Little is known about its effects on pregnancy. The objective of this study was to evaluate the pregnancy outcomes in women suffering from EDS. STUDY DESIGN: We conducted a population-based, retrospective cohort study using the United States' Health Care Cost and Utilization Project's Nationwide Inpatient Sample to evaluate pregnancy outcomes in women with EDS, compared to those without EDS, delivering between 1999 and 2013. We used unconditional regression analysis, adjusted for maternal age and race, to compare maternal and fetal outcomes among pregnancies in women with and without EDS. RESULTS: Of the total 13,881,592 births in our cohort, 910 deliveries were to women with EDS. Women with EDS were more likely to be Caucasian, earn a higher income, and smoke. Births to women with EDS were more likely to be premature (OR 1.51 (95% CI 1.20-1.89)). Pregnancies complicated by EDS were more likely to be associated with cervical incompetence (OR 3.22 (95% CI 2.04-5.07)), antepartum hemorrhage (OR 1.79 (95% CI 1.20-2.66)) and placenta previa (OR 2.23 (95% CI 1.29-3.86)). Pregnant women with EDS were also more likely to be delivered by cesarean section (OR 1.61 (95% CI 1.41-1.85)), as well as stay longer than 7 days in the hospital (OR 3.10 (95% CI 2.34-4.09)). CONCLUSION: Pregnant women with EDS are at higher risk of antepartum hemorrhage, placenta previa, cervical incompetence and preterm birth, as well as delivering by cesarean section, when compared to women without EDS. These risks should be taken into consideration and cervical surveillance should be considered.

TO THE EDITOR: Postictal psychosis (PIP) is defined as development of psychosis (eg, presence of hallucinations, bizarre behavior) within 7 days of seizure activity; it represents approximately 25% of the psychosis of the epilepsy population. 1,2 Appropriate seizure control remains the best method to prevent PIP; however, refractory patients may require pharmacotherapy with antipsychotics. We present the first known case of a patient who developed PIP and was successfully treated with quetiapine.Case Report. A 36-year-old white male with no previous history of mental illness or PIP presented to the psychiatric emergency department with altered mental status (ie, psychosis) following several seizures with no loss of consciousness over the past few days. His past medical history was significant for partial and generalized seizures occurring 3-4 times a month since the age of 12 years. Past medications were phenytoin and topiramate. Current medications included oxcarbazepine 300 mg twice daily for 1 month and zonisamide 100 mg once daily for an unknown duration. The patient's symptoms were sphincter relaxation and screaming prior to his seizure. Upon admission, his confusion persisted, with a waxing and waning of auditory and visual hallucinations and verbal aggression. Results of a head computed tomography scan performed on the day of admission were negative; drug screen urinalysis was negative for illegal substances.The patient was hospitalized for 9 days. Quetiapine 25 mg twice daily was initiated on day 2 of his admission and increased to 50 mg twice daily on day 4. The reason for selecting quetiapine initially was due to the patient's concurrent complaints of difficulty sleeping and presence of psychotic symptoms. Oxcarbazepine 300 mg twice daily and zonisamide 200 mg twice daily were continued for seizure control. He remained seizure free throughout his admission. Upon discharge, he was calm and denied any auditory or visual hallucinations.The patient was readmitted 6 weeks later with similar psychotic symptoms and was discharged after 4 days with a resolution of psychosis. It is uncertain whether he had been adherent to quetiapine prior to his second admission. Discharge medications during his second admission were oxcarbazepine 300 mg twice daily; clorazepate 3.75 mg, onehalf tablet at night; zonisamide 200 mg twice daily; and quetiapine, which was increased from 100 mg/day from the previous admission to 200 mg/day. Based on personal communication with the caregiver 7 months after the second admission, the patient continued to take quetiapine 200 mg/day, had not experienced any psychotic symptoms, and had not been hospitalized .Discussion. Currently, no studies using quetiapine in this population are known. A comprehensive review evaluated drugs or nonpharmacologic interventions used in patients with PIP. 3 Only one abstract, which described a randomized controlled trial, met the criteria for inclusion in the above study. 4 This study compared olanzapine 10 mg/day with haloperidol 12 mg/day in 16 adults with...

Background Patients with substance use disorders (SUD), specifically opioid use disorder (OUD) and injection drug use (IDU) utilize healthcare resources for prolonged inpatient treatment of serious infections stemming from their addictions. For a variety of reasons, physicians treating these patients refuse to send these patients home to receive outpatient parenteral antimicrobial therapy (OPAT), and instead keep the patient in the hospital for several weeks or longer to complete treatment for the injection-related infections. Patients who do not have history of IDU are sent home with a PICC line to receive OPAT once they are no longer acutely ill and therefore no longer meet criteria to remain inpatient, which is the established standard of care. Patients with OUD and IDU are not allowed the same standard of care, and furthermore do not receive adequate, if any, therapy for their primary problem and reason for their serious infection – the addiction. Flow chart of the MAT-OPAT process Methods Medication-assisted treatment (MAT) with buprenorphine-naloxone has been approved for treating adults with opioid use disorder as part of a comprehensive treatment program that also includes counseling and behavioral therapy. Until now in our healthcare system there has been no comprehensive and integrated program to safely discharge patients with OUD and IDU to receive OPAT via a PICC line, while simultaneously treating their addiction. We describe the implementation of a MAT-OPAT program. Please refer to the chart included. Results We present a successful case of a 36-year-old male with a history of endocarditis associated with IV drug use and the intervention of the Healthcare System to link the patient to appropriate Infectious disease, behavioral health and medication adherence treatment for opioid abuse. The patient completed the IV antibiotic therapy and remained enrolled in the behavioral health program with a successful outcome. Conclusion MAT-OPAT implementation in large healthcare system with continuous outpatient support that includes Infectious Disease services, behavioral health and drug abuse rehabilitation therapy can be a successful strategy to minimize readmisión, cost and complications in patients with history of IV drug use and infections that require prolonged intravenous antibiotic therapy. Disclosures All Authors: No reported disclosures

Background. Butalbital-containing combination (BCC) analgesics have the potential for the development of tolerance and dependence. Misuse and withdrawal of these agents should be considered in patients presenting with new-onset psychosis. This case highlights how butalbital withdrawal may be missed in the emergency department setting and underscores how early identification may affect management and prognosis. Case Presentation. A 40-year-old female with a history of migraine, depression, and anxiety presented to the emergency department (ED) with new-onset psychosis following a recent seizure-like episode. At home, the patient was prescribed butalbital-acetaminophen-caffeine (Fioricet), duloxetine, alprazolam, and zolpidem for these conditions. On arrival to the ED, the patient was disoriented and appeared to be responding to internal stimuli. Following initial medical evaluation, the patient was cleared for further psychiatric assessment, during which she developed acute-onset autonomic instability while waiting for a bed on the inpatient psychiatric unit. She then became agitated, requiring multiple emergency medications, and eventually required emergent intubation and was admitted to the intensive care unit (ICU). Following extubation, a psychiatric consultation was performed. On assessment, the patient was alert and oriented and no longer exhibited psychotic symptoms. She admitted to using butalbital-acetaminophen-caffeine (Fioricet) daily for the past 10 years and had recently run out of her prescribed medication. She acknowledged that she was taking more than prescribed and requested substance use treatment resources, for which she was subsequently discharged to an inpatient drug rehabilitation facility. Conclusions. Given the time constraints inherent to the ED setting, a complete substance use history (both illicit and prescribed) may be challenging to obtain. However, it remains critical for providers to identify patients at risk for life-threatening withdrawal from sedative, hypnotics, and anxiolytic agents.