A chilling sequence of searches last week inquired into research to prevent deaths during seclusion and restraint. (The first query was actually “deaths during restraint,” but we modified that to “restraint death” for better results.) The newest study, from the University of Miami, reports a “reliable forensic tool for identifying the excited delirium syndrome at autopsy.”
RESULT: Brain biomarkers for identifying excited delirium as a cause of sudden death
Forensic Science International (PubMed) | Sep 10, 2009
The following result, from another forensic journal, reports that psychiatric patients may also die of thromboembolism while physically restrained for long periods. The deceased in this small study had no history of thrombotic risk factors; all had been restrained for several days.
RESULT: Fatal thromboembolic disease: a risk in physically restrained psychiatric patients
Journal of Forensic and Legal Medicine | Jul 1, 2009
Search: restraint death
There were also several searches related to reducing the risk of death during restraint. The query “pulse oximetry during restraint” showed that during the past two years, despite intense regulatory focus on reducing this risk, there have been no new studies of this simple method that can prevent death. The article below is the most recent result on the subject.
RESULT: Portable Pulse Oximeter Use During Patient Restraint
Psychiatric Times | Oct 1, 2007
Search: pulse oximetry during restraint
There may be brain biomarkers for it, but does “excited delirium” actually exist? A search using that phrase as a search term locates an article that addresses the question, with perspectives from both psychiatrists and police. The lead author of the biomarker study is quoted at length.
RESULT: A knee in the neck of excited delirium
Canadian Medical Association Journal | Mar 11, 2008
Search: excited delirium
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SEARCH TIP: On persistence
Our records show four distinct but related searches in the Mental/Nervous tab this week that include the term “restraint”:
- deaths during restraint
- use of pulse oximetry during restraint
- physical monitoring of a patient during restraint
- reducing risk associated with seclusion and restraint
The results were quite different for each, yielding a rich variety of information on the topic.
Another approach is to use search terms drawn from a phrase in one of the results. Trying the search term “excited delirium,” the topic of the first result above, revealed a diagnostic controversy that adds another perspective to the topic.
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OTHER RECENT SEARCHES ON SEARCHMEDICA
Search: catatonia
RESULT: The Catatonia Syndrome: Forgotten But Not Gone
Archives of General Psychiatry | Nov 1, 2009
Although it is often masked by other disorders, catatonia is easily recognized and treated, according to the authors of this review. Despite a widespread assumption that it is a form of psychosis, catatonia is not confined to schizophrenia, they write.
Search: verbal and mental abuse
RESULT: Understanding the Dynamics of Abusive Relationships
Psychiatric Times | Sep 1, 1996
Someone sent feedback to commend this 13-year-old review that describes the dynamics of abusive relationships in common language. It draws inferences in part from testimony during the trial of O.J. Simpson.
Search: depression practice parameter adult
RESULT: Practice Parameter for Psychiatric Consultation to Schools
Guidelines.gov | Oct 5, 2009
This 2004 guideline from the American Academy of Child and Adolescent Psychiatry is both misdated and contrary to the search term specification of “adult.” What went wrong, and how can this search be improved?
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SEARCH TIP: Practice Guidelines
As to the publication date, if you scroll to the bottom of the guideline you’ll see the words “Date Modified 11/9/09” (or perhaps a later date by the time you read this). Unfortunately, that trumps earlier dates on the same page. As a result of this problem, listed publication dates on results from the National Guideline Clearinghouse are often erroneous.
However, it’s easy to eliminate guidelines that mention adults. Use the term “NOT” in the query, which allows you to exclude irrelevant terms.
We found guidelines about depression in adults by restricting the search to the Practice Guidelines article category and using the query depression NOT children NOT adolescents.
