Case Reports
28 December 2020
Vol. 15 No. 1 (2021)
Massive pulmonary embolism masked as an episode of acute agitation in a psychiatric patient: a case report
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
872
Views
488
Downloads
78
HTML
Authors
Management of the psychiatric diseases' reacutization is a frequent occurrence in emergency medicine. During this coronavirus disease 2019 pandemic, a further increase in access to the emergency room was reported, and the reasons are numerous. Although the essential prerogative of the emergency department is to provide immediate clinical assistance by rapidly setting an effective diagnostic and therapeutic path, there are multiple obstacles to providing adequate care for Emergency Department patients with mental illness. In this report, we describe the case of a 65-year-old female patient with severe schizophrenia who was evaluated in the emergency room for acute agitation masking subtle, persistent dyspnea. The possibility of an underlying medical cause should not be underestimated or completely forgotten due to the difficult approach to the psychiatric patient.
Altmetrics
Downloads
Download data is not yet available.
Citations
Rapporto salute mentale. Analisi dei dati del sistema informativo per la salute mentale (SISM) 2015. Available from: http://www.salute.gov.it/imgs/C_17_pubblicazioni_2550_allegato.pdf
Rapporto salute mentale. Analisi dei dati del sistema informativo per la salute mentale (SISM) 2017. Available from: http://www.salute.gov.it/imgs/C_17_pubblicazioni_2841_allegato.pdf
Jelinek GA, Weiland TJ, Mackinlay C, et al. Knowledge and confidence of Australian emergency department clinicians in managing patients with mental health-related presentations: findings from a national qualitative study. Int J Emerg Med 2013;6:2. DOI: https://doi.org/10.1186/1865-1380-6-2
Bojdani E, Rajagopalan A, Chen A, et al. COVID-19 pandemic: impact on psychiatric care in the United States. Psychiatry Res 2020;289:113069. DOI: https://doi.org/10.1016/j.psychres.2020.113069
Dubey S, Biswas P, Ghosh R, et al. Psychosocial impact of COVID-19. Diabetes Metab Syndr 2020;14:779-88. DOI: https://doi.org/10.1016/j.dsx.2020.05.035
Dombagolla MHK, Kant JA, Lai FWY, et al. Barriers to providing optimal management of psychiatric patients in the emergency department (psychiatric patient management). Australas Emerg Care 2019;22:8-12. DOI: https://doi.org/10.1016/j.auec.2019.01.001
Weiland TJ, Mackinlay C, Hill N, et al. Optimal management of mental health patients in Australian emergency departments: barriers and solutions. Emerg Med Australas 2011;23:677-88. DOI: https://doi.org/10.1111/j.1742-6723.2011.01467.x
Sivakumar S, Weiland TJ, Gerdtz MF, et al. Mental health-related learning needs of clinicians working in Australian emergency departments: a national survey of self-reported confidence and knowledge. Emerg Med Australas 2012;23:697-711. DOI: https://doi.org/10.1111/j.1742-6723.2011.01472.x
Chennapan K, Mullinax S, Anderson E, et al. Medical screening of mental health patients in the emergency department: a systematic review. J Emerg Med 2018;55:799-812. DOI: https://doi.org/10.1016/j.jemermed.2018.09.014
Goldhaber SZ, Grodstein F, Stampfer MJ, et al. A prospective study of risk factors for pulmonary embolism in women. JAMA 1997;277:642. DOI: https://doi.org/10.1001/jama.1997.03540320044033
Ogłodek EA, Just MJ, Grzesińska AD, et al. The impact of antipsychotics as a risk factor for thromboembolism. Pharmacol Rep 2018;70:533-9. DOI: https://doi.org/10.1016/j.pharep.2017.12.003
Di Nisio M, van Es N, Büller HR. Deep vein thrombosis and pulmonary embolism. Lancet 2016;388:3060-73. DOI: https://doi.org/10.1016/S0140-6736(16)30514-1
Konstantinides SV, Meyer G, Becattini C, et al.; The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J 2019;54:1901647. DOI: https://doi.org/10.1183/13993003.01647-2019
Elliott CG, Goldhaber SZ, Jensen RL. Delays in diagnosis of deep vein thrombosis and pulmonary embolism. Chest 2005;128:3372-6. DOI: https://doi.org/10.1378/chest.128.5.3372
Wilson E, Phair J, Carnevale M, Koleilat I. Common reasons for malpractice lawsuits involving pulmonary embolism and deep vein thrombosis. J Surg Res 2020;245:212-6. DOI: https://doi.org/10.1016/j.jss.2019.07.079
Cioni G, Bellandi G, Bertolini S, et al. A multisystem approach by bed-side ultrasound in patients with COVID-19 infection: a case series. Ital J Med 2020;14:106-11. DOI: https://doi.org/10.4081/itjm.2020.1288
Cioni G. A pulmonary embolism-like pattern for the early identification of patients with SARS-CoV2 interstitial pneumonia: a case report. Ital J Emerg Med 2020;9:74-7. DOI: https://doi.org/10.23736/S2532-1285.20.00023-3
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497. DOI: https://doi.org/10.1016/S0140-6736(20)30183-5
Garriga M, Pacchiarotti I, Kasper S, et al. Assessment and management of agitation in psychiatry: Expert consensus. World J Biol Psychiatry 2016;17:86-128. DOI: https://doi.org/10.3109/15622975.2015.1132007
Gottlieb M, Long B, Koyfman A. Approach to the agitated emergency department patient. J Emerg Med 2018;54:447-57. DOI: https://doi.org/10.1016/j.jemermed.2017.12.049
Torales J, O’Higgins M, Castaldelli-Maia JM, Ventriglio A. The outbreak of COVID-19 coronavirus and its impact on global mental health. Int J Soc Psychiatry 2020;66:317-20. DOI: https://doi.org/10.1177/0020764020915212
Cui LB, Wang XH, Wang HN. Challenges facing coronavirus disease 2019: Psychiatric services for patients with mental disorders. Psychiatry Clin Neurosci 2020 [Epub ahead of print]. DOI: https://doi.org/10.1111/pcn.13003
Percudani M, Corradin M, Moreno M, et al. Mental health services in Lombardy during COVID-19 outbreak. Psychiatry Res 2020;288 [Epub ahead of print]. DOI: https://doi.org/10.1016/j.psychres.2020.112980
How to Cite
Massive pulmonary embolism masked as an episode of acute agitation in a psychiatric patient: a case report. (2020). Italian Journal of Medicine, 15(1). https://doi.org/10.4081/itjm.2020.1414
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.