Introduction: Altered mental status caused by certain acute poisonings creates barriers for effective doctor-patient communication and compromises the process of informed consent (IC) for treatment. A categorization of toxicological patients with regard to communication capacity would be helpful for practical purposes.
Aim: This article has the following aims:
Materials and Methods: A retrospective study of the medical documentation of 2088 patients with acute intoxications, treated in the Clinic of Intensive Treatment of Acute Intoxications and Toxicoallergies at Naval Hospital, Varna during the 2010–2013 period: case files, IC forms, was conducted. The R program package, version 3.4.2 (2017-09-28), was used for statistics.
Results: Toxic cerebral syndrome was found in 966 cases of acute intoxication, 46% of all patients, with especially high percentages in the medicament, alcohol, and narcotics intoxication groups. Regaining lucid mental state was observed within 1 hour in 21.9% of patients, and for the rest, it took from 2 hours to 7 days. Only 1211 patients, or 58%, signed the admission IC form themselves.
Conclusion: Characterization of acute intoxications with regard to capacity for effective doctor-patient communication is necessary because of the great percentage of patients with cerebrotoxic syndrome. Good knowledge of the specificity of toxicology patients and good communication skills of physicians can help the proper process of informed decisions of the patient.
Valkanova M. Medical law. 1st ed. Varna, Bulgaria: Steno; 2014. (in Bulgarian).
Boncheva I. Medical psychology. 1st ed. Varna, Bulgaria: Steno; 2013. p. 89–129. (in Bulgarian).
Lisaev P. Medical deontology and medical law. Sofia, Bulgaria: Medicine and physical education; 2014. p. 9–89. (in Bulgarian).
Stoev V. Clinical communication. Sofia, Bulgaria: Softtrade; 2010. (in Bulgarian).
Jonsen AR, Siegler M, Winslade WJ. Clinical ethics: a practical approach to ethical decisions in clinical medicine. Introduction. (Ebook). 8th ed. New York, USA: McGraw-Hill Education; 2015.
Lipkin Jr. M, Schoenthaler A, Mohan V. Chapter 1. The medical interview. In: Feldman MD, Christensen JF, editors. Behavioral medicine: a guide for clinical practice. (Ebook). 4th ed. New York, USA: McGraw-Hill Education; 2014.
Radanov S. Medical dеontology. Sofia, Bulgaria: Ciela; 2004. (in Bulgarian).
Eckerline CA, Shopp JD. I. Special aspects of emergency medicine. Chapter 5: Legal aspects of emergency care. Consent. In: Stone CK, Humphries RL, editors. Current diagnosis & treatment: Emergency medicine. (Ebook). 8th ed. New York, USA: McGraw Hill Education; 2017.
Barstow C, Shahan B, Roberts M. Evaluating medical decision-making capacity in practice. Am Fam Physician. 2018;98(1):40-6.
Laponis R, Feldman MD. Section I: The doctor & patient. Chapter 4. Difficult patients/difficult situations. In: Feldman MD, Christensen JM, Satterfield JM, Laponis R, editors. Behavioral medicine: a guide for clinical practice. (Ebook). 4th ed. New York, USA: McGraw-Hill Education; 2014.
Stamenova P, Milanova M. Chapter 14. Consciousness. Attention. Altered mental status. In: Milanov I, editor. Neurology. Sofia, Bulgaria: Medicine and physical education; 2012. (in Bulgarian).
Zinovieva D. Medical law. 2nd ed. Sofia, Bulgaria: Ciela; 2016. p. 138–227. (in Bulgarian).
Monov A. Altered mental status with exogenous poisonings. In: Koychev K, editor. Comatose and syncopal states. 1st ed. Sofia, Bulgaria: Medicine and physical education; 1987. (in Bulgarian).
Marinov P. Acute intoxications - a contemporary view. 1st ed. Varna, Bulgaria: Steno; 2018. (in Bulgarian).
Simon RP, Aminoff MJ, Greenberg DA. Clinical neurology. Chapter 4, Confusional states. (Internet). 10th ed. McGraw-Hill Education; 2018 (cited 2018, Jul 25).
Yovcheva M. Deontological problems of clinical toxicology in Bulgaria, connected to communication difficulties, during the decade 2000-2010. J IMAB. 2012; 18(3):308–11.
Bedi G, Cecchi GA, Slezak DF, Carrillo F, Sigman M, de Wit H. A window into the intoxicated mind? Speech as an index of psychoactive drug effects. Neuropsychopharmacology. 2014; 39(10):2340–8. doi: 10.1038/npp.2014.80.
Berent S, Albers JW. Neurobehavioral toxicology neurological and neuropsychological perspectives. Volume I: Foundations and methods. 1st ed. London, UK: Taylor & Francis; 2015.
Brust JSM. Section XVIII. Neurologic toxidromes. In: Merritt HH, Rowland LP, Louis ED, Mayer SA, editors. Merritt’s neurology. 13th ed. Philadelphia, USA: Wolters Kluwer; 2016. p. 1074–89.
Harris JB, Blain PG. Neurotoxicology: what the neurologist needs to know. J Neurol Neurosurg Psychiatry. 2004; 75(Suppl 3):iii29-34. doi: 10.1136/jnnp.2004.046318.
Popova M, Salovski P, Stoychev R, Aleksandrova M, Marev D, Ivanov D. Acute and chronic neurointoxications: clinical presentation, diagnostics, and treatment. Pleven, Bulgaria: Eurasia-Abagar; 1999. p. 6-38. (in Bulgarian).
Wachter RM, Gupta K. Understanding patient safety. Chapter 11. Other complications of healthcare. (Internet). 3rd ed. New York: McGraw-Hill Education; 2018 (cited 2018 Jul 30). Available from: http://accessmedicine.mhmedical.com/content.aspx?bookid=2203§ionid=170435458
Siff JE, Baskin BE. Section 26:Special situations. Chapter 303: Legal issues in emergency medicine. In: Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM, editors. Tintinalli’s emergency medicine: A comprehensive study guide. 8th ed. New York, USA: McGraw-Hill Education; 2015.
Mihaylova V, Liochkova M, Alakidi A, Kazandzhiev K, Shopov D. Forced interventions against persons with mental disorders - medical-legal accents. Trakia J Sci. 2018; 16(Suppl.1):110–6. doi:10.15547/tjs.2018.s.01.021.
Marco CA, Brenner JM, Kraus CK, McGrath NA, Derse AR, ACEP Ethics Committee. Refusal of emergency medical treatment: case studies and ethical foundations. Ann Emerg Med. 2017; 70(5):696–703. doi: 10.1016/j.annemergmed.2017.04.015.