Phelan Maruca-Sullivan, MD, a fourth-year resident in the Yale Department of Psychiatry, is the first author of a case report about a 36-year-old man whose self-inflicted traumatic brain injury went undiscovered in the hospital emergency department for 16 hours.
The case report, "Missing the point: self-inflicted traumatic brain injury in psychosis," was published December 21 in the journal BMJ Case Reports. Maruca-Sullivan’s co-author was Matthew Goldenberg, MD, Assistant Professor of Psychiatry.
According to the paper’s summary, the man was brought to the hospital after being found acting unusually with blood on his head and clothing. “He presented acutely psychotic and reported that he had a pen in his head,” according to the paper.
Medical personnel noted the man had a superficial puncture wound to his right temple, and they cleared him for a psychiatric evaluation. Sixteen hours later the man developed nausea and a headache, and vomited once. A CT scan was ordered, and it revealed the presence of a metal pen tip lodged in the man’s brain.
He underwent a craniotomy to remove the pen, and was hospitalized for a prolonged period for psychosis, according to the paper.
“This case highlights the difficulty inherent in evaluating and treating the medical symptoms of certain psychiatric patients,” the paper states. “Physicians, especially those not trained in psychiatry, face considerable challenges in determining the reliability of information obtained from psychiatric patients. Our patient's delusional and disorganized mental status contributed to a delay in the diagnosis and treatment of a potentially life-threatening injury. The case raises important questions about how best to evaluate and assess medical symptoms by psychiatric patients.”
Read the case report here.