Routine versus ad hoc screening for acute stress following injury: who would benefit and what are the opportunities for prevention.

BACKGROUND: Screening for acute stress is not part of routine trauma care owing in part to high variability of acute stress symptoms in identifying later onset of posttraumatic stress disorder (PTSD). The objective of this pilot study was to assess the sensitivity, specificity, and power to predict onset of PTSD symptoms at 1 and 4 months using a routine screening program in comparison to current ad hoc referral practice. METHODS: Prospective cross-sectional observational study of a sample of hospitalized trauma patients over a four-month period from a level-I hospital in Canada. Baseline assessments of acute stress (ASD) and subsyndromal ASD (SASD) were measured using the Stanford Acute Stress Reaction Questionnaire (SASRQ). In-hospital psychiatric consultations were identified from patient discharge summaries. PTSD symptoms were measured using the PTSD Checklist-Specific (PCL-S). Post-discharge health status and health services utilization surveys were also collected. RESULTS: Routine screening using the ASD (0.43) and SASD (0.64) diagnoses were more sensitive to PTSD symptoms at one month in comparison to ad hoc referral (0.14) and also at four months (0.17, 0.33 versus 0.17). Ad hoc referral had greater positive predictive power in identifying PTSD caseness at 1 month (0.50) in comparison to the ASD (0.46) and SASD (0.43) diagnoses and also at 4 months (0.67 versus 0.25 and 0.29). CONCLUSIONS: Ad hoc psychiatric referral process for acute stress is a more conservative approach than employing routine screening for identifying persons who are at risk of psychological morbidity following injury. Despite known limitations of available measures, routine patient screening would increase identification of trauma survivors at risk of mental health sequelae and better position trauma centers to respond to the circumstances that affect mental health during recovery.

Bilateral anterior capsulotomy for intractable depression.

A group of eight patients with severe depression lasting 6 years or longer were treated with anterior capsulotomy and followed prospectively. Stereotactic surgery was used to produce radiofrequency lesions in the anterior limbs of both internal capsules. For all patients, there are follow-up data for at least 24 months. At 24-to-36 months postoperatively, four patients were either not-depressed or mildly depressed; one was mildly-to-moderately depressed; one was moderately-to-severely depressed; and only one remained severely depressed. One patient developed a progressive vascular dementia with parkinsonism caused by autopsy-proven arteriolosclerosis.

Serotonin syndrome after concomitant treatment with linezolid and meperidine.

Serotonin syndrome has been reported with administration of linezolid and serotonin reuptake inhibitors. Meperidine blocks the neuronal reuptake of serotonin. Serotonin syndrome after concomitant linezolid and meperidine therapy has not been described. We describe serotonin syndrome after concomitant use of linezolid and meperidine in a 27-year-old man with acute leukemia.