Analgesia and other causes of amnesia that mimic post-traumatic amnesia (PTA): A cohort study

Objective. This study explores the possibility that a post-traumatic amnesia (PTA) like phenomenon is caused by the administration of drugs in hospital following injury and that this may be observed in patients who have not suffered a traumatic brain injury (TBI). This work also explored the possibility for an additional contribution to this phenomenon of demographic and psychological variables. Method. Sixty-three orthopaedic patients with no evidence of brain injury were recruited to a two-phase study. Medication records, demographic, and psychological data were obtained at the phase 1. At follow-up interviews (phase 2), psychological data (mood and post-traumatic stress disorder, PTSD) were again obtained and retrospective assessment of PTA using the Rivermead PTA protocol was carried out in 47 patients. Results. Thirty-eight per cent (N=18) of the total sample (N=47) reported a PTA-like phenomenon despite not having suffered TBI. A logistic regression model including the receipt of opioids, surgery, and anxiety-related variables, was significant in predicting this phenomenon (χ²=22.054, df=4, p≤.01) and accounted for up to 57.5% of variation in the data. Age, either alone or in interaction with opioid use, depression, and PTSD symptoms were not significant predictors. PTA-like phenomenon did not occur without at least one predictive factor. Conclusion. Receiving opioids, undergoing surgery, and suffering clinical levels of anxiety at an early stage following injury, can lead patients who have not suffered a TBI to report a PTA-like phenomenon at follow-up. This suggests that retrospective PTA assessment on actual brain injury patients may also be influenced by these factors.     

Inpatient Standards of Care and the Suicidal Patient. Part I: General Clinical Formulations and Legal Considerations

The most common legal action involving psychiatric care is the failure to reasonably protect patients from harming themselves. In this regard it is critical to understand that courts have tended to impose much stricter standards on inpatient than on outpatient care; that at the present time, most malpractice actions involve clinical activities related to inpatient care (negligent admission, treatment, supervision, discharge, etc.). This article reviews the current climate in the legal and clinical formulation of standards of care for hospitalized adult suicidal patients. It suggests general guidelines for effective assessment, management, and treatment procedures that balance the need for high-quality care by a reasonable and prudent practitioner with the requirements of court-determined and statutory standards. The authors specifically discuss court cases that show common failure situations in inpatient care, discharge planning, and follow-up (e.g., problems in pharmacotherapy, the decision to hospitalize, the assessment of imminence and lethality, etc.). The paper also emphasizes the crucial element of clinical judgment in developing any inpatient standard of care.     

“Anxious Suicidality”: A New Subtype of Childhood Suicide Ideation?

The current study examined the presence of anxiety in children with suicide ideation. From a sample of 100 inpatients, children who displayed suicide ideation (n = 27) were selected and divided into two groups, high and low anxiety. Findings indicated that children with suicide ideation and anxiety were less happy and satisfied, experienced more negative life events, and were more distractible and intense than children with suicide ideation only. Additionally, according to their self-reports, parents of children with high anxiety reported more obsessive-compulsive and anxiety symptoms as well as greater hostility than parents of children with low anxiety. The authors have identified a subgroup of children with suicide ideation who are highly anxious and can be termed as experiencing “anxious suicidality.”