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Excited delirium

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https://www.readbyqxmd.com/read/29136301/ketamine-for-the-acute-management-of-excited-delirium-and-agitation-in-the-prehospital-setting
#1
Kyle A Weant, Lauren M Linder, Clint A Ross
BACKGROUND: Traditional first-line therapy in the prehospital setting for the acutely agitated patient includes an antipsychotic in combination with a benzodiazepine. Recently, interest has grown regarding the use of ketamine in the prehospital setting as an attempt to overcome the limitations of the traditional medications and provide a more safe and effective therapy. This review provides an overview of the pharmacology of ketamine, evaluates the literature regarding ketamine use for prehospital agitation, and proposes an algorithm that may be used within the prehospital setting...
November 14, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29107155/the-bbi-at-the-bbi-a-culture-change
#2
Ian Galea, V Hugh Perry
The blood-brain interface (BBI) is the subject of a new named series at Brain, Behavior, and Immunity. It is timely to reflect on a number of advances in the field within the last ten years, which may lead to an increased understanding of human behavior and a wide range of psychiatric and neurological conditions. We cover discoveries made in solute and cell trafficking, endothelial cell and pericyte biology, extracellular matrix and emerging tools, especially those which will enable study of the human BBI. We now recognize the central role of the BBI in a number of immunopsychiatric syndromes, including sickness behaviour, delirium, septic encephalopathy, cognitive side effects of cytokine-based therapies and the frank psychosis observed in neuronal surface antibody syndromes...
October 26, 2017: Brain, Behavior, and Immunity
https://www.readbyqxmd.com/read/28990246/excited-delirium-a-systematic-review
#3
Philippe Gonin, Nicolas Beysard, Bertrand Yersin, Pierre-Nicolas Carron
STUDY OBJECTIVE: We aimed to clarify the definition, epidemiology, and pathophysiology of excited delirium syndrome (ExDS) and to summarize evidence-based treatment recommendations. METHODS: We conducted a systematic literature search of MEDLINE, Ovid, Web of Knowledge, and Cochrane Library for articles published to March 18, 2017. We also searched the grey literature (Google Scholar) and official police or medical expert reports to complete specific epidemiological data...
October 9, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28959192/brainstem-influence-on-thalamocortical-oscillations-during-anesthesia-emergence
#4
Christopher M Scheib
Theories of mechanisms that impair or prevent consciousness during anesthesia that are related to thalamocortical oscillations have been proposed. Many methods of EEG analysis have been proposed as measures of anesthetic effects but only a few have potential to provide measures of those anesthetic effects that are directly related to thalamocortical oscillations. Some of these methods will be explained and demonstrated with examples chosen to provide evidence for or against two of the proposed mechanisms. The first of the two mechanisms to be addressed is the "traveling peak" (Ching et al...
2017: Frontiers in Systems Neuroscience
https://www.readbyqxmd.com/read/28880357/-the-use-of-dexmedetomidine-in-extreme-agitation
#5
E Roosens, J P Mulier, G Heylens, J De Fruyt
In clinical practice antipsychotics, benzodiazepines and/or antihistamines are used to calm agitated patients. If agitation persists and patients have contraindications for these substances, then anesthetics, such as propofol, can also be used as well, to serve as a sedative. Our attention was drawn to a particular case in which dexmedetomidine was used as a sedative.<br/> AIM: To study the literature on the use of α2-agonists, such as dexmedetomidine, in the treatment of extreme agitation.<br/> METHOD: We reviewed the relevant scientific literature...
2017: Tijdschrift Voor Psychiatrie
https://www.readbyqxmd.com/read/28836486/delayed-in-custody-death-involving-excited-delirium
#6
Daniel B Kennedy, Dennis M Savard
This case study presents a 37-year-old male who was experiencing excited delirium (ExD) and died in a county jail 4 days after being taken into custody. The male died in a jail observation cell without having been restrained and was not under the influence of a drug stimulant. The subject had a documented psychiatric history of bipolar disorder and schizophrenia and was known to consume marijuana, cocaine, and methamphetamines. This case illustrates the pernicious effects of ExD and how its lethality can be delayed when many cases involve drug use and use of force where subjects die shortly thereafter...
January 1, 2017: Journal of Correctional Health Care
https://www.readbyqxmd.com/read/28776216/ongoing-issues-with-the-diagnosis-of-excited-delirium
#7
EDITORIAL
Roger W Byard
No abstract text is available yet for this article.
August 3, 2017: Forensic Science, Medicine, and Pathology
https://www.readbyqxmd.com/read/28745250/-recognising-positional-asphyxia-not-always-the-cause-of-death-in-victims-in-an-unusual-position
#8
G Reijnen, P J E Vos, C Das, U J L Reijnders
Deceased individuals may be found in a position that raises the question of whether or not the individual died from being in that position. We describe 3 victims of 35, 84 and 54 years of age, respectively. All were found in an unusual position that may have impeded breathing. Breathing may be impaired by compression of the thoracic wall or by extrathoracic airway obstruction caused by the position. Reduced independence, with causes varying from dementia to inebriation, is a risk factor for positional asphyxia...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28668987/a-case-of-fatal-idiosyncratic-reaction-to-the-designer-drug-3-4-methylenedioxypyrovalerone-mdpv-and-review-of-the-literature
#9
Brigitte Desharnais, Yann Dazé, Laura M Huppertz, Pascal Mireault, Cameron D Skinner
The stimulant designer drug 3,4-methylenedioxypyrovalerone (MDPV) was first synthesized by Boehringer Ingelheim in 1969 and introduced on the black market in 2006. Only a small number of fatal intoxication cases have been reported in the literature, all with significant blood MDPV concentrations. In this report, we describe one fatality attributed to an idiosyncratic reaction to MDPV. The victim displayed agitation, violent behavior and delirium followed by cardiac arrest. Hyperthermia was observed at the hospital...
July 1, 2017: Forensic Science, Medicine, and Pathology
https://www.readbyqxmd.com/read/28533149/prevalence-and-characteristics-of-catatonia-on-admission-to-an-acute-geriatric-psychiatry-ward
#10
Jorge Cuevas-Esteban, Maria Iglesias-González, Maria Rubio-Valera, Jordi Serra-Mestres, Antoni Serrano-Blanco, Luisa Baladon
BACKGROUND: This study aims to describe the prevalence of catatonia in a population of older acute psychiatric inpatients according to different diagnostic criteria. Secondary objectives are: to compare the catatonic symptom profile, prevalence, and severity, in respect to the underlying aetiology, and to evaluate the association between catatonic and somatic comorbidity. METHODS: The study included 106 patients admitted to an acute geriatric psychiatry ward. Catatonia was assessed using the Bush Francis Catatonia Rating Scale (BFCRS)...
August 1, 2017: Progress in Neuro-psychopharmacology & Biological Psychiatry
https://www.readbyqxmd.com/read/28386585/comprehensive-histological-and-immunochemical-forensic-studies-in-deaths-occurring-in-custody
#11
REVIEW
Kenneth Nugent, Menfil A Orellana-Barrios, Dolores Buscemi
In-custody deaths have several causes, and these include homicide, suicide, natural death from chronic diseases, and unexplained death possibly related to acute stress, asphyxia, excited delirium, and drug intoxication. In some instances, these deaths are attributed to undefined accidents and natural causes even though there is no obvious natural cause apparent after investigation. Understanding these deaths requires a comprehensive investigation, including documentation of circumstances surrounding the death, review of past medical history, drug and toxicology screens, and a forensic autopsy...
2017: International Scholarly Research Notices
https://www.readbyqxmd.com/read/28325154/the-behavioral-profile-of-methylenedioxypyrovalerone-mdpv-and-%C3%AE-pyrrolidinopentiophenone-pvp-a-systematic-review
#12
Cornel N Stanciu, Thomas M Penders, Samantha A Gnanasegaram, Elvin Pirapakaran, Juvraj S Padda, Jeeven S Padda
BACKGROUND: New psychoactive substances are emerging at an alarming rate. With novel structures and properties they produce unique behavioral characteristics during intoxication. Synthetic cathinones are some of the most common. More and more are presenting to emergency departments due to consequences of use. Aside from isolated reports, little is known about these compounds. OBJECTIVE: Here we review literature pertaining to two common synthetic cathinones, MDPV and alphaPVP, and correlate clinically with guidance on management of intoxications...
March 21, 2017: Current Drug Abuse Reviews
https://www.readbyqxmd.com/read/28087785/thermolytic-degradation-of-synthetic-cannabinoids-chemical-exposures-and-pharmacological-consequences
#13
Brian F Thomas, Timothy W Lefever, Ricardo A Cortes, Megan Grabenauer, Alexander L Kovach, Anderson O Cox, Purvi R Patel, Gerald T Pollard, Julie A Marusich, Richard C Kevin, Thomas F Gamage, Jenny L Wiley
Synthetic cannabinoids are manufactured clandestinely with little quality control and are distributed as herbal "spice" for smoking or as bulk compound for mixing with a solvent and inhalation via electronic vaporizers. Intoxication with synthetic cannabinoids has been associated with seizure, excited delirium, coma, kidney damage, and other disorders. The chemical alterations produced by heating these structurally novel compounds for consumption are largely unknown. Here, we show that heating synthetic cannabinoids containing tetramethylcyclopropyl-ring substituents produced thermal degradants with pharmacological activity that varied considerably from their parent compounds...
April 2017: Journal of Pharmacology and Experimental Therapeutics
https://www.readbyqxmd.com/read/27790150/excited-delirium-and-sudden-death-a-syndromal-disorder-at-the-extreme-end-of-the-neuropsychiatric-continuum
#14
REVIEW
Deborah C Mash
Over the past decade, the excited delirium syndrome (ExDS) has raised continued controversy regarding the cause and manner of death of some highly agitated persons held in police custody, restrained or incapacitated by electrical devices. At autopsy, medical examiners have difficulty in identifying an anatomic cause of death, but frequently cite psychostimulant intoxication as a contributing factor. The characteristic symptoms of ExDS include bizarre and aggressive behavior, shouting, paranoia, panic, violence toward others, unexpected physical strength, and hyperthermia...
2016: Frontiers in Physiology
https://www.readbyqxmd.com/read/27755988/eight-years-of-psychiatric-examination-of-detainees-by-forensic-physicians-in-the-netherlands
#15
Karen E van den Hondel, Anne Linde Saaltink, Peter Paul M Bender
BACKGROUND: Forensic physicians are responsible for first-line medical care of detainees (individuals held in custody) in the police station. The Dutch police law contains a 'duty of care', which gives the police responsibility for the apparent mentally ill and/or confused people they encounter during their work. The police can ask a forensic physician to do a primary psychiatric assessment of any apparent mentally ill detainee. The forensic physician determines if the apparent mentally ill behavior of the detainee is due to a somatic illness, or has a psychiatric cause for which the detainee needs admission to a psychiatric hospital...
November 2016: Journal of Forensic and Legal Medicine
https://www.readbyqxmd.com/read/27723094/blunt-craniofacial-trauma-as-a-manifestation-of-excited-delirium-caused-by-new-psychoactive-substances
#16
Roger W Byard, Matthew Cox, Peter Stockham
The body of a 19-year-old male was found apparently concealed underneath bushes with recent head and facial trauma, and multiple superficial abrasions. Subsequently, it was discovered that the decedent had been running into objects and buildings following the ingestion the evening before of what was thought to be lysergic acid diethylamide (LSD). Blood staining of a nearby wall close to where the body was lying was in keeping with the described behavior. Toxicology revealed 3,4-methylenedioxymethamphetamine (Ecstasy), in addition to two only recently available drugs 2-(4-bromo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine, (25B-NBOMe), and 1-(3,4-methylenedioxyphenyl)-2-(1-pyrrolidinyl)-1-butanone, (MDPBP)...
November 2016: Journal of Forensic Sciences
https://www.readbyqxmd.com/read/27589986/unsuspected-serotonin-toxicity-in-the-icu
#17
Catharina E van Ewijk, Gabriel E Jacobs, Armand R J Girbes
BACKGROUND: Delirium is a frequently occurring syndrome in patients admitted to the intensive care unit (ICU) or medium care unit (MCU), yet the pathophysiology remains poorly understood. An excess of central serotonin can lead to an altered mental status, associated with autonomic hyperactivity, and neuromuscular excitation. Drugs with serotonergic properties are frequently and for prolonged periods administered to ICU/MCU patients. Therefore, central serotonergic toxicity may constitute a predisposing, contributing or precipitating factor in the emergence of delirium...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27533346/involvement-of-the-nadph-oxidase-nox2-derived-brain-oxidative-stress-in-an-unusual-fatal-case-of-cocaine-related-neurotoxicity-associated-with-excited-delirium-syndrome
#18
Stefania Schiavone, Irene Riezzo, Emanuela Turillazzi, Luigia Trabace
Here, we investigated the possible role of the Nicotinamide Adenine Dinucleotide Phosphate oxidase NOX2-derived brain oxidative stress in a fatal case of cocaine-related neurotoxicity, associated to excited delirium syndrome. We detected a strong NOX2 immunoreactivity, mainly in cortical GABAergic neurons and astrocytes, with a minor presence in microglia, glutamatergic and dopaminergic neurons as well as a significant immunostaining for other markers of oxidative stress (8OhDG, HSP70, HSP90, and NF-κB) and apoptotic phenomena...
October 2016: Journal of Clinical Psychopharmacology
https://www.readbyqxmd.com/read/27517801/prehospital-ketamine-is-a-safe-and-effective-treatment-for-excited-delirium-in-a-community-hospital-based-ems-system
#19
Thomas R Scaggs, David M Glass, Megan Gleason Hutchcraft, William B Weir
Excited delirium syndrome (ExDS) is defined by marked agitation and confusion with sympathomimetic surge and incessant physical struggle, despite futility, which may lead to profound pathophysiologic changes and sudden death. Severe metabolic derangements, including lactic acidosis, rhabdomyolysis, and hyperthermia, occur. The pathophysiology of excited delirium is a subject of ongoing basic science and clinical research. Positive associations with ExDS include male gender, mental health disorders, and substance abuse (especially sympathomimetics)...
October 2016: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/27354385/response-to-letter-from-steven-b-karch-re-excited-delirium-a-psychiatric-review
#20
EDITORIAL
Maurice Lipsedge
No abstract text is available yet for this article.
July 2016: Medicine, Science, and the Law
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