The Characteristics and Symptomatological Evaluation of Hyperventilation Syndrome in Critical Care Settings

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  • 救急医療における過換気症候群の特性と精神症状評価

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An association between hyperventilation syndrome (HVS) and mental disorders have not been well characterized in emergency settings. We reviewed the percentage, backgrounds, and psychiatric symptoms with HVS seen at a critical care center and addressed the role of psychiatrists. The study subjects included 116 patients with HVS presenting to an advanced medical emergency and critical care center in I prefecture between April 1, 2002 and August 31, 2003. On admission, 26 patients with a past history of psychiatric disease and 39 patients without were examined for psychiatric symptoms by psychiatrists. The number of visits by male and female patients with HVS accounted for 0.7% and 4.6% of the total visits at the critical care center, respectively. In both sexes, HVS occurred most frequently in individuals aged 20 to 29 years. More than half of the patients received a primary diagnosis of mental disorder according to the International Statistical Classification of Diseases and Related Health Problems, Ninth Revision (ICD-9). All patients with a past history of psychiatric disease and 64% of patients without had a score of 70 or lower on the Global Assessment Scale, indicating decreased activity of daily living associated with psychiatric symptoms. On the Brief Psychiatric Rating Scale, mild to severe symptoms of somatic concern, anxiety, tension, and/or depression were observed in at least 50% of the patients with a past history of psychiatric disease, while mild to severe symptoms of anxiety and/or depression were noted in more than half of the patients without. Also, 69% of the patients with a past history and 31% of those without had depression as evidenced by a total score of 16 or higher on the 17-item Hamilton Rating Scale for Depression. In addition to HVS, stress related disorders were diagnosed in approximately 40% of patients with or without a past history on average, mood disorder in approximately 20% of patients in both groups, and panic disorder in 8% of those in both groups when patients were examined for psychiatric disorders on the basis of ICD-10. These results showed that patients with HVS represented a substantial part of emergency outpatients and had psychiatrically characteristic manifestations including anxiety and significant depression. In conclusion, medical care of patients with HVS at emergency and critical care centers requires stress management as well as early identification and treatment of depression. For this purpose, psychiatric specialists should preferably be involved in medical care from the first presentation.

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