Delirium medical

Antipsychotic medications are indicated in the treatment of acute and chronic psychotic disorders. These include schizophrenia, schizoaffective disorder, and manic states occurring as part of a bipolar disorder or schizoaffective disorder. The co-adminstration of antipsychotic medication with antidepressants has also been shown to increase the remission rate of severe depressive episodes that are accompanied by psychotic symptoms. Antipsychotic medications are frequently used in the management of agitation associated with delirium, dementia, and toxic effects of both prescribed medications (e.g. L-dopa used in Parkinson s disease) and illicit dtugs (e.g. cocaine, amphetamines, andPCP). They are also indicated in the management of tics that result from Gilles de la Tourette s syndrome, and widely used to control the motor and behavioural manifestations of Huntington s disease. 

C. The symptoms are not due to a general medical condition (e.g., anatomical lesions and infections of the brain, visual epilepsies) and are not better accounted for by another mental disorder (e.g., delirium, dementia. Schizophrenia) or hypnopompic hallucinations. 

Other sedative-hypnotic medications, such as barbiturates, may play a useful role in severe withdrawal from this group of drugs. For example, in a case series of GBL withdrawal, use of intravenous pentobarbital in the range of 1-2 mg/kg/hour lowered the total requirement for intravenous lorazepam (Sivilotti et al. 2001). Antipsychotic medications are often used to reduce psychotic agitation. However, because antipsychotic medications lower the seizure threshold and may contribute to loss of central control of temperature leading to hyperthermia or neuroleptic malignant syndrome (NMS), they are not indicated as first-line medications for GHB withdrawal delirium (Dyer and Roth 2001 McDaniel and Miotto 2001 Sharma et al. 2001). If anti-... 

Phencyclidine (PCP) abuse remains a serious public health problem in large urban areas of the United States, with recent trends suggesting increased use after a period of decline (Crider, this volume). Most clinical and research attention has focused on the psychiatric and medical manifestations of acute or subacute PCP intoxication, especially the organic mental disorders (toxic delirium, psychosis, or depression) that PCP can induce (McCarron et al. 1981 McCarron, this volume Sioris and Krenzelok 1978). 

Uncomplicated, with delirium, with delusions, and with depressed mood Dementia due to HIV disease Dementia due to head trauma Dementia due to Parkinson s disease Dementia due to Huntington s disease Dementia due to Pick s disease Dementia due to Creutzfeldt-Jakob disease Dementia due to a specific general medical condition (specify) Dementia that is substance-induced Dementia due to multiple etiologies Dementia not otherwise specified... 

Delirium is characterized by a disturbance of consciousness and a change in cognition that develops over a short period of time, usually hours or days. The course can fluctuate over the course of the day, usually worsening in the evening. Underlying medical problems such as urinary tract infections in the elderly, substance abuse, or withdrawal symptoms in adults may precipitate delirium.1... 

Information about prescription drag use alcohol or other substance use family medical history and history of trauma, depression, or head injury should be obtained. It is important to rule out medication use as a contributor or cause of symptoms (e.g., anticholinergics, sedatives, hypnotics, opioids, antipsychotics, and anticonvulsants) as contributors to dementia symptoms. Other medications may contribute to delirium, e.g.,... 

Delirium is an acute disorder that affects cognition and attention. Delirium or confusion is more frequent in advanced age. The incidence also increases with high number of medications, frailty, comobirdity and previous cognitive impairment. 

Dementia may be hard to differ from delirium (Table 6.1). The most important tool is a thorough medical history. Dementia has a slow progress whereas delirium is characterised by a rapid change in cognitive functions. Depression and anxiety could be mistaken for delirium, but the impaired consciousness in delirium sets it apart from affective disorders. 

Medications may be necessary for patients with delirium especially in patients with severe behavioural disturbances and agitation. Any medications used may however be hazardous and actually lengthen the condition. A continuous reassessment of the need for theses kind of drugs should be done. Antipsychotic drugs may be needed especially if vision hallucinations and agitated behaviour are predominant. Short-acting benzodiazepines may be used for a limited time. There is no... 

Memantine is approved for treatment of moderate to severe Alzheimer s disease. It is an antagonist at glutamatergic NMDA-receptors. Memantine is well tolerated and has a small beneficial effect at six months in moderate to severe AD (McShane et al. 2006). For patients with dementia one has to be careful wit all kind of medications that may affect the central nervous system. Delirium and hallucinations are common adverse effects in patients with dementia. Agitation may be due to delirium and external causes should be ruled out before adding another psychoactive drug. Sleep disturbance is common in demented elderly patients. Sleep deprivation may in a patient with dementia induce delirium. Nonpharmacological treatment for delirium or hallucinations should be considered first. 

Groleau G (1994) Lithium toxicity. Emerg Med Clin North Am 12 (2) 511-531 Han L, McCusker J, Cole M et al. (2001) Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. Arch Intern Med 161 (8) 1099-1105... 

Korevaar JC, van Munster BC, de Rooij SE (2005) Risk factors for delirium in acutely admitted elderly patients a prospective cohort study. BMC Geriatr 5 6 Kudoh A, Takase H, Takahira Y et al. (2004) Postoperative confusion increases in elderly longterm benzodiazepine users. Anesth Analg 99 (6) 1674-1678 McCusker J, Cole M, Dendukuri N et al. (2001) Delirium in older medical inpatients and subsequent cognitive and functional status a prospective study. Cmaj 165 (5) 575-583 McCusker J, Cole M, Dendukuri N et al. (2003) The course of delirium in older medical inpatients a prospective study. J Gen Intern Med 18 (9) 696-704 McShane R, Areosa Sastre A, Minakaran N (2006) Memantine for dementia. Cochrane Database Syst Rev 19 (2) CD003154... 

Saravay SM, Kaplowitz M, Kurek J et al. (2004) How do delirium and dementia increase length of stay of elderly general medical inpatients Psychosomatics 45 (3) 235-242... 

In general, however, very little is permanently remembered for more than a few hours after recovery, which no doubt accounts for the commonly held medical belief that delirium is characterized by subsequent amnesia... ... 

Speech is slurred, the voice develops a monotonous nasal sound, and its volume wanes to an almost inaudible level. This period of incoherent mumbling is sometimes referred to in older medical literature as mussitant delirium (mumbling delirium). 

Surprisingly, it appeared that there had been hardly any therapeutic progress in the management of belladonna poisoning since the 19 century, when opium was the most commonly used treatment. The first six decades of the 20 century spawned many new drugs, but no one seemed to have reported anything good for atropine delirium in mainstream medical journals. 

I can almost hear some of the musings of the unbelievers After all, this study was done by psychiatrists. Who knows, maybe they absent-mindedly moved the decimal points. In any case, the new treatment method did not make it into mainstream American psychiatry, much less general medical practice. Nor did the good news that physostigmine was an effective antidote for atropine delirium. (Incidentally, I met Forrer s colleague. Dr. Miller, in 1981, 30 years after their first publications about atropine coma therapy. He was invited to... 

Delirium. Delirium is an abrupt change in mental status often accompanied by agitation and seemingly psychotic symptoms that may resemble mania. Unlike mania, however, delirium is commonly characterized by a fluctuating level of consciousness and disorientation. The chief precipitants of delirium include infections, medications, and metabolic disturbances. Therefore, all patients who present in an acutely agitated state should undergo a comprehensive yet expeditious medical evaluation to rule out potential causes of delirium. This evaluation must include a thorough physical examination and a battery of laboratory tests. 

The mental status examination remains an essential part of the evaluation. Often patients with schizophrenia will appear nnkempt or otherwise oddly dressed. Sometimes they will be friendly and affable, but when they are paranoid, they can be angry and hostile. Patients may have odd stereotypical movements that can become extreme in catatonic states. The patient with schizophrenia is usually quite alert and well oriented to his/her surroundings. This observation helps to distinguish the psychosis of schizophrenia from that of a delirium due to a medical illness or substance use. 

In addition to this partial listing, a wide assortment of medical illnesses can produce a state of delirium, which though distinct from psychotic illnesses often does manifest certain psychotic symptoms like hallucinations and paranoia. 

Delirium. Closely related to the previous disorders is delirium, which includes both psychosis and a fluctuating level of consciousness. The fluctuating sensorium is the key to distinguishing delirium from other causes of psychosis. Medical illnesses or drugs cause delirium it is a medical emergency that requires prompt medical treatment. 

---