ECT for Cotard syndrome in a 13-year-old.

This is a case report about a 13-year-old girl who presented with depression, severely reduced daily functioning, and eventually nihilistic delusions about being dead. The condition was interpreted as a presentation of Cotard syndrome as part of early-onset schizophrenia. Treatment with an antidepressant and multiple antipsychotic medications was not effective. The patient was then treated with ECT, resulting in subjective and measurable positive effects.

Children and adolescents in the Psychiatric Emergency Department: a 10-year survey in Copenhagen County.

BACKGROUND: Knowledge on psychiatric emergencies in children and adolescents is limited. The Psychiatric Emergency Departments (PED) in Copenhagen enable the acute examination of children and adolescents 24 h a day, 7 days a week. However, very little is known about who presents to the PED, and the reason for their visit. AIM: To describe the prevalence and characteristics of presentations in PED and treatment provided. METHODS: A retrospective population based study comprising data of more than 4000 visitors presenting to PED from 2001-2010. In 2003 and 2006, two randomly chosen years, a more thorough analysis was performed, based on the individual emergency charts. Inter-rater reliability was high. RESULTS: Visits increased nearly threefold during the period. Symptom score for 2003 and 2006 revealed that more than one third of the visitors had suicidal ideation. Depressive and anxiety symptoms together with suicidal ideation rose significantly (P < 0.001). Psychoses and suicidal attempts remained unchanged. In one third of the visits, the discharge diagnosis was anxiety and stress-related disorders, followed by personality, behavioural and emotional disorders. Between 15% and 20% of the visits resulted in admission and more than 50% in referral for outpatient follow-up. CONCLUSIONS: The number of presenting psychiatric emergencies has increased over the last 10 years. Comparing symptoms from 2003 and 2006 showed a significant rise in their severity. This study highlights the need for 24-h access for acute evaluation by physicians skilled in child and adolescent psychiatry, and raises concern that the severity could increase.

[Can emergency admissions to departments of internal medicine be replaced by planned admissions?]. / Kan akutte indlaeggelser konverteres til planlagte indlaeggelser på medicinske afdelinger?

INTRODUCTION: The aim of the study was to describe the pattern of admissions to a medical department and to analyse how far acute admissions can be replaced by planned subacute admissions to an outpatient department. MATERIALS AND METHODS: All acute admissions to the medical department during two six-day periods were registered. The department's registrars filled in a structured questionnaire and the senior registrars evaluated the admissions. In addition, a local general practitioner evaluated one-third of the admissions. RESULTS: Altogether, 214 consecutive patients were entered in the study. One-third of the patients had consulted their GP in the week before the admission. Admissions from the casualty department and from GPs were assessed as appropriate in 92% and 71% of the cases, respectively. The senior registrars assessed that 17-20% of the acute admissions could have been replaced by a subacute, planned admission. Only 5% of the patients shared this conclusion. The ability to predict the total length of stay was limited, and greatest accuracy was achieved in prediction of short-term stays. DISCUSSION: In a medical department with many acute admissions, it is possible to replace acute admissions with planned subacute admissions for a large group of patients.