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A Standardized Approach to Treatment Over Objection in Patients Lacking Decision-Making Capacity Secondary to Neurologic Disease

Ader, Jeremy; Otten, Marc L; Critchfield, Adam; Prager, Kenneth M
Neurologic diseases, ranging from Alzheimer dementia to mass lesions in the frontal lobe, may impair decision making. When patients with neurologic disease lack decision-making capacity, but refuse treatment, should they be treated over their objection? To address this type of ethical dilemma in medical illness, Rubin and Prager developed a standardized 7-question approach: (1) How imminent is harm without intervention? (2) What is the likely severity of harm without intervention? (3) What are the risks of intervention? (4) What are the logistics of treating over objection? (5) What is the efficacy of the proposed intervention? (6) What is the likely emotional effect of a coerced intervention? (7) What is the patient's reason for refusal? We describe the application of the standardized Rubin/Prager approach as a checklist to the case of a 50-year-old woman with a large frontal lobe meningioma, who lacked capacity as a result of the meningioma, but refused surgery. This approach may be applied to similar ethical dilemmas of treatment over objection in patients lacking capacity as a result of neurologic disease.
PMCID:9647797
PMID: 36380893
ISSN: 2163-0402
CID: 5457572

Abrupt Late-onset Psychosis as a Presentation of Coronavirus 2019 Disease (COVID-19): A Longitudinal Case Report [Case Report]

Parker, Catherine; Slan, Aaron; Shalev, Daniel; Critchfield, Adam
INTRODUCTION/BACKGROUND:Coronavirus Disease 2019 (COVID-19) is a pandemic infection caused by the Severe Acute Respiratory Syndrome 2 Coronavirus (SARS-2-CoV). Although most prominently associated with pulmonary manifestations, COVID-19 is increasingly implicated in neuropsychiatric complications, including delirium and psychosis. There is a potential causal link between COVID-19 infection and psychotic symptoms; however, case reports to date have been incomplete, as the patients described had known psychiatric histories or other plausible medical causes for altered mental status. We present a longitudinal case of COVID-19 psychosis in a patient who underwent comprehensive diagnostic evaluation. This case is a contribution to the inchoate characterization of neuropsychiatric manifestations of COVID-19 infection. CASE REPORT/METHODS:We present a case of late-onset psychosis in a middle-aged man with no psychiatric history who tested positive for COVID-19 on admission following a recently resolved upper respiratory illness. His acute presentation-characterized by delusions, hallucinations, and disorganized thought and behavior, for which he required inpatient medical admission and subsequent inpatient psychiatric hospitalization-was successfully treated. During his hospitalization, he underwent comprehensive medical and neurological workup (including neuroimaging; electroencephalography; and serum and cerebrospinal fluid testing) that was grossly unremarkable. DISCUSSION/CONCLUSIONS:Despite myriad potential causes of the patient's psychosis, this patient's diagnostic workup was largely unrevealing, apart from his nasopharyngeal SARS-2-CoV reverse transcriptase polymerase chain reaction assay. As such, psychosis secondary to COVID-19 infection emerged as the presumptive diagnosis.
PMID: 33656820
ISSN: 1538-1145
CID: 5064352

Cardiovascular disorders

Chapter by: Shapiro, P; Critchfield, Adam
in: Kaplan & Sadock's comprehensive textbook of psychiatry by Sadock, Benjamin J; Sadock, Virginia A; Ruiz, Pedro (Eds)
Philadelphia : Wolters Kluwer, [2017]
pp. ?-
ISBN: 1451100477
CID: 5457602

On Psychotherapy, LGBT Identity, and Cultural Visibility: In Conversation with Alison Bechdel

Critchfield, Adam R.; Pula, Jack
ISI:000212490300005
ISSN: 1935-9705
CID: 5457582

On writing illness : how Virginia Woolf finds a new language for illness in The Voyage Out, Mrs Dalloway, and The Waves

Critchfield, Adam
ORIGINAL:0016713
ISSN: 1538-9421
CID: 5457592