The Inexplicably Suicidal Patient

摘要: CASE Confused and suicidal Mr. A, age 39, becomes disoriented while walking approaches a suspension bridge. He borrows passerby's cell phone calls his sister. His sister later states that he was confused expressed final goodbyes, saying, "I will see Mom in heaven." gives back the leaps off A nearby boat rescues him almost immediately. is brought to trauma unit, where treated for lacerated liver. After stabilized, awake answering questions appropriately. placed on suicide precautions direct 24-hour, one-to-one supervision. Our psychiatric team evaluates him. reports no history of diabetes, hypertension, cardiac disorders, or neurologic but does have cognitive developmental delay. has illness, attempts, self-injurious behavior. denies family using alcohol, tobacco, illicit drugs; drug screen negative. unemployed, collects disability, lives with What step would you take next? a) order workup b) depressive disorder c) review clues behavior d) all above The authors' observations In our initial evaluation, we find obvious reason A's confusion attempt. We decide closely days leading up jumping HISTORY Otitis media treatment chronic otitis sought ear pain at local emergency room (ER) 10 before prescribed amoxicillin, 500 mg tid days, meclizine, 25 every 8 hours as needed dizziness. Immediately after first dose both drugs, patient told feeling "weird," denied being dizzy. Thinking unusual from stopped taking it continued amoxicillin. On second day noticed bouts confusion. could perform daily activities, difficulty. niece said had ask help minor tasks, such opening can soup. 3, developed prominent auditory hallucinations. described hearing unrecognizable male female voices chattering mumbling throughout day. progressively worsened, antibiotic did not mention family. conversation her brother 7,"he wasn't himself ... talking about my mother what didn't make sense." She asked neighbor check A; reported "OK." amoxicillin--day 10--Mr. became increasingly agitated. says us shortly wandering onto bridge jumping, having difficult time dealing suspect amoxicillin might been responsible psychotic symptoms. Potential neuropsychiatric effects include following except: hallucinations anxiety irritability euphoria Treatment modalities pharmaceutical used treat infectious diseases carry many potential adverse effects. When presents new-onset symptoms, explore whether they are related an underlying mood medication side Three important considerations to: * determine condition reversible by discontinuing identify characterize previously unrecognized avoid inaccurate diagnosis leads nonindicated treatment. …