![]() Results of screening laboratory tests, a chest x-ray, and an electrocardiogram, as well as her vital signs, were all unremarkable. She was admitted to a second inpatient psychiatric unit for depression with catatonic features. A grew more withdrawn, became less communicative, and developed odd, stereotyped movements (such as holding a sock in the air for minutes at a time and slowly crossing and uncrossing her legs). After 1 week, she was discharged from the unit to a residential program. Her psychological evaluation revealed that she was socially detached and had difficulty asserting herself and reaching out to others in times of distress, with no evidence of thought disorder or personality pathology. Her score on a test of working memory, the Wechsler Memory Scale Digit Span subtest, was in the normal range, and she reported no subjective cognitive dysfunction. Screening neuropsychological tests to assess cognitive deficits included a 100-point Mental Status Examination her score (97 of 100) was not indicative of gross cognitive impairment. She was tranferred to the inpatient psychiatric unit for further treatment of her depression and thoughts of suicide. A brain magnetic resonance imaging (MRI) scan revealed a focus in the right globus pallidus consistent with a subacute stroke and no other abnormalities. The next week in the general hospital she received antibiotics (for aspiration pneumonia) and hydration for mild rhabdomyolysis. She endorsed poor sleep, a lack of interests, feelings of guilt, low energy, poor concentration, lethargy, and a continued desire to end her life. ![]() Her eye contact was poor, her affect was flat, and she manifested word-finding difficulty. ![]() While lying on the bed (hugging a pillow and curled into a fetal position), she exhibited athetoid movements of her trunk, feet, and hands. Her mental status examination was notable for profound psychomotor retardation, hypophonia, and prolonged speech latency. She was admitted to the medical intensive care unit, where she was treated for an aspiration pneumonia (with intravenous antibiotics), and she was extubated. Her CO level after HBO 2 therapy was 7.3%. She was intubated for airway protection and was transferred to a large general hospital, where she received 1 hyperbaric oxygen (HBO 2) treatment at a pressure of 3.0 atm for 90 minutes. Quetiapine, zolpidem, oxycodone, and citalopram were present in her serum. ![]() On arrival, her vital signs were stable, but she was obtunded her CO level was elevated (31.7% normal, < 5%). She was rushed to a nearby city hospital. A failed to show for a regularly scheduled appointment. Police found her some hours later after her therapist called 911 when Ms. A, a 57-year-old woman with a history notable for alcoholism and depression, attempted suicide by ingesting a large amount of alcohol and medications, then lying down in a bathtub next to a pan of lit charcoal briquettes in a closed room. ![]()
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