Adverse drug event delirium

Skeletal and respiratory muscle weakness Cardiorespiratory deconditioning Nosocomial infections Malnutrition Decubitus wounds Adverse drug events Fatigue Dyspnea Anxiety Delirium Depression Sleep deprivation Cognitive dysfunction Impaired communication Loss of control... 

It is important to be aware of possible adverse drug withdrawal events (ADWE). These events may be caused by physiological withdrawal reaction, but it is also possible that the underlying disease is worsened. An example of ADWE is delirium or seizures that may occur after abrupt discontinuing of benzodiazepines or alcohol. 

Given an inadequate drug response, or in patients with manic delirium who pose an immediate risk to themselves or others, we would consider ECT. Although BILAT stimulus electrode placement may be more effective than unilateral (UND) placement, this conclusion is currently only tentative, given the small number of patients studied. Finally, the combined use of ECT plus an antipsychotic may benefit the most treatment-resistant patient and has not been reported to induce serious adverse events (303, 304, 305 and 306). 

Several cases of torsade de pointes have been reported with intravenous haloperidol used with lorazepam to treat delirium (SEDA-18, 30) (SEDA-18, 47). Acid mucopolysaccharide deposition may be associated with neuroleptic drug treatment as a possible mechanism contributing to rare cardiovascular adverse events (57). 

Drug administration route Postinjection delirium/sedation syndrome is a serious adverse event that has been associated with olanzapine pamoate [78 ]. 

Four SGA long-acting injections are currently available risperidone microspheres, olanzapine pamoate, paliperidone palmitate and aripiprazole extended-release injection. The extended-release characteristics are achieved differently with each drug. A case analysis of clinical frials with olanzapine pamoate (2000-2008) reported an occurrence of postinjection delirium/sedation syndrome in approximately 0.07% of injections or 1.4% of patients [78 ]. A review of the published literature and clinical trial databases for olanzapine pamoate, risperidone microspheres and paliperidone palmitate found only one other case of postinjection delirium/sedation syndrome occurring in a patienf on placebo in a paliperidone palmitate trial. In four randomised, double-blind, placebo-controlled trials of paliperidone palmitate, the most common treatment-emergent adverse event was somnolence/sedation overall treatment discontinuation rates due to adverse events were similar to placebo. 

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