Medication Noncompliance Research Articles

Nomogram model for predicting medication adherence in patients with various mental disorders based on the Dryad database

ObjectiveTreatment compliance among psychiatric patients is related to disease outcomes. How to assess patient compliance remains a concern. Here, we established a predictive model for medication compliance in patients with...

7647 Myxedema Coma- A Rare and Fatal Manifestation of Severe Hypothyroidism

Abstract Disclosure: B.K. Ray: None. R. Kaur: None. L. Kaur: None. M. Thakur: None. Introduction: Myxedema coma is a severe and life-threatening form of hypothyroidism. It is a rare occurrence with an incidence of 0.22 per million per year, associated with a high mortality rate ranging from 30 to 60% even with early diagnosis and treatment. This condition arises when the body's response to hypothyroidism is overwhelmed by factors like infection, surgery, and medication noncompliance. The definitive management is with thyroid hormones but supportive measures and identification and treatment of the precipitating factors is also vital. The case discussed concerns an elderly woman with myxedema coma due to noncompliance to Levothyroxine. This case stresses the importance of consistent medical follow-ups. Case Presentation: A 73 year old female presented to the hospital with altered mental status for about 32 hours. Vital signs at presentation showed hypotension (80/50 mmHg), bradycardia (54 beats per minute), tachypnea (32 breaths per minute) and hypothermia (33.2 °C). A computed tomography scan of the brain and Computed tomography angiography of the head/neck showed no stenosis or large vessel occlusion of the vasculature. Initial pertinent laboratory test results revealed a white blood cell count of 6.1 (3.7–11.0×103/uL), hemoglobin level of 14.3 (11.5–16.0 g/dL), sodium level of 131 (136–145 mmol/L), glucose level of 142 (65–125 mg/dL). Troponin, lactate and procalcitonin were normal. She was intubated and transferred to the Intensive care unit. Thyroid function tests revealed a markedly elevated TSH of 37.9 (0.4 to 4.0 mIU/L) and a decreased T4 of 0.3 (0.9-1.7 ng/dL). She was immediately started on hydrocortisone 100 mg Three times daily and initiated on intravenous levothyroxine monotherapy with a loading dose of 200 mcg followed by 100 mcg daily. Her T4 level was trended daily and she demonstrated gradual improvement. She was successfully extubated. On discussion she reported noncompliance with her medications. Hydrocortisone was tapered and she was started on her home dose of oral Levothyroxine (200 mcg) after four days of Intravenous levothyroxine. She was counselled on medication compliance and discharged to home. Conclusion: Myxedema, an extreme form of hypothyroidism, is life-threatening and requires immediate admission to intensive care. Symptoms are usually vague, and require a high degree of suspicion. Treatments include thyroid hormone supplementation, steroid replacement and supportive care. Early detection and quick intervention are crucial for survival. Patient education on medication compliance, regular testing, and reporting new medication to prevent interference with thyroid metabolism is crucial. Presentation: 6/1/2024

A conceptual framework for psychiatric nurses to facilitate medication compliance among adults living with depression.

Medication non-compliance is a significant healthcare issue that is widespread. Extensive research has identified factors that contribute to medication non-compliance in different healthcare settings. As a result, there was a need to develop a conceptual framework to facilitate medication compliance among adults living with depression. The purpose of this study was to develop a conceptual framework for psychiatric nurses to facilitate medication compliance among adults living with depression. A qualitative, exploratory, descriptive and contextual research design was utilised to investigate the experiences of adults living with depression who are non-compliant with medication. The study consisted of three phases: an empirical phase, a classification of concepts and a development phase. Following the empirical phase, a conceptual framework was developed based on the classified concepts. Three sets of results were merged for the cross-validation analysis, combining findings from the systematic review, the researcher's previously conducted and published minor dissertation and the current study. A conceptual framework was developed to assist psychiatric nurses in effectively promoting an internal locus of control among adults living with depression. The resulting conceptual framework provides valuable insights and serves as a valuable tool for future research endeavours aimed at enhancing medication compliance among adults living with depression.Contribution:This framework serves as a valuable guide for future studies that aim to explore medication compliance among adults living with depression, specifically by focussing on the concept of internal locus of control.

Artificial intelligence generates proficient Spanish obstetrics and gynecology counseling templates

BackgroundEffective patient counseling in Obstetrics and gynecology is vital. Existing language barriers between Spanish-speaking patients and English-speaking providers may negatively impact patient understanding and adherence to medical recommendations, as language discordance between provider and patient has been associated with medication noncompliance, adverse drug events, and underuse of preventative care. Artificial intelligence large language models may be a helpful adjunct to patient care by generating counseling templates in Spanish. ObjectivesThe primary objective was to determine if large language models can generate proficient counseling templates in Spanish on obstetric and gynecology topics. Secondary objectives were to (1) compare the content, quality, and comprehensiveness of generated templates between different large language models, (2) compare the proficiency ratings among the large language model generated templates, and (3) assess which generated templates had potential for integration into clinical practice. Study designCross-sectional study using free open-access large language models to generate counseling templates in Spanish on select obstetrics and gynecology topics. Native Spanish-speaking practicing obstetricians and gynecologists, who were blinded to the source large language model for each template, reviewed and subjectively scored each template on its content, quality, and comprehensiveness and considered it for integration into clinical practice. Proficiency ratings were calculated as a composite score of content, quality, and comprehensiveness. A score of >4 was considered proficient. Basic inferential statistics were performed. ResultsAll artificial intelligence large language models generated proficient obstetrics and gynecology counseling templates in Spanish, with Google Bard generating the most proficient template (p<0.0001) and outperforming the others in comprehensiveness (P=.03), quality (P=.04), and content (P=.01). Microsoft Bing received the lowest scores in these domains. Physicians were likely to be willing to incorporate the templates into clinical practice, with no significant discrepancy in the likelihood of integration based on the source large language model (P=.45). ConclusionsLarge language models have potential to generate proficient obstetrics and gynecology counseling templates in Spanish, which physicians would integrate into their clinical practice. Google Bard scored the highest across all attributes. There is an opportunity to use large language models to try to mitigate the language barriers in health care. Future studies should assess patient satisfaction, understanding, and adherence to clinical plans following receipt of these counseling templates.

Factors Associated with Medication Noncompliance in Dogs in New Zealand.

Client compliance with prescribed medication instructions to treat their pets is a concern. This study describes factors associated with the noncompliance of dog owners with veterinary recommendations for medication, as well as client-reported barriers and aids to administering medications. A cross-sectional survey of dog owners' compliance with veterinary medication recommendations was performed from 9 January 2019 to 18 July 2020. A convenience sample of owners who prescribed medication for their dogs during or following elective veterinary examination was surveyed regarding medication administration experience and compliance. Owners were followed up to determine if the course of medication had been completed. Compliance data were analyzed descriptively. Logistic regression was performed with compliance as the outcome. Medication noncompliance was recorded for 47% (71/151) of owners. Increasing dog age was associated with better owner compliance (p < 0.05). Pet owners who used "nothing" as an aid to medicating were less likely to be noncompliant (p < 0.05). Forty-seven percent (71/151) of owners reported that "nobody" showed them how to administer the medication. One-third of dog owners (47/151) reported challenges in medicating their pets. The most common reason cited by clients reporting challenges was a resistant pet. Demonstration of medication administration techniques and discussion about available aids to medicating a pet may improve client compliance.

The Interrelationship between Diabetes Mellitus and Emotional Well-Being: Current Concepts and Future Prospects.

Diabetes mellitus is a lifelong metabolic disorder that impacts people's well-being and biopsychosocial status. Psychiatric problems and diabetes mellitus have a complex, reciprocal interaction in which one condition affects the other. In this narrative review, we provide an overview of the literature on the psychological effects of diabetes, expound on the evaluation of emotional disorders in the setting of diabetes, and suggest interventions aimed at enhancing both mental and physical health. Diabetes can make daily life complicated and stressful. Frequent blood glucose testing, taking medications on a regular basis, adhering to a tight diet plan, and exercising are some examples of the suggested daily routine of subjects with diabetes. Furthermore, comorbid diseases and typical diabetic complications can have a detrimental impact on quality of life. When mental health conditions coexist with diabetes mellitus, there is a greater likelihood of medication noncompliance, a decreased commitment to diabetes-related self-care, increased functional impairment, inadequate glycemic control, a higher risk of complications, and overall higher healthcare expenses. Thus, evaluation of the mental health status of patients with diabetes is crucial. When treating psychological issues and psychiatric disorders, a comprehensive biopsychosocial approach should be taken, and where appropriate, psychopharmacological therapies or psychotherapy should be applied. The goal of continuous education and assistance for self-care is to give individuals with the disease the information and abilities they need to control their condition over time.

Eploring Determinants of Adherence to Medical Regimens in Patients with Chronic Conditions Beyond Hypertension and Diabetes

Chronic diseases are significantly increasing globally and increasing premature deaths among population. CDC has defined chronic diseases are the conditions that last 1 year or more and require ongoing medical support or limit the daily activities or both. Diabetes and hypertension are popular chronic diseases. But there are many others are also now increasing. The current study was conducted to find out the prevalence of noncompliance among chronic diseases like thyroid diseases, Asthma, COPD, Orthopedic problems and epilepsy. Also to understand the determinants factors among them. It was a hospital based cross sectional study. The sample size was calculated and it was 36 for each disease. Total 40 study participants of each disease were included. It was randomly selected the individuals diagnosed with the mentioned chronic diseases who have been diagnosed and on treatment for more than 3 years from hospital. Result: A total of 200 patients participated in the study. The study included 40 patients from each chronic disease that is thyroid disorders, COPD, Orthopedic problems, Asthma and Epilepsy. The rural population comprised 69% of the total study group. The prevalence of medical noncompliance was found in 56.5% of all the patients. People having the disease for longer period of time were more non-compliant. The study revealed that family support and regular follow up with doctor are two important determinates factors which has positive impact on compliance. Conclusion: Noncompliance to medication regimen among chronic disease patients is an important issue for public health consideration. This current study recorded an overall noncompliance level of 57.5%. The factors identified as contributing to medication noncompliance in this study were regular follow ups, family support, adequate knowledge regarding their disease and importance of taking medication with or without symptoms.

Treatment and Toxicity Considerations in Tuberculosis: A Narrative Review.

Tuberculosis remains one of the most significant bacterial infections plaguing the medical community worldwide. The bacteria Mycobacterium tuberculosis retains the ability to manifest as an active infection, latent infection, miliary infection, or reactivation of latent infections in times of immunosuppression. Therefore, the medication regimen to treat the condition revolves around four medications, each with a mechanism that targets a different part of the bacteria. Isoniazid weakens the cell wall but produces neuropathy and hepatotoxicity as side effects. Rifampin interrupts protein synthesis but creates the opportunity for many drug-to-drug interactions and red-orange discolorations as side effects. Pyrazinamide is poorly understood, but it is believed to acidify the internal environment of the bacteria, with gout exacerbations and arthralgias as major side effects. Ethambutol also works as a bacteriostatic medication to interrupt the cell membrane; however, its mechanism is poorly understood. The most concerning side effect is optic neuropathy. The unfavorable side effect profile for tuberculosis treatment may contribute to the higher rates of medication noncompliance with therapy and needs to be addressed in the future.

Fatal Hemoperitoneum Secondary to a Spontaneous Splenic Vein Rupture.

Spontaneous hemoperitoneum is rare and is often labeled as idiopathic because the source of bleeding is never found. We report the case of a 35-year-old male who died of a splenic vein rupture. The decedent was a chronic alcoholic with a reported history of cirrhosis and medication noncompliance. Internal examination revealed pale visceral organs, marked hemoperitoneum, a fibrotic/nodular liver, esophageal varices, and a ruptured splenic vein. Pertinent microscopic findings include liver parenchyma with bridging fibrous septa, nodules of regenerating hepatocytes, and the presence of Mallory-Denk bodies. The immediate cause of death was determined to be splenic vein rupture with the underlying cause of death being chronic alcoholism. This case is reported to emphasize the importance of correlating past medical history with thorough vascular dissection in cases of spontaneous hemoperitoneum. In a patient with fatal hemoperitoneum and risk factors for splenic vein pathology (ie, cirrhosis, portal vein hypertension), a high suspicion should be kept for splenic vein rupture.

It's complicated: The relationship of non-narcotic medications and postoperative opioid use in radical cystectomy patients

IntroductionThe effect of individual non-narcotic analgesics in cystectomy enhanced recovery after surgery (ERAS) is unknown. Additionally, many non-narcotic medications are associated with side effects pertinent to the cystectomy population. To better understand the actual use and utility of these medications, we sought to characterize the association between non-narcotic medications and milligram morphine equivalent (MME) narcotic score during the postoperative inpatient stay. MethodsWe reviewed 260 consecutive ERAS cystectomy patients. The MME impact of non-narcotic compliance and cumulative dose of medication received was evaluated separately with general linear models. We also assessed relationship of non-narcotic compliance to patient reported pain score, length of stay (LOS), and time to return of bowel function (ROBF) and performed manual review of postoperative documentation to identify reasons for medication noncompliance. ResultsCompliance with postoperative acetaminophen, gabapentin, and ketorolac was low. There was an inverse relationship between ketorolac dose and MME on postoperative day 1 (−0.026 MME/mg; P = 0.004) and postoperative day 2 (−0.33 MME/mg; P < 0.001). Compliance with ketorolac was associated with lower MME on postoperative day 1 (26.1 MME v. 33.6 MME; P = 0.023). There were no such associations identified with gabapentin or acetaminophen. Gabapentin compliance was associated with earlier ROBF (3.7 days v. 4.3 days; P = 0.006). Ketorolac compliance was associated with lower pain score on POD1 (3.25 VAS v. 4.07 VAS; P = 0.019) and POD2 (3.05 VAS v. 3.85 VAS; P = 0.040) There was no association between medication compliance and LOS. The most common reasons identified for non-compliance with gabapentin and ketorolac were renal function concerns (38% and 40% respectively), bleeding concerns with ketorolac (20%) and concerns for neurologic adverse effect with gabapentin (16%). ConclusionCompliance with non-narcotic medications in our ERAS cystectomy protocol was poor. There was a modest association with ketorolac and postoperative MME but no association with gabapentin or acetaminophen. Further study will clarify the role of these medications for cystectomy patients. Component specific analysis of protocolized care is valuable and may alter care pathways.

Effect of preoperative alpha-blockers on ureteroscopy outcomes: A meta-analysis of randomised trials.

This work aims to determine the efficacy and safety of preoperative alpha-blocker therapy on ureteroscopy (URS) outcomes. In this systematic review and meta-analysis of randomised trials of URS with or without preoperative alpha-blocker therapy, outcomes included the need for ureteral dilatation, stone access failure, procedure time, residual stone rate, hospital stay, and complications. Residual stone rates were reported with and without adjustments for spontaneous stone passage, medication noncompliance, or adverse events leading to patient withdrawal. Data were analysed using random-effects meta-analysis and meta-regression. Certainty of evidence was assessed using the GRADE criteria. Among 15 randomised trials with 1653 patients, URS was effective and safe with a stone-free rate of 81.2% and rare (2.3%) serious complications. The addition of preoperative alpha-blockers reduced the need for ureteral dilatation (risk ratio [RR] = 0.48; 95% CI = 0.30 to 0.75; p = 0.002), access failure rate (RR = 0.36; 95% CI = 0.23 to 0.57; p < 0.001), procedure time (mean difference [MD] = -6min; 95% CI = -8 to -3; p < 0.001), risk of residual stone in the primary (RR = 0.44; 95% CI = 0.33 to 0.66; p < 0.001) and adjusted (RR = 0.52; 95% CI = 0.40 to 0.68; p < 0.001) analyses, hospital stay (MD = -0.3days; 95% CI = -0.4 to -0.1; p < 0.001), and complication rate (RR = 0.46; 95% CI = 0.35 to 0.59; p < 0.001). Alpha-blockers increased ejaculatory dysfunction risk and were less effective for renal/proximal ureter stones. The certainty of evidence was high or moderate for all outcomes. The main limitation of the review was inconsistency in residual stone assessment methods. While URS is an effective and safe treatment for stone disease, preoperative alpha-blocker therapy is well tolerated and can further improve patient outcomes.

A288 ALCOHOL RELAPSE AND ADVERSE OUTCOMES IN EARLY VERSUS ROUTINE LIVER TRANSPLANT FOR ALCOHOL-ASSOCIATED LIVER DISEASE IN THE PROVINCE OF BRITISH COLUMBIA

Abstract Background Liver transplant is a life-saving treatment for patients with alcohol-associated liver disease (ALD) resulting in decompensated cirrhosis or severe alcoholic hepatitis, significantly reducing mortality compared to supportive treatment. Despite its previous wide acceptance, there is a lack of strong evidence to justify a 6-month abstinence period. In 2019, BC Transplant policies were updated to allow liver transplant within 6-months of alcohol use in carefully selected patients with limited life expectancy and favorable multidisciplinary psychosocial assessment. Aims This study aims to assess alcohol relapse rates and adverse outcomes in patients who received an early liver transplant for ALD. Methods A retrospective chart review was performed on all adult patients who underwent liver transplant in the province of British Columbia between January 1, 2020, and December 31, 2022. Follow up data was extracted until May 31, 2023. Patients were included if they had alcohol documented as a contributing factor to their liver disease prior to transplant. Early transplant was defined as alcohol abstinence of 179-days or less and routine transplant as 180-days or more. Alcohol use and time to alcohol use were determined by patient history, random biochemical testing, and health-care utilization for an alcohol-associated complication. Graft dysfunction or rejection resulting in a change in therapeutic management, noncompliance determined by clinician documentation, rehospitalization, and death were recorded as adverse events. Results 278 patients underwent liver transplant during the study period. 81 patients were classified as alcohol-related, and 15 received early transplant. The mean follow-up period was 20.5 months. Early transplant recipients were more likely to be younger (median 45 vs. 58 years, p = 0.003) and have a higher MELD score at the time of transplant (median 37 vs. 17, p ampersand:003C 0.001). There was no significant difference in post-transplant alcohol relapse (13 vs. 15%, hazard ratio = 0.78, 95% CI [0.17, 3.55], p = 0.74). Graft dysfunction was increased in patients who received early transplant (53 vs. 25%, relative risk = 2.17, 95% CI [1.15, 4.10]). There was no significant difference between rates of noncompliance (0 vs. 9%), rehospitalization (53 vs. 56%), or death (0 vs. 2%). Conclusions Alcohol relapse is similar between early and routine liver transplant. Graft dysfunction is increased in early transplant, although other adverse events including medication noncompliance, rehospitalization, and death are not significant different. These results are favorable for the continued use of early liver transplant for ALD, providing an effective treatment for ALD and significantly reducing mortality in patients with a limited life expectancy. Funding Agencies None

Income Level and Insurance Status Are Correlated with Medical Non-Compliance after Bone Marrow Transplant in Children

Income Level and Insurance Status Are Correlated with Medical Non-Compliance after Bone Marrow Transplant in Children

Perspectives on the representation of frailty in the electronic frailty index

BackgroundFrailty is a state of increased vulnerability from physical, social, and cognitive factors resulting in greater risk of negative health-related outcomes and increased healthcare expenditure. A 36-factor electronic frailty index (eFI) developed in the United Kingdom calculates frailty scores using electronic medical record data. There is currently no standardization of frailty screening in Canadian primary care. In order to implement the eFI in a Canadian context, adaptation of the tool is necessary because frailty is represented by different clinical terminologies in the UK and Canada. In considering the promise of implementing an eFI in British Columbia, Canada, we first looked at the content validation of the 36-factor eFI. Our research question was: Does the eFI represent frailty from the perspectives of primary care clinicians and older adults in British Columbia?MethodsA modified Delphi using three rounds of questionnaires with a panel of 23 experts (five family physicians, five nurse practitioners, five nurses, four allied health professionals, four older adults) reviewed and provided feedback on the 36-factor eFI. These professional groups were chosen because they closely work as interprofessional teams within primary care settings with older adults. Older adults provide real life context and experiences. Questionnaires involved rating the importance of each frailty factor on a 0–10 scale and providing rationale for ratings. Panelists were also given the opportunity to suggest additional factors that ought to be included in the screening tool. Suggested factors were similarly rated in two Delphi rounds.ResultsThirty-three of the 36 eFI factors achieved consensus (> 80% of panelists provided a rating of ≥ 8). Factors that did not achieve consensus were hypertension, thyroid disorder and peptic ulcer. These factors were perceived as easily treatable or manageable and/or not considered reflective of frailty on their own. Additional factors suggested by panelists that achieved consensus included: cancer, challenges to healthcare access, chronic pain, communication challenges, fecal incontinence, food insecurity, liver failure/cirrhosis, mental health challenges, medication noncompliance, poverty/financial difficulties, race/ethnic disparity, sedentary/low activity levels, and substance use/misuse. There was a 100% retention rate in each of the three Delphi rounds.Conclusions and next stepsThree key findings emerged from this study: the conceptualization of frailty varied across participants, identification of frailty in community/primary care remains challenging, and social determinants of health affect clinicians’ assessments and perceptions of frailty status. This study will inform the next phase of a broader mixed-method sequential study to build a frailty screening tool that could ultimately become a standard of practice for frailty screening in Canadian primary care. Early detection of frailty can help tailor decision making, frame discussions about goals of care, prevent advancement on the frailty trajectory, and ultimately decrease health expenditures, leading to improved patient and system level outcomes.

Home Care Nurses' Knowledge and Attitudes Regarding Telehealth to Promote Medication Compliance among Older Adults.

Medication noncompliance among older adults is a persistent problem resulting in morbidity, hospital readmissions, and decreased quality of life. Home care nurses are in a key position to assist older adults to employ medication compliance strategies that are tailor-made to fit their individual needs and abilities. The purpose of this study was to understand the knowledge and attitudes of home care nurses regarding telehealth practices to promote medication compliance of older adult patients and their perceived readiness to do so. We employed a qualitative research approach using semi-structured interviews. Individual interviews were conducted via Teams platform for a maximum of 60 minutes. Participants were home care nurses who use telehealth technology to advance medication compliance strategies. Ten interviews were conducted. Several themes emerged from the data which suggested home care nurses accept telehealth technology, are supportive of its continued use, and are willing to be educated on future advances in this technology to assist older adults with medication compliance strategies. Universities and home care agencies must provide opportunities to prepare nurses to utilize telehealth technologies to promote medication compliance among older adult home care patients.

Factors Associated With Leaving Against Medical Advice Among Patients With Documented Medication Noncompliance Admitted For Heart Failure With Reduced Ejection Fraction

Factors Associated With Leaving Against Medical Advice Among Patients With Documented Medication Noncompliance Admitted For Heart Failure With Reduced Ejection Fraction

Bi-Atrial Thrombus via Patent Foramen Ovale with Medical Noncompliance: A Case Report

Bi-Atrial Thrombus via Patent Foramen Ovale with Medical Noncompliance: A Case Report

Medication Compliance of Patients Attending a Pain Clinic at a Tertiary Hospital in Malaysia

Pain is a public health problem with profound physical, emotional, and societal costs. Conventional oral analgaesics are usually the first treatment, which is cost-effective and relatively safe. However, medication noncompliance is a serious healthcare concern. Medication noncompliance has remained a significant challenge despite considerable efforts to improve patient compliance. Therefore, a study was done to assess medication compliance at a Pain Clinic in a tertiary hospital in Malaysia. The study period was from December 2019 to January 2020. A total of 180 patients participated in the study. The study showed that pain clinic patients’ medication compliance was 65%. With the improvement of medication compliance, the quality of life of patients with pain can be improved.

Left cardiac sympathetic denervation in children. A matter of facts

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac sympathectomy (CS) is a second-line treatment for drug-refractory adrenalin-sensitive channelopathies. We present our series of paediatric sympathectomies for long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT) as adjunctive treatment. Methods Between 2011 and 2021, 30 CS (28 left, 2 right) were performed by videothoracoscopy in 28 patients (21 LQTS and 7 CPVT), aged 8 days to 21 years. The mean follow-up was 29 months. All patients were treated pharmacologically before surgery, three had an implantable cardiac defibrillator (ICD). Indications for CS in patients with CPVT included previous cardiac arrest (3/7) and sustained VT induced by emotion/stress despite medication (4/7). In LQTS, indications included syncope (4/21), VT despite medication (7/21) and high risk of malignant arrhythmias (10/21). Results There were no intraoperative complications or deaths. Four patients had transient palpebral ptosis with mild miosis, 23/28 patients were monitored by ICD or subcutaneous holter. After sympathectomy, 24/28 remain asymptomatic; three patients experienced syncope and one received appropriate discharge. Seven patients experienced VT (3/7 due to pharmacological non-compliance) of which three required ICD and four improved with medication. During follow-up, five high-risk patients received ICDs for primary prevention. Conclusion CS is an effective and safe technique in children as an adjunctive treatment for severe arrhythmias due to channelopathies. After CS, 85% remained asymptomatic. Medication non-compliance is an important cause of VT after CS, although ICD was occasionally required. In our experience, long-term remote monitoring is key to effective follow-up.

A unique presentation of echo phenomena in a patient with catatonia: a case report and literature review

BackgroundCatatonia is a complex syndrome notable for a highly variable presentation. Standardized exam and criteria can enumerate possible presentations, but recognition of novel catatonic phenomenon may facilitate better understanding of catatonia’s core features.Case presentationA 61 year-old divorced pensioner with history of schizoaffective disorder was hospitalized for psychosis in the setting of medication noncompliance. While hospitalized, she developed multiple classic catatonia signs such as staring and grimacing, as well as a bizarre echo phenomenon while reading text that improved alongside other catatonic symptoms with treatment.ConclusionEcho phenomenon are a component of catatonia often recognized when presenting as echopraxia or echolalia, but other echo phenomenon are well established in the literature. Recognition or novel catatonic symptoms like this can lead to improved recognition and treatment of catatonia.