91% and an NPV of 96% in identifying patients who were subsequently identified with AD or other dementing disorder. These data suggest that this may be a useful instrument in identifying patients who should undergo diagnostic evaluation for AD and other dementing disorders. Additionally, extrapolation from the data in this practice suggests that there may be between 75 and 100 AD patients in the typical primary care practice, many of whom may not be diagnosed.