Pulmonary Embolism during Stuporous Episodes of Catatonia Was Found to Be the Most Frequent Cause of Preventable Death According to a State Mortality Review: 6 Deaths in 15 Years.

Case reports have indicated that pulmonary embolism (PE) can be associated with deaths during episodes of catatonia. A 15-year death registry in Kentucky state psychiatric hospitals was reviewed for deaths during episodes of catatonia. From 2002 to May of 2016, reports of 96 deaths at these state psychiatric hospitals were found and reviewed by the state mortality committee. The charts of the identified catatonic patients were thoroughly reviewed. All 6 deaths occurred during episodes of what Fink and Taylor would call retarded catatonia and Ungvari would call acute stuporous catatonia. The deaths were sudden and appeared to be explained by PE. They accounted for 6% (6/96) of the state hospital deaths. Moreover, they explained 32% (6/19) of the deaths that the committee considered preventable at some level, making pulmonary embolism by far the most important cause of preventable deaths. Catatonia diagnosis and treatment were far from optimal. The stupor in these 6 patients lasted many weeks with a median duration of catatonic symptoms while hospitalized of 45 days in the total sample and 75 days in four patients who died suddenly. If replicated in other mortality databases from other states or countries, two lessons in prevention of these PE deaths in catatonia would be the urgent needs to: 1) improve the skills of clinicians (psychiatrists and internists) for diagnosing and treating stuporous episodes of catatonia and 2) quickly and aggressively treat stuporous episodes of catatonia.

Dataset on psychosocial risk factors in cases of fatal and near-fatal physical child abuse.

This article presents the psychosocial risk factors identified in the cases of 20 children less than four years of age who were victims of fatal or near-fatal physical abuse during a 12 month period in the Commonwealth of Kentucky. These data are related to the article "History, injury, and psychosocial risk factor commonalities among cases of fatal and near-fatal physical child abuse" (Pierce et al., 2017) [1].

History, injury, and psychosocial risk factor commonalities among cases of fatal and near-fatal physical child abuse.

Failure to recognize child maltreatment results in chronic exposure to high-risk environments where re-injury or death may occur. We analyzed a series (n=20) of fatal (n=10) and near-fatal (n=10) physical child abuse cases from the Commonwealth of Kentucky to identify commonalities and determine whether indicators of maltreatment were present prior to the child's fatal or near-fatal event. We conducted retrospective state record reviews involving children <4years of age classified as physical child abuse by the Cabinet for Health and Family Services during a 12 month period. Cases were distributed across 17 counties. IRB approvals were obtained. Three reviewers concurrently abstracted case data from medical, social, and legal documents, and descriptive statistics were analyzed. Median age of subjects was 7.5 months (range 1-32 months); 55% were male. Psychosocial risk factors (PRFs) were present in 100% of cases. Traumatic brain injury (95%) and bruising (90%) were the most common injuries. Of the 14 children with available prior medical records, 9 (64%) had sentinel injuries in the form of prior unexplained bruising; all nine suffered subsequent traumatic brain injury resulting in four deaths. A male was caring for the child at the time of the final event in 70% of cases. Our study identified key commonalities across cases of fatal and near-fatal abuse, highlighting the prevalence of psychosocial risk factors and the significance of prior unexplained bruising as a herald of escalating abuse. Further study is warranted to ascertain the predictive value of our findings in the larger population.

Two Sudden and Unexpected Deaths of Patients with Schizophrenia Associated with Intramuscular Injections of Antipsychotics and Practice Guidelines to Limit the Use of High Doses of Intramuscular Antipsychotics.

Intravenous haloperidol has been associated with torsades de pointes (TdP). These two sudden deaths were probable adverse drug reactions (ADRs) following intramuscular (IM) antipsychotics. The autopsies described lack of heart pathology and were highly compatible with the possibility of TdP in the absence of risk factors other than the accumulation of antipsychotics with a high serum peak after the last injection, leading to death within hours. The first case was a 27-year-old African-American male with schizophrenia but no medical issues. His death was probably caused by repeated IM haloperidol injections of 10 mg (totaling 35 mg in 2 days). The second case involves a 42-year-old African-American female with metabolic syndrome. Her probable cause of death was the last ziprasidone IM injection of 20 mg in addition to (1) three extra haloperidol doses (2 hours before the ziprasidone injection, 5 mg oral haloperidol; approximately 21 hours earlier, 5 mg oral haloperidol; and 2 days prior, one 10 mg IM haloperidol injection), (2) 10 mg/day of scheduled oral haloperidol for 6 days before death, and (3) a long-acting paliperidone injection of 156 mg 18 days before death. The study of haloperidol glucuronidation and its impairment in some African-Americans is urgently recommended.

Developing and tailoring mental health technologies for child welfare: the Comprehensive Assessment and Training Services (CATS) Project.

This article describes the development and implementation of the Comprehensive Assessment and Training Services Project, a multidisciplinary center designed to prevent children from lingering in the foster care system and to provide early interventions to prevent lifelong problems. This article outlines the conditions that led to the identified need for such a program; the conceptual model used to guide protocol development and refinement: the methodological approach to evaluation, intervention, and technology transfer; specific program components; and, finally, the challenges and barriers to success.

Sensation seeking and symptoms of disruptive disorder: association with nicotine, alcohol, and marijuana use in early and mid-adolescence.

This study examined the association of Sensation Seeking and symptoms of Disruptive Disorders and investigated the associations of each with the risk of nicotine, alcohol, and marijuana use in 11- to 14-yr.-old boys and girls from psychiatric and pediatric clinics (n = 206). Sensation Seeking and symptoms of Disruptive Disorder were significantly related, and both were associated with drug use. In particular, Sensation Seeking was strongly associated with drug use in early and mid-adolescents seen in a clinical setting. Measurement of Sensation Seeking and symptoms of Disruptive Disorder should help identify and characterize youth who are at increased risk for drug use during early and mid-adolescence-a time when onset of use may be a harbinger of long-term habit.

Sensation seeking, puberty, and nicotine, alcohol, and marijuana use in adolescence.

OBJECTIVE: To examine the relationship among nicotine, alcohol, and marijuana use; level of sensation seeking (SS); and pubertal development. METHOD: Subjects were early and middle adolescent males and females recruited from a psychiatric clinic (n = 77) and two general pediatric clinics (n = 131). SS was measured by using the Sensation Seeking Scale for Children. Pubertal development was measured with a modified Pubertal Development Scale that was completed by the adolescent and his/her parent about the adolescent. Adolescent self-reports of nicotine, alcohol, and marijuana use were also obtained using questionnaires. RESULTS: SS was higher in males and females who reported nicotine and alcohol use and in males who reported marijuana use. SS was positively associated with pubertal development in males and females, even when controlling for age. Furthermore, SS mediated the relationship of pubertal development and drug use in males and females. CONCLUSIONS: The observation that SS mediates the relationship between pubertal development and drug use in males and females may contribute to understanding changes in drug use that are seen during adolescence. In addition, SS is associated with drug use and is easily measured in a variety of clinical settings.