9/10/2023 0 Comments Suicide carbon dioxide poisoning![]() It was composed of memory decline, gait disturbance, and ataxia at the time of admission. A month later, severe cognitive dysfunction occurred to him. He was taken to an emergency room at a hospital and underwent symptomatic care, not HBOT, for CO poisoning and rhabdomyolysis. With uncontrolled residual psychotic symptoms, he attempted suicide by inhaling charcoal fumes. Although the doctor recommended him admission for controlling residual hallucinations, he insisted on keeping outpatient clinic treatment. After consulting a doctor, he stopped the work for a moment due to aggravated symptoms. He reported that he found it hard to work because the voices reproached him. His psychotic symptoms were improved after medication, while auditory hallucinations remained unchanged. On being diagnosed with schizophrenia, he took medicines: amisulpride 800 mg, procyclidine 5 mg, propranolol 80 mg, and diazepam 2 mg. He worked in a large company after graduating from college. He had no family history related to psychiatric or other medical conditions. These symptoms had developed a week before his first visit to the hospital. ![]() He had visited the hospital for 2 years to treat psychotic symptoms including auditory hallucinations and persecutory delusions. Case reportĪ 38-year-old male diagnosed with schizophrenia is currently in partial remission. This case gives an example as the first report for a patient with schizophrenia using donepezil for DNS. Interestingly, we experienced an episode of a patient with schizophrenia and CO-induced DNS who responded well to donepezil after unsuccessful HBOT. Several case reports recently found that acetylcholinesterase inhibitors (AchEIs) were effective in cognitive impairment ( 16, 17). Although hyperbaric oxygen therapy (HBOT) is commonly applied to patients with DNS there are no randomized trials showing improvement of neuropsychological symptoms by HBOT in patients with CO poisoning ( 9, 10).įew available treatments are for DNS, despite proposed treatments including steroids, aspirin, cerebral vasodilators, bromocriptine, L-dopa, barbiturates, and dextroamphetamine ( 9, 11– 15). It can be defined as severe neuropsychiatric symptoms developed after 2–40 days of lucidity in patients with CO poisoning ( 6– 8). ![]() Delayed neurological sequelae (DNS) can be developed according to the duration of CO exposure. The symptoms of CO poisoning range from slight headache and anxiety to the most severe manifestations such as urinary/stool incontinence, inability to walk, and cognitive impairment ( 5). The lifetime risk of suicide rate among patients with schizophrenia is approximately 14.1% in the global population, and 26.8% of individuals with schizophrenia attempt suicide ( 1, 2), and the psychotic symptoms, as well as paranoid delusions and commanding hallucinations, are associated with a high risk of suicide ( 3).Ĭarbon monoxide (CO) poisoning by burning charcoal is one of the most popular methods of suicide ( 4). Although the mechanism of the phenomenon is unclear, it can be possible reasons that the neuroprotective effect of donepezil and white matter insult by CO poisoning. Surprisingly, with 5–10 mg donepezil, both cognitive function and the psychotic symptoms of the patient remarkably improved.Ĭonclusion: This case showed a good response of donepezil for a patient with schizophrenia and CO-induced DNS after ineffective HBOT. Though hyperbaric oxygen therapy (HBOT) was applied 10 times, his cognitive impairment did not recover. He was hospitalized with delayed neurological sequelae (DNS). Objectives: This report aims to introduce a rare case of a dramatic recovery by donepezil with a patient with schizophrenia who suffered from remaining psychotic symptoms despite proper treatment and had a cognitive impairment by carbon monoxide (CO) poisoning sequelae.Ĭase report: A 38-year-old male who developed schizophrenia 2 years ago had attempted suicide via CO inhalation due to his uncontrolled symptoms.
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