After receiving lorazepam, the patient showed marked improvement. The EP’s final impressions were atypical chest pain and acute panic attack precipitated by abrupt benzodiazepine withdrawal. After discussing the case with the patient’s FP, the EP discharged the patient home with instructions to complete the cardiac evaluation as an outpatient. The EP also recommended that the patient resume taking lorazepam and follow-up with her FP within one week to discuss a benzodiazepine taper and alternative therapy for anxiety.
Case 2
[The 36-year-old woman with altered mental status.]
When the EP entered the patient’s room, he witnessed the patient staring at her husband and striking him repetitively with her right arm. When the EP asked the patient to stop hitting, her husband told the EP that everything was alright and that the patient’s neurologist had previously told them this behavior was caused by a seizure. While in the next examination room, one of the EP’s colleagues had overheard some of the patient’s history and recognized the name of the patient’s neurologist as a specialist in partial complex seizures—one who had retired from the local medical school about 10 years ago.
After records from the local university hospital confirmed the patient’s diagnosis of partial complex seizures, she was given intravenous lorazepam 2 mg; she became alert, conversational, and stopped flailing her right arm. She was then admitted to the hospital for medical stabilization of her frequent seizures.
Editor’s Note: Part 2 of this article will appear in the June 2016 issue of Emergency Medicine and will cover psychiatric presentations related to dementia, cancer, cardiac disease, nutritional deficiencies, endocrine disorders, and toxins.
