Iatrogenic Complications of Compulsory Treatment in a Patient Presenting with an Emotionally Unstable Personality Disorder and Self-Harm

Table 1

Summary of interventions and complications during the acute hospital admission. There were at least 17 episodes of physical restraint, with nine requiring rapid tranquillisation and four requiring intubation and admission to ICU.

Day	Intervention and treatment	Complications or unintended consequences
1	Restraint, rapid tranquillisation, high-dose antipsychotics and benzodiazepines (above British National Formulary (BNF) maximum dose); Dressed wounds	Transfer to ICU for intensive monitoring
2	Restraint, rapid tranquillisation, above BNF maximum dose antipsychotics and benzodiazepines
3		Clinical deterioration and signs of neuroleptic malignant syndrome (NMS) were noted, with temperature of 40.6°C and creatinine kinase (CK) units/L
5	Restraint and sedation with midazolam and propofol; PICC line insertion
12		Clostridium difficile diarrhoea, acute kidney injury
13	Nasogastric (NG) tube
23	Restraint and rapid tranquillisation twice	Sepsis, acute kidney injury, possible neuroleptic malignant syndrome
27		methicillin-resistant Staphylococcus aureus (MRSA) septicaemia confirmed
35	Restraint and rapid tranquillisation followed by sedation and intubation; Wound debrided	Left internal jugular vein thrombus
48	Tracheostomy	Left lower lobe collapse, pneumothorax
50		Superior ventricular tachycardia, septic shock secondary to chest infection
52	Bronchoscopy	Hypotension unresponsive to inotropes, anaemia, blood transfusion
53	Active cooling, continuous veno-venous hemodiafiltration (CVVHDF)	Patient reports memories of waking up during active cooling, nightmares of being covered with ice
55		Klebsiella sepsis, ongoing renal failure, herpes simplex virus (HSV) isolated from bronchoscopy
62		Pulmonary embolus and pulmonary infarction, right heart strain
71		Fungal septicaemia
94	Restrained and sedated
99	Subcutaneous fluids, NG feeding, catheterisation, redetention under S3 MHA
103	2 : 1 observations	Urinary tract infection
108	Restraint and rapid tranquillisation twice
116	Restrained and rapid tranquillisation failed, reintubation and transfer to ICU; Arterial and central venous line inserted
120	Restraint, mitts and splints put on patient to prevent self-harm	Stridor requiring adrenaline and nebulisers
123	Restrained and sedated
128	Transferred to specialist unit

ICU: intensive care unit.