Management of a complex patient - intravenous olanzapine use.

OBJECTIVE:: This case report aims to highlight the challenges faced by mental health clinicians in managing complex medical and psychiatric presentation, with a particular interest in intravenous (IV) olanzapine use outside the emergency department (ED) and intensive care unit setting. CONCLUSION:: There is no current prescribing guideline regarding the use of IV olanzapine for acute agitation associated with schizophrenia and bipolar disorder. Most of the literature available regarding the use of IV olanzapine has originated from studies performed in the ED setting, with the majority of studies reporting a favourable efficacy and safety profile for IV olanzapine. Further research on the utilization of IV olanzapine in the general medical ward is required. Until more data is available, use of IV olanzapine in the acute arousal setting on a general medical ward remains off-label.

Forestier's disease presenting with dysphagia and dysphonia.

Forestier's disease, also known as diffuse idiopathic skeletal hyperostosis (DISH), is a pathology of the vertebral bodies characterised by exuberant osteophyte formation. Symptoms range from negligible back discomfort to, less commonly, debilitating dysphagia and airway disturbances. Conservative management including analgesia, chiropractic and diet modification are common and effective treatments. However, when conservative management fails to alleviate symptoms, particularly compressive symptoms, surgical management is indicated. We report a 55-year-old man presenting with 6months' progressive dysphagia and dysphonia. He was managed successfully with an anterior cervical osteophytectomy without fusion. A literature review is included.