title: Theoretical and practical issues related to the management of severe and refractory psychotic illness complicated by pulmonary embolism.
abstract: Pulmonary embolism (PE) is a potentially fatal condition. We describe the educative case of a young adult male, with a longstanding history of schizophrenia, who was receiving anticoagulant treatment because of repeated episodes of PE in the past. He presented with severe exacerbation of psychosis and did not respond to oral and parenteral antipsychotic medication during inpatient treatment. He was taken up for electroconvulsive therapy (ECT) and received a single ECT uneventfully. The ECT course had to be interrupted because of the unexpected development of a 4-day febrile illness, after which he experienced sudden onset breathlessness, which was diagnosed as acute-on-chronic PE. After the crisis resolved with 4 days of intensive care, he was managed with clozapine. We discuss concerns associated with the psychiatric management of patients with PE; special issues include the use of restraints, parenteral antipsychotic medications, anticoagulants, and ECT.
authors.affiliation: Department of Psychiatry, Dr. D. Y. Patil Hospital and Medical College, Navi Mumbai, Maharashtra, India.
authors.forename: Payal H
authors.initials: PH
authors.lastname: Chandele
authors.affiliation: Department of Psychiatry, Dr. D. Y. Patil Hospital and Medical College, Navi Mumbai, Maharashtra, India.
authors.forename: Rashmin
authors.initials: R
authors.lastname: Cholera
authors.affiliation: Department of Psychiatry, Dr. D. Y. Patil Hospital and Medical College, Navi Mumbai, Maharashtra, India.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Kale
authors.affiliation: Department of Psychiatry, Dr. D. Y. Patil Hospital and Medical College, Navi Mumbai, Maharashtra, India.
authors.forename: Aparna
authors.initials: A
authors.lastname: Ramakrishnan
authors.affiliation: Department of Medicine, St. John's Medical College and Hospital, Bengaluru, Karnataka, India.
authors.forename: Cecil R
authors.initials: CR
authors.lastname: Ross
authors.affiliation: Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: Chittaranjan
authors.initials: C
authors.lastname: Andrade
keywords: Anticoagulation; antipsychotic drugs; electroconvulsive therapy; intramuscular injection; pulmonary embolism; thromboembolism
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