Cases reported "Delirium"

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1/53. 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.
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ranking = 1
keywords = depression
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2/53. Recurring short delirium with postpartum onset in two sisters.

    We report on a 30-year-old woman who twice developed a short postpartum psychosis with organic signs, but without obvious organic cause. Extensive investigations only yielded a state of moderate hypercoagulability. Her sister had developed similar signs and symptoms during her second puerperium and died 5 days after her delivery. We discuss the combination of various precipitating factors for postpartum psychosis, the possible impact of the findings on its cause and its classification. copyright copyright 1999 S. Karger AG, Basel
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ranking = 91.879685921129
keywords = psychosis
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3/53. delirium associated with vitamin B12 deficiency after pneumonia.

    A case is presented of a 65-year-old man with chronic schizophrenia who, after four years of remission, developed psychotic symptoms after pneumonia. The patient was found to be deficient in vitamin B12. His psychosis remitted within 5 days of administration of vitamin B12 and folic acid. This case emphasizes the need to measure vitamin B12 in psychogeriatric patients, especially when they present with a severe infection and organic mental symptoms.
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ranking = 45.939842960565
keywords = psychosis
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4/53. The interaction of delirium and seizures.

    The induction of a delirium by medical illness, somatic treatments, or experimental drugs occasionally relieves psychotic, excited, and manic states. An induced delirium is a feature of modern electroconvulsive therapy (ECT), and was a feature of insulin coma therapy and psychosurgery. Case material explores the relationship between psychosis, mania, seizures, and electroencephalogram. From our understanding of the mechanism of ECT in relieving intractable status epilepticus, we suggest a hypothesis for the beneficial interaction between delirium and ECT.
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ranking = 52.34870273648
keywords = psychosis, manic
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5/53. Paradoxical lithium neurotoxicity: a report of five cases and a hypothesis about risk for neurotoxicity.

    There have been many reports of probable lithium-induced organic brain syndromes occurring when serum lithium levels are within or close to the therapeutic range. The authors report on five patients who developed clinical syndromes suggestive of severe neurotoxicity during lithium treatment. In all cases lithium levels were between .75 and 1.7 mEq/liter. The patients who developed neurotoxicity had markedly higher global ratings of psychotic symptomatology and anxiety in the pretoxic period than did patients who never deveoped neurotoxicity. When the acute manic state is characterized by marked psychotic symptoms and intense anxiety, it may be associated with increased vulnerability to the development of severe lithium neurotoxicity.
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ranking = 6.408859775915
keywords = manic
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6/53. 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.
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ranking = 229.69921480282
keywords = psychosis
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7/53. 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.
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ranking = 1
keywords = depression
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8/53. Scleroderma cerebritis, an unusual manifestation of progressive systemic sclerosis.

    A 42-year-old female with scleroderma experienced two exacerbations in which behavioral changes were the main clinical features. On both occasions she presented with paranoid delusions, perceptual aberrations, and disorientation. After treatment with corticosteroids, the patient's mental status returned to normal, and her electroencephalogram showed an increase in alpha wave frequency, which is consistent with a resolving delirium. Unlike systemic lupus erythematosus, scleroderma rarely involves the central nervous system. This case illustrates an unusual manifestation of progressive systemic sclerosis, primary cerebral involvement which presented as an acute organic brain syndrome. connective tissue diseases, notably systemic lupus erythematosus, often present neuropsychiatric symptoms. Despite the fact that there appears to be a clinical and pathological continuum among the connective tissue diseases, an organic psychosis rarely occurs in progressive systemic sclerosis (scleroderma. Described here is a patient with scleroderma in whom behavioral abnormalities were the main features of two exacerbations of the disease.
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ranking = 45.939842960565
keywords = psychosis
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9/53. 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.
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ranking = 3.2187654140952
keywords = bipolar disorder
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10/53. Delirious mania.

    OBJECTIVES: To define the characteristics of delirious mania. methods: A list of patients exhibiting both delirium and mania admitted to an academic psychiatric treatment unit of a tertiary care medical center was maintained for 6 years. A literature review for the terms 'delirium' and 'bipolar disorder' was undertaken. RESULTS: Few articles identify the syndrome. Most cite Bell (On a form of disease resembling some advanced stages of mania and fever. Am J Insanity 1849; 6: 97-127) as the first observer and Bond (Recognition of acute delirious mania. Arch Gen psychiatry 1980; 37: 553 554) as the most recent. Fourteen instances were identified in the case list. Delirious mania is a syndrome of the acute onset of the excitement, grandiosity, emotional lability, delusions, and insomnia characteristic of mania, and the disorientation and altered consciousness characteristic of delirium. Almost all patients exhibited signs of catatonia. Bond (1980) recommends lithium and a neuroleptic combination as the treatment. In the present series, electroconvulsive therapy was found to be safe and rapidly effective, with all cases responding within three treatments and requiring less than six treatments in the course. The rapidity of response is the same as that of patients with catatonia. CONCLUSION: Delirious mania warrants specific identification in the diagnostic nomenclature. The distinction between delirious mania and the excited or malignant forms of catatonia requires study.
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ranking = 3.2187654140952
keywords = bipolar disorder
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