The bridge player—a brief acute psychotic episode in an elderly man due to playing computer games
✍ Scribed by Elizabeta B. Mukaetova-Ladinska; Clare Lawton
- Publisher
- John Wiley and Sons
- Year
- 1999
- Tongue
- English
- Weight
- 49 KB
- Volume
- 14
- Category
- Article
- ISSN
- 0885-6230
No coin nor oath required. For personal study only.
✦ Synopsis
A 70-year-old passionate bridge player, with no previous psychiatric history and apparently physically well, was urgently assessed in Accident and Emergency Department due to altered behaviour. He has been playing bridge on his computer continuously for 36 hours, taking only a limited amount of liquid (0.35 l) and a snack. He was found at his home the following day, constantly washing his hands, with pressure of speech. He believed everybody was going to die, that he was already dead and that there was no blood left in him. He was seen by his GP, who administered sedatives, but his condition remained unchanged. Eighteen hours later, he was assessed in the A&E Department of the local hospital and agreed to undergo inpatient psychiatric treatment.
On admission, he was mentally and physically overactive. He had no involuntary movements and no clouding of consciousness. He was fully oriented in time, place and person, with hypervigility of concentration, ¯ight of ideas and persistent multiple delusions of being immortal and on top of the world. He had no hallucinatory experiences.
Physical examination, including temperature and ECG, was normal, except for hypertension (162/128 mmHg) and tachycardia (110/min). There were no focal neurological signs and symptoms. Blood electrolyte results and LFTs showed physiological values (sodium 141 mmol/l, potassium 3.9 mmol/l, glucose 6.4 mmol/l, urea 3.1 mmol/l, creatinine 45 mmol/l, albumin 37 g/l, calcium 2.41 mmol/l, total bilirubin 11 mmol/l, ALT 30 U/l). There was an increase in urine ketons and CRP (14 mg/l).
On admission, he was incontinent of urine and was drinking liquid excessively. He was treated with thioridazine 25 mg tds. Within 12 hours of admission his aect and speech were normal.