1/18. torsades de pointes secondary to intravenous haloperidol after coronary bypass grafting surgery.PURPOSE: Postoperative delirium occurs in about 2% of patients undergoing major cardiac surgery including coronary artery bypass grafting surgery (CABG). haloperidol (Sabex, Boucherville, canada) is a drug commonly used in the intensive care unit for the treatment of delirium and is usually considered safe even at high doses and is rarely implicated in the development of malignant ventricular arrhythmias such as torsades de pointes. The purpose of this study is to report such a complication of use of haloperidol after myocardial revascularization. CLINICAL FEATURES: The patient reported underwent uneventful triple bypass surgery. Administration of large intravenous doses of haloperidol was necessary for control of psychomotor agitation due to delirium. torsades de pointes occurred in the absence of QT prolongation on the third postoperative day following use of the drug with no other obvious etiological factor. CONCLUSION: awareness of this rare complication is key to judicious use of this drug in the post CABG patient in whom such an arrhythmia may have very deleterious consequences because of the underlying cardiac condition.- - - - - - - - - - ranking = 1keywords = delirium (Clic here for more details about this article) |
2/18. 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 = delirium (Clic here for more details about this article) |
3/18. Alcohol withdrawal as an underrated cause of agitated delirium and terminal restlessness in patients with advanced malignancy.A significant number of patients with terminal cancer experience terminal restlessness or an agitated delirium in the final days of life. Multifactorial etiologies may contribute to agitation and restlessness for any one patient; alcohol withdrawal may be underrated as a contributing factor. The symptoms and signs of alcohol withdrawal--autonomic dysfunction, tremor, anxiety, sleep disturbances, insomnia, and abnormal vital signs--may continue for 6 to 12 months after the cessation of alcohol. We report four patients with terminal restlessness in whom we believe alcohol withdrawal to be a significant causal factor and a fifth patient who subsequently benefited from our team's increased awareness of this clinical problem. Formal assessment of alcohol withdrawal may be of more value in the palliative setting than using the currently accepted assessment instruments. Many of the medications utilized for the treatment of agitated delirium and terminal restlessness in the palliative care setting are effective therapies for alcohol withdrawal.- - - - - - - - - - ranking = 2keywords = delirium (Clic here for more details about this article) |
4/18. Adjunctive valproic acid for delirium and/or agitation on a consultation-liaison service: a report of six cases.The authors present six cases in which valproate was used in patients seen by a consultation-liaison service (CLS) to manage delirium and/or psychotic agitation. The intravenous (IV) preparation (Depacon, Abbott laboratories) was used in two nothing by mouth (NPO) patients, while the liquid oral preparation (Depakene, Abbott laboratories) was used via nasogastric tube (NGT) in the other patients. All of these cases had suboptimal responses and/or concerning side effects from conventional therapy with benzodiazepines and/or antipsychotics. In all six cases, the CLS use of valproic acid combined with conventional antidelirium medications resulted in improved control of behavioral symptoms without significant side effects from valproic acid. Consultation-liaison psychiatrists should consider the addition of valproic acid to control behavioral symptoms of delirium when conventional therapy is inadequate. This may be especially advisable when problematic side effects result from more conventional psychopharmacological management. Specifically, intravenous valproate sodium may be a viable option for NPO patients.- - - - - - - - - - ranking = 2.3333333333333keywords = delirium (Clic here for more details about this article) |
5/18. Acute respiratory failure with a single dose of quetiapine fumarate.OBJECTIVE: To report a case of acute respiratory failure after a single dose of quetiapine fumarate in an elderly patient with a history of chronic obstructive pulmonary disease (COPD). CASE SUMMARY: A 92-year-old woman with a history of COPD was admitted to the hospital with pneumonia. Her symptoms improved with antibiotics. Because of acute agitation and delirium, quetiapine 50 mg twice daily was started. After receiving the first dose, the woman developed acute respiratory failure and severe central nervous system depression. She required mechanical ventilation and supportive care in the intensive care unit (ICU). She had a full recovery within 24 hours. DISCUSSION: Quetiapine is an atypical antipsychotic that has been used successfully for the treatment of schizophrenia and bipolar disorder for many years. Recently, it has also been used to treat delirium and agitation. It has proven to be very safe, even in the elderly. In previously reported cases, serious adverse effects were seen in patients who ingested very high doses of quetiapine. Those patients required intubation and supportive care in the ICU. To our knowledge, as of January 19, 2006, this is the first case report of acute respiratory failure of such severity with one dose of quetiapine. Using the Naranjo probability scale, we conclude that the acute respiratory failure observed in this patient was probably related to quetiapine. CONCLUSIONS: This case suggests that quetiapine can have significant adverse effects even with a single 50 mg dose. Elderly patients, especially those with significant underlying pulmonary pathology, should be monitored closely when started on this medication.- - - - - - - - - - ranking = 0.66666666666667keywords = delirium (Clic here for more details about this article) |
6/18. The management of agitation in demented patients with propranolol.Congress and the FDA have strongly suggested that tranquilizers and antipsychotics not be used in agitated demented frail elderly patients. The medical profession has not moved away from the tradition of antipsychotic sedation of such patients. Use of 'modern second generation low dose' antipsychotics continue to be the standard of care. propranolol, a non-selective beta-blocker with good penetration of the CNS, is a reasonable and safe alternative to sedatives and antipsychotics. Anti-dementia drugs are complementary to propranolol. A case study which contrasts the two pharmacologic approaches is detailed. A method of estimating delirium-agitation risk in dementia patients (DRN method) is described.- - - - - - - - - - ranking = 0.33333333333333keywords = delirium (Clic here for more details about this article) |
7/18. delirium during intravenous sedation with midazolam alone and with propofol in dental treatment.A 62-year-old man visited our clinic for dental implantation under intravenous sedation. He demonstrated increased psychomotor activity and incomprehensible verbal contact during intravenous sedation. Although delirium caused by midazolam or propofol in different patients has been reported, the present case represents a delirium that developed from both drugs in the same patient, possibly because of the patient's smaller tolerance to midazolam and propofol.- - - - - - - - - - ranking = 0.66666666666667keywords = delirium (Clic here for more details about this article) |
8/18. Post-triathalon delirium.This is a case presentation of acute delirium in a previously healthy man. It was originally discussed during morbidity and mortality Conference at The George washington, Georgetown Residency Program in emergency medicine, December 1989.- - - - - - - - - - ranking = 1.6666666666667keywords = delirium (Clic here for more details about this article) |
9/18. Slow progressive bilateral posterior artery infarction presenting as agitated delirium, complicated with Anton's syndrome.Three patients presented with an acute agitated delirium as the earliest sign of bilateral posterior cerebral artery infarction. All patients showed a unique slow progressive deterioration with a remarkably long interval between the first neuropsychological and subsequent visual and neurological symptoms, ranging from 3 to 30 days. Repeated CT scans demonstrated hypodensities in the posterior artery territory only after a long interval of 9-12 days, in case 3, and between 33 and 48 days in case 2. In the latter case MRI was still negative 33 days after onset. In 2 patients the cortical blindness was complicated with anosognosia for blindness. Clinical condition worsened progressively in all patients, leading to death, probably due to brainstem infarction. In all 3, the combination of clinical and radiological findings indicated a 'top of the basilar' distribution, which could be confirmed in two by autopsy.- - - - - - - - - - ranking = 1.6666666666667keywords = delirium (Clic here for more details about this article) |
10/18. Treatment of severe, refractory agitation with a haloperidol drip.A case of agitated delirium secondary to bilateral occipital cerebral infarctions in a cancer patient was refractory to trials of large doses of intravenous psychotropic agents, but continuous intravenous infusion of haloperidol controlled agitation rapidly and safely. A total haloperidol dose of 600 mg/day was used without complications. haloperidol by continuous infusion should be considered in the management of severe, refractory agitation in patients who are medically ill.- - - - - - - - - - ranking = 0.33333333333333keywords = delirium (Clic here for more details about this article) |
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