1/31. Postoperative delirium indicating an adverse drug interaction involving the selective serotonin reuptake inhibitor, paroxetine?We report a postoperative delirium expressed by a 49-year-old female patient during recovery from anaesthesia. Prominent features of the delirium, which lasted for nearly 2 days, included agitation, confusion, uncontrolled limb movements, abnormal ocular function, hypertension, pyrexia, brisk reflexes, ankle clonus and raised creatine kinase. The delirium did not respond to naloxone, diazepam or flumazenil. The patient had not been prescribed neuroleptics but, before surgery, she had been taking the selective serotonin reuptake inhibitor, paroxetine, to relieve her depression. During surgery, she was given morphine, which increases release of the neurotransmitter, serotonin, and ondansetron, which blunts neuronal release of dopamine. Although there is no clear explanation for the delirium, it had many features in common with problems associated with paroxetine withdrawal, the serotonin syndrome and the malignant neuroleptic syndrome. We offer several alternative explanations for this event, all of which rest on disruption of serotonergic and/or dopaminergic transmission and which could also involve inhibition by paroxetine of the P450 enzyme, CYP2D6, which metabolizes ondansetron.- - - - - - - - - - ranking = 1keywords = confusion (Clic here for more details about this article) |
2/31. Non-convulsive status epilepticus with marked neuropsychiatric manifestations and MRI changes after treatment of hypercalcaemia.We describe a 77-year-old woman who developed a confusional state, cognitive impairment, behavioural abnormalities and dysphasia after treatment of hypercalcaemia. Repeated EEG recording revealed rhythmic sharp-wave activity over the right parietal-occipital lobe. magnetic resonance imaging (MRI) showed marked hyperintense signal changes bilaterally. The diagnosis of a non-convulsive status epilepticus (NCSE) was made. With antiepileptic treatment the patient improved and MRI as well as EEG changes were almost all reversible. NCSE is an important differential diagnosis of patients with neuropsychiatric symptoms and can develop after rapid lowering of serum calcium levels in hypercalcaemia.- - - - - - - - - - ranking = 462.48381375575keywords = confusional state, confusion (Clic here for more details about this article) |
3/31. Can delirium relieve psychosis?A delirium presages a poor prognosis in hospitalized patients, but an incidental delirium is a feature of some psychiatric treatments. We report five cases in which delirium preceded the relief of affective and psychotic symptoms of a major mental illness. The experience stimulated a review of the literature on delirium in psychiatric treatments. Five inpatients (aged 53 to 69 years) with an exacerbation of chronic mental illness developed deliria from medications (n = 4) and electrolyte disturbance (n = 1). The deliria were managed with medication washout or correction of electrolyte imbalance. The progress of the patients was noted clinically and summarized. The clinical signs of delirium such as confusion, disorganized speech, sleep-wake cycle changes, and hallucinations persisted for 24 to 72 hours. As the delirium cleared, psychotic and affective symptoms improved or resolved. The improvements persisted for 1 to 5 months, with low doses of medications in two of the cases. A delirium may precede clinical improvement in affective and psychotic symptoms. Historically, some treatments for mental illness induce an incidental delirium (e.g., electroconvulsive therapy [ECT] and insulin coma). Why a delirium should presage a beneficial effect on psychosis is unclear, but the emergence of delirium may herald a beneficial pathophysiology.- - - - - - - - - - ranking = 1keywords = confusion (Clic here for more details about this article) |
4/31. The many faces of confusion. Timing and collateral history often hold the key to diagnosis.Recognition of a patient's state of confusion is only the beginning of a clinical odyssey that can implicate a huge spectrum of diagnostic possibilities. Among these are delirium, depression, dementia, and sensory deprivation. However, with appropriate physical examination and laboratory studies, collateral history, and clarification of time course for the symptom complex, the cause of confusion need not remain confusing.- - - - - - - - - - ranking = 6keywords = confusion (Clic here for more details about this article) |
5/31. disulfiram-ethanol induced delirium.OBJECTIVE: To report a case of delirium, without major autonomic symptoms, as the primary manifestation of concomitant use of alcohol while taking disulfiram. CASE SUMMARY: A 50-year-old white woman with a history of bipolar disorder, type I, and alcohol dependence being treated with disulfiram was admitted to an inpatient psychiatric unit with a three- to four-day history of a change in mental status, including deficits in orientation, concentration, and visual hallucinations. Significant finding on review of systems included the spurious report of a 9.1-kg weight loss. tachycardia and nonfocal neurologic signs on physical examination were also noted. Extensive metabolic, infectious, and neurologic work-up revealed no abnormalities that alone could explain the patient's acute confusional state. It was subsequently discovered that the patient had imbibed alcohol on at least two separate occasions while taking disulfiram prior to her change in mental status and that a similar, although shorter, experience had occurred previously. DISCUSSION: This is the first case, to the authors' knowledge, that describes an acute confusional state as the primary manifestation of a patient taking alcohol while being prescribed disulfiram as aversive therapy for alcohol abuse. Possible pathophysiologic mechanisms for delirium as a complication of alcohol ingestion while taking disulfiram include disturbances in various neuroendocrine axes, neurotransmitter systems, and metabolic derangements. Other reports of possible neuropsychiatric complications of disulfiram therapy are also reviewed. CONCLUSIONS: The differential diagnosis for the presentation of delirium in a patient known to be undergoing aversive therapy for alcohol dependence with disulfiram should include nonadherence to alcohol abstinence.- - - - - - - - - - ranking = 924.9676275115keywords = confusional state, confusion (Clic here for more details about this article) |
6/31. Delirious mania in the elderly.Delirious mania is a clinical syndrome in which the signs and symptoms of delirium manifest themselves in the context of a manic episode. Though there have been numerous descriptions and case reports of this syndrome, all have described mania as the presenting feature, with signs of delirium developing subsequently, and none of the vignettes have involved elderly patients. We report two cases of elderly individuals with mania who initially presented as in a delirium. Both of them experienced clear manic episodes, which were confirmed by their psychiatric histories and clinical responses to mood stabilizers. Mania needs to be in the differential diagnosis of elderly people presenting with confusion, disorientation, and perceptual changes, particularly in those with a history of bipolar disorder.- - - - - - - - - - ranking = 1keywords = confusion (Clic here for more details about this article) |
7/31. Subjective experience of a confusional state.BACKGROUND: Confusional states associated with medical and surgical conditions require more study and biochemical explanation. AIMS: To understand impairment of consciousness, cognition and memory. METHOD: A psychiatrist reports experience of his changing mental state over 5 days from notes made immediately on recovery. RESULTS: A prodromal phase of declining consciousness, understanding and memory registration over perhaps 48 h was difficult to detect. During unconsciousness there were four brief partial reversals with arousal, and some mental functioning (memory, formation of beliefs) occurred. CONCLUSIONS; Self-report can be a useful addition in clinical study, and patients with renal failure require psychological and psychiatric study. Comparison with the mental effects of benzodiazepine or of an anaesthetic such as nitrous oxide might throw light on the pathology.- - - - - - - - - - ranking = 1849.935255023keywords = confusional state, confusion (Clic here for more details about this article) |
8/31. Possible ergotamine-caffeine-associated delirium.An elderly patient with a history of chronic migraine was hospitalized with systolic hypertension and significant mental status changes, including increasing confusion, combative behavior, and remarkably detailed auditory hallucinations of several weeks' duration. Daily increased consumption of a product containing ergotamine 1 mg and caffeine 100 mg coincided with both onset and increasing severity of symptoms. To our knowledge, this is the first case reported in the contemporary literature of severe mental status changes and hallucination possibly due to ergotamine-caffeine.- - - - - - - - - - ranking = 1keywords = confusion (Clic here for more details about this article) |
9/31. melatonin for treatment and prevention of postoperative delirium.Postoperative delirium is a common problem associated with increased morbidity and mortality, prolonged hospital stay, additional tests and consultations and therefore, increased cost (1,2). The reported incidence of delirium or confusion after surgery ranges from 8% to 78% (2,3-5), depending on methods and population studied. The elderly seem to be at significantly increased risk for this complication. Sleep-wake cycle disruption has been associated with delirium and behavioral changes (5) and sleep deprivation can even result in psychosis (6). Environmental changes (i.e., hospital stay), medications, and general anesthesia can affect the sleep-wake cycle (3,4). plasma melatonin levels, which play an important role in the regulation of the sleep-wake cycle, are decreased after surgery (18) and in hospitalized patients (7,11). We report the successful use of melatonin in treating severe postoperative delirium unresponsive to antipsychotics or benzodiazepines in one patient. In another patient with a history of postoperative delirium, melatonin was used to prevent another episode of delirium after repeat lower extremity surgery. IMPLICATIONS: Postoperative delirium or confusion after surgery is a common problem associated with complications and death. delirium has been linked to sleep-wake cycle disruption. melatonin levels, which play an important role in regulating the sleep-wake cycle, are decreased after surgery. Two cases are presented where melatonin was used to treat and prevent postoperative delirium.- - - - - - - - - - ranking = 2keywords = confusion (Clic here for more details about this article) |
10/31. delirium at high altitude.A 35-year-old man on a trek to the Mount Everest region of nepal presented with a sudden, acute confusional state at an altitude of about 5000 m. Although described at higher altitudes, delirium presenting alone has not been documented at 5000 m or at lower high altitudes. The differential diagnosis which includes acute mountain sickness and high altitude cerebral edema is discussed. Finally, the importance of travelling with a reliable partner and using proper insurance is emphasized in treks to the Himalayas.- - - - - - - - - - ranking = 462.48381375575keywords = confusional state, confusion (Clic here for more details about this article) |
| | Next -> |