Delirium anxiolytics

Glassification of Substance-Related Disorders. The DSM-IV classification system (1) divides substance-related disorders into two categories (/) substance use disorders, ie, abuse and dependence and (2) substance-induced disorders, intoxication, withdrawal, delirium, persisting dementia, persisting amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorder. The different classes of substances addressed herein are alcohol, amphetamines, caffeine, caimabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, hypnotics or anxiolytics, polysubstance, and others. On the basis of their significant socioeconomic impact, alcohol, nicotine, cocaine, and opioids have been selected for discussion herein. 

Antipsychotics are drugs that have a specific sedative effect, and which improve the attitude and calm the behavior of psychotic patients. They do not cause dependence, and have been proposed for treating psychotic disorders (elimination of psychotic symptomatology— delirium, hallucinations) and schizophrenic patients. Drugs of this group are also frequently referred to as neuroleptics. The term major tranquilizer was used previously to distinguish them from minor tranquilizers/anxiolytics. 

Delirium during emergence from sevoflurane anesthesia has often been documented. Four patients, an adult and three children aged 3-8 years, who were able to recount the experience, have been reported (599). They had full recall of postoperative events, were terrified, agitated, and distressed, and hence presented with acute organic mental state dysfunction which was short-lived. Two were disoriented and had paranoid ideation. They were not in any pain or were not distressed by pain if it was present. The authors hypothesized that misperception of environmental stimuli associated with sevoflurane s particular mode of action may have been the underlying cause of this phenomenon. Anxiolytic premedication and effective analgesia did not necessarily prevent the problem. 

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