Psychiatric Issues in Emergency Care Settings Vol 6 No 2

•Methadone can build up to toxic levels in the body if it is taken too often, if the dose is too high, or if it is taken with certain other medications or supplements.

Immigrants in general appear to have lower rates of mental disorders than their US-born counterparts (Table). In the first study of its kind, funded by the National Institute of Mental Health, the affects of immigration and years of residence in the United States on the mental health of Caribbean black, Latino, and Asian populations were examined. Researchers also found differences within population groups that were related to subgroup categories such as ethnicity, gender, English language proficiency, years of US residence, and age at immigration.

In patients with dementia who are physically aggressive and dangerous to themselves or others, the use of intramuscular haloperidol or lorazepam may be appropriate. Because haloperidol causes less drowsiness and cognitive impairment than lorazepam, it is preferred in patients with dementia and delirium. The usual dose of haloperidol for elderly patients with dementia is 0.5 to 1 mg; this dose can be repeated every 25 to 30 minutes until the patient is no longer dangerous to self or others. If benzodiazepine or alcohol withdrawal is suspected, lorazepam is the preferred medication. Physical restraints may be appropriate until the medication takes effect.

The reason that antipsychotic medications cause weight gain is that there is increased activity of the enzyme AMP-kinase in the hypothalamus, the area of the brain that controls hunger. The increase in AMP-kinase levels occurs because antipsychotic medications interfere with the protein histamine. For some time it has been suspected that histamine plays a significant role in weight control, and these findings, from a study conducted in mice by scientists at Johns Hopkins University, confirm this. The researchers hope that these findings will contribute to the development of a new class of effective antipsychotics that do not cause weight gain.

Fliege H, Grimm A, Eckhardt-Henn A, et al. Frequency of ICD-10 factitious disorder: survey of senior hospital consultants and physicians in private practice. Psychosomatics. 2007;48:60-64.

Worsening anxiety is a common symptom that may result in psychiatric consultation or evaluation in an emergency setting. Aneurysms are rarely considered in the medical differential for anxiety disorders, and the available literature and research regarding this possible connection are very limited. Overlooking this diagnosis, however, can have disastrous consequences. Here we present 2 case reports as well as a review of the literature regarding a possible relationship between aortic and thoracic aneurysms and psychiatric symptoms.