This article describes a case of Serotonin syndrome (SS), which developed in
a patient with treatment resistant schizophrenia post-hemi colectomy. Patient
was a 38-year-old, male with treatment resistant schizophrenia who
developed septic shock secondary to ischemic sigmoid volvulus, complicated
with nosocomial pneumonia and surgical site infection post-operation.
Antipsychotics (haloperidol and amisulpiride) was reinitiated a week postoperation
when his medical condition was stabilized as patient began to show
symptoms of psychosis. Haloperidol was later switched to olanzapine as he
was still agitated and disturbed. Fluvoxamine 50mg was added as he
displayed hair-pulling behavior. Clopixol accuphase and parental sedation
with midazolam and phenergen was given as adjunctive management for
agitation. Several days after, he became more restless. Central nervous
system examination revealed rigidity, tremors, hyperreflexia and clonus.
Discontinuation of fluvoxamine and amisulpiride with reduction of
olanzapine to 20mg ON resulted in full neurologic recovery within the first 24
hours. It was not well understood how this patient developed serotonin
syndrome despite him on low dose of fluvoxamine. Clinicians should be
aware of risk of serotonin syndrome when adding serotonergic agents to
antipsychotics especially in patients’ post-hemi colectomy.
Objective: To study the demographic data of patients and the pattern of crime in the study group, to look at the outcome of assessment by psychiatrist on fitness to plea and insanity at time of offense and to assess association between the nature of crime with presence of psychopathology during the crime. Method: This is a retrospective study. All available case notes for 342 forensic admissions from January 2007 until March 2010 were reviewed. All related information on 135 patients that committed violent crime was taken for analysis. Result: Majority of patients were male, Malay, single, education up to secondary school and unemployed. Only 38% of patients had encountered psychiatric services, 20% had previous imprisonment and 49% had history of substance usage. In cases involving victims (87%), 64% the victims were known to the patient, 53% had hallucination or delusion or both at the time of crime and 90% was found to have some diagnosis of mental illness after psychiatrist assessment. Only 81% of formal forensic reports were available in the case note and it showed 94% were fit to plea and 82% were at sound mind at the time of offense. Conclusion: Substance abuse had high prevalence among the patient. Almost 2/3 never had any encounter with psychiatric services before the admission. Even with the high percentage of patient diagnosed with mental illness, they were still found to be fit to plea in court and are at sound mind at the time of offense
Tujuan menjalankan kajian ini adalah untuk mengetahui tahap kekerapan penyelidikan yang berkaitan dengan kesihatan mental yang dijalankan di fasiliti Kementerian Kesihatan Malaysia. Sebanyak 258 fasiliti Kementerian Kesihatan yang terlibat dalam kajian ini meliputi Hospital Mental, Hospital dengan perkhidmatan Pakar Psikiatri, Hospital tanpa perkhidmatan Pakar Psikiatri dan Pejabat Kesihatan Daerah. Borang kajiselidik telah dihantar melalui pos kepada Pengarah Hospital dan Pegawai Kesihatan Daerah dengan kadar maklumbalas 70.2%. Hasil kajian mendapati hanya 23(13.1%) fasiliti sahaja yang menjalankan kajian mengenai kesihatan mental. Sebanyak 37 kajian berkaitan kesihatan mental telah dijalankan bagi tahun 2003-2004. Penyebab utama penyelidikan kurang dijalankan disebabkan oieh peruntukan yang tidak mencukupi dan tiada kepakaran untuk menjalankan penyelidikan yang berkaitan dengan kesihatan mental. Antara penyebab lain adalah kekurangan anggota, NGO tidak berminat dan tiada latihan. Kesimpulannya menunjukkan tahap penyelidikan kesihatan mental di fasiliti Kementerian Kesihatan masih rendah.