1/14. Dual diagnosis patients in the urban psychiatric emergency room. Substance abuse among the mentally ill has become increasingly prominent. This article describes the problems presented by dual diagnosis patients in the urban, publicly funded, psychiatric emergency room. When such patients become acutely ill, neither the public health system nor the mental health clinician is adequately prepared to provide care. The inability to effectively treat these patients has become strikingly clear in recent years. In 1986, the Psychiatric Emergency Service at san francisco General Hospital began to overflow with patients who required overnight stays. The intoxicated substance abusers with acute psychiatric complaints were the most difficult to manage clinically and administratively. Suggestions are offered for innovative approaches to this group of public patients: dual training of clinicians, flexible treatment programs prepared to deal with the whole person, and public funding that reflects patients' needs rather than clinicians' preferences. ( info) |
2/14. reserpine and phencyclidine-associated psychosis: three case reports. Three cases of chronic severe psychosis associated with a history of extensive phencyclidine usage successfully treated with reserpine are described. In two cases, reduction in reserpine dosage did not result in relapse into psychosis. ( info) |
3/14. Legal issues associated with PCP abuse--the role of the forensic expert. These cases illustrate some of the complex issues associated with PCP-related litigation. The concept that malice is implied when an experienced drug user commits a crime while under the influence of the drug is not held in most states, at the present time. The authors have now reviewed in detail four cases of unexpected death following the use of neck holds in PCP-intoxicated individuals. In all of the cases, multiple carotid compression holds had been attempted, according to the history. skin abrasions, hemorrhage into the soft tissues of the neck, and fractures of the hyoid bone and thyroid cartilage provide structural evidence of the application of substantial force to the neck. On autopsy, there has been no evidence of lethal injuries to the bronchial tree, brain, or heart. Drugs related to PCP are known to alter the carotid sinus reflex. Mechanical stimulation of the carotid sinus in the neck normally results in a slowing of heart rate and a decrease in blood pressure. carotid sinus stimulation, coupled with the effects of PCP on blood vessels, might result in a marked fall in the blood pressure that could lead, ultimately, to death. Individuals intoxicated with PCP may be at a higher risk to complications of carotid compression neck holds. Hence, additional cases would be expected to become medicolegal issues. ( info) |
4/14. Thyroid storm presenting as coma. Presented is the case of a 32-year-old man admitted with coma, hyperthermia, and tachycardia. The patient had a progressive downhill course and died in the medical ICU ten hours after admission. autopsy and further investigation revealed thyroid storm as the most likely cause of death. ( info) |
| Although hypertension can be associated with phencyclidine (PCP) use, subarachnoid hemorrhage (SAH) is a rare result. The radiological and pathological findings are reported of a patient with acute SAH who had chromatographic evidence of PCP in his blood. The occurrence of SAH in a patient who uses PCP may be caused by a disrupted arterial vessel wall and/or vasospasm due to the pharmacological action of the drug on the cerebral vasculature. ( info) |
6/14. Phencyclidine in CSF and serum: a case of attempted filicide by a mother without a history of substance abuse. A previously healthy 30-year-old black woman with no history of substance abuse was hospitalized after she attempted to drown her 4-year-old son. She had become progressively confused and delusional after a flu-like illness 2 weeks before. serum and lumbar CSF samples assayed for phencyclidine (PCP) by gas chromatography-mass spectrometry with d5 PCP as an internal standard were positive. The patient recovered rapidly after treatment with haloperidol and acidification of her urine. Suspicion of PCP abuse should remain high among patients with psychosis, even for those with no history of substance abuse. ( info) |
7/14. Improvement of phencyclidine-associated psychosis with ECT. Phencyclidine-associated psychosis may mimic classic forms of both schizophrenia and affective psychosis. Treatment of phencyclidine-associated psychosis may prove very difficult for some patients. A patient who developed a severe phencyclidine-associated psychosis and failed to respond to high doses of antipsychotics is described. The patient responded dramatically to electroconvulsive therapy. ( info) |
8/14. PCP intoxication in seven young children. Five infants and two young children were treated at a large children's hospital for phencyclidine intoxication. The clinical symptoms and signs were mostly neurologic, including diminished response to tactile and verbal stimuli (100%), ataxia (71%), nystagmus (57%), constricted pupils (57%), depressed sensorium, and stupor associated with a blank, expressionless stare (57%). Notably absent were the behavioral aberrations such as aggression, which are usually seen with PCP intoxication in older children and adults. The possibility of drug intoxication was denied by most of the parents or surrogate parents accompanying these small children and infants for treatment. It is suggested that a systematic investigation for possible PCP exposure, including a urine toxicology screen for PCP (preferably by immunoassay methods), be conducted whenever an infant or child is brought for emergency treatment of unresponsiveness, bizarre behavior, dyskinesis, dystonic posturing, atypical oculomotor and pupil findings, or evidence of hallucinations. ( info) |
9/14. The efficacy of ECT in phencyclidine-induced psychosis. Four patients are described who had a history of PCP abuse, prolonged psychosis, and poor neuroleptic response. Three of these patients were given ECT; all showed a dramatic response after the third or fourth treatment. The authors recommend that ECT be tried in psychotic patients who have used PCP if they fail to respond to antipsychotic medications after 1 week of inpatient treatment. ( info) |
10/14. PCP in amniotic fluid and breast milk: case report. The presence of phencyclidine (PCP) in breast milk and amniotic fluid of a young drug abuser is described. Implications drawn from these data include the possible use of amniocentesis in women with well-documented histories of drug abuse who have low levels of PCP in urine, and the restriction of breast feeding in women who have abused PCP. ( info) |