Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011206 (delirium)
 5,996 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The author reviews the literature reporting the untoward effects of withdrawing monoamine oxidase inhibitors (MAOIs). The withdrawal of these agents can result in severe anxiety, agitation, pressured speech, sleeplessness or drowsiness, hallucinations, delirium and paranoid psychosis. MAOI withdrawal phenomena resemble the symptoms produced by the discontinuation of chronically administered psychostimulants. The capacity of MAOI to exert amphetamine-like effects presynaptically, and the propensity of somatic treatments for depression to subsensitize presynaptic receptors regulating the release of catecholamines, can provide a basis for the development of psychotic syndromes upon the withdrawal of MAOIs. Evidence for this hypothesis is reviewed.
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PMID:Monoamine oxidase inhibitor withdrawal phenomena: symptoms and pathophysiology. 284 11

The administration of neuroleptics in the treatment of psychosis and nonspecific behavioral disorders associated with psychotic symptoms in elderly patients is not without consequences. The potential side effects (e.g., dystonia, parkinsonian syndrome, and akathisia) of medications used in treating delirium, dementia, or confusional states are discussed. General guidelines are presented regarding choice of sedatives and antipsychotics and dosage, with attention to management of the individual elderly patient with psychosis.
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PMID:Antipsychotic medication and the elderly. 285 80

Antipsychotic agents can be useful in the treatment of elderly patients who manifest psychotic signs and symptoms. Geropsychiatric disorders in which these drugs may be indicated include chronic schizophrenia persisting into late life, paraphrenia, dementia, and delirium. Unfortunately, antipsychotic drugs are more difficult to use in elderly patients than in younger psychotic patients. A clearly positive clinical response is less likely to occur in elderly patients, particularly in those who have an underlying dementia. In addition, the incidence of adverse effects in elderly patients is high. However, if these cautions are kept in mind, the clinician can select the appropriate antipsychotic based on a patient's particular medical status and, thus, reduce the patient's disability and enhance the patient's quality of life.
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PMID:Antipsychotic drugs and the elderly. 287 Oct 11

The pharmacological treatment of two female adolescent patients meeting DSM-III criteria for psychotic depression is described. A combined antipsychotic and tricyclic antidepressant regimen led to clinical remission. However, a recrudescence in both psychotic and depressive symptoms developed as plasma desipramine levels rose 4 times higher than anticipated from the oral doses prescribed. Clinical improvement occurred in both cases when plasma desipramine levels were reestablished below 200 ng/ml. Thus, we recommend prospective monitoring of desipramine plasma levels, especially when an antipsychotic agent that inhibits the metabolism of the tricyclic antidepressant is also used. We further suggest that deterioration with the reemergence of the presenting clinical syndrome, without signs of delirium, represents a distinct manifestation of antidepressant toxicity. Finally, these cases support the existence of a therapeutic upper limit for desipramine plasma concentrations, above which clinical deterioration occurs.
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PMID:Symptom exacerbation in psychotically depressed adolescents due to high desipramine plasma concentrations. 287 36

Clinical examination of 106 patients with acute alcoholic psychoses has shown a definite effect of neuroleptic therapy with phenothiazine drugs on the pathomorphosis of psychotic attacks. It has been found that the main direction of the therapeutic pathomorphosis in the studied group is the appearance in the structure of attacks of the alternately changing main forms of alcoholic psychoses-delirium, verbal hallucinosis, and paranoid, as well as an increase in the number of patients with consciousness disturbances of delirious or delirious-oneiric type by the end of the attack. Positive results of the use of eglonyl in the treatment of acute alcoholic hallucinosis are presented.
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PMID:[Effect of neuroleptic therapy on the structure of an episode in acute alcoholic psychoses]. 288 49

We report two cases of severe withdrawal symptoms after abrupt discontinuation of a long-term normal-dose benzodiazepines (BZD) administration. Case 1, a 61-year-old man, suffered from delirium on the 7th day after abrupt discontinuation of nitrazepam, 10 mg/day. Case 2, a 49-year-old woman, suffered from auditory hallucination on the 4th day and visual cognitive disorder on the 5th day after abrupt discontinuation of nitrazepam, 5 mg/day, and triazolam, 0.5 mg/day. A withdrawal syndrome after discontinuation of normal-dose BZD is uncommon, and a psychotic withdrawal reaction is even more uncommon. We show how a continuous administration of BZD for a period of longer than 6 months and the presence of severe insomnia are risk factors predictive of a psychotic reaction. We also explain the predictive method used to determine the onset time of such a severe state. In the case of a psychotic state, we recommend intravenous diazepam injection. To prevent withdrawal reaction, we also recommend a gradual reduction after administration of normal-dose BZD.
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PMID:[Two cases of psychotic state following normal-dose benzodiazepine withdrawal]. 290 78

The neurologic evaluation of an individual cardiac transplant recipient often does not lead to a succinct bedside diagnosis. There are few consistent clinical observations. The onset of seizures in the early postoperative period is associated with embolic cerebral infarction. Seizures occur most commonly, however, as a neurotoxic manifestation of cyclosporine. The onset of an acute delirium or psychosis in the first week after cardiac transplantation usually has multiple causative factors and is reversible. A postoperative brachial plexopathy or mononeuropathy can be identified with a neurologic examination, confirmed by appropriate electrophysiologic testing and is usually reversible. The onset of periorbital inflammation, ophthalmoplegia, and nasal turbinate or sinus invasion and necrosis is consistent with phycomycosis. Most patients, however, present with nonspecific findings of impaired mentation with or without focal neurologic signs. These patients require a fairly systematic search for potentially treatable neurologic complications (see Table 3). In a medically stable patient an aggressive diagnostic approach, at times including stereotaxic brain aspirate or biopsy, is indicated. In the severely ill patient with multiple organ failure, empirical therapy for the most probable treatable disorder is justified.
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PMID:Neurologic complications of cardiac transplantation. 304 45

Psychiatric symptoms attributable to vitamin B12 deficiency have been described for decades. The earlier reports are for the most part in accord with more recent ones, despite being diagnostically less specific in psychiatric and hematologic terms. These symptoms seem to fall into several clinically separate categories: slow cerebration; confusion; memory changes; delirium, with or without hallucinations and/or delusions; depression; acute psychotic states; and (more rarely) reversible manic and schizophreniform states. While there still remain abundant hematologic, psychiatric, neurologic, or nutritional reasons for obtaining a serum vitamin B12 level, its use in the investigation of the etiology of a patient's dementia seems unjustified. However, acute or subacute changes in a demented patient's mental status, specifically a clouding of their consciousness, may make such testing advisable as part of the complete workup of their delirium regardless of a normal hematologic picture.
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PMID:What are the psychiatric manifestations of vitamin B12 deficiency? 275 65

Clinical and epidemiological investigations of mentally ill patients in old and new cities of northern Tyumen Province have revealed a substantial and peculiar impact of demographic dynamics on the indices of hospital dynamics. Thus, the schizophrenia morbidity appeared more than threefold lower in fast-developing cities (Nizhnevartovsk, Surgut, Nefteiugansk) compared to the old ones (Tobolsk, Tyumen). In the former group of cities, the attack form of the disease prevailed. Characteristically, environmental factors played major role in the onset of the disease. The patients were highly adapted in social terms. Alcoholism turned malignant with adaptation disorders progressing rapidly and involving a peculiar type of anosognosia. Alcoholic delirium took shape on the background of an "incomplete" clinical picture of predisposing alcoholism. Adaptation disorders preceded the delirium in which psychotic disorders were colored psycho-organically.
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PMID:[Clinico-epidemiologic characteristics of mental diseases in one of the regions of western Siberia]. 321 21

A patient who developed neuroleptic malignant syndrome (NMS) from the use of several neuroleptic agents and the therapeutic interventions used to reverse the syndrome are described, and the clinical presentation and treatment of NMS are reviewed. Fever, leukocytosis, seizures, delirium, and elevated serum creatine phosphokinase levels developed in a 17-year-old girl who was receiving perphenazine and haloperidol. The patient was admitted to a hospital for treatment of atypical psychosis and received haloperidol and, later, thioridazine. Autonomic disturbances, altered consciousness, and muscular rigidity developed. Thioridazine was discontinued in favor of perphenazine because of anticholinergic adverse effects. Symptoms persisted despite treatment with benztropine and diphenhydramine. After the diagnosis of NMS was made, all neuroleptics were discontinued, and the patient began therapy with dantrolene sodium and bromocriptine. Dramatic improvement in the patient's condition followed. NMS has four characteristic signs: hyperthermia, muscular rigidity, altered consciousness, and autonomic dysfunction. Mechanisms believed to cause NMS include alteration of central neuoregulatory mechanisms and neuroleptic-induced imbalance between central dopaminergic and gamma-aminobutyric acid neurotransmitter systems. Bromocriptine, amantadine, dantrolene sodium, and electroconvulsive therapy have been used effectively in the treatment of NMS. NMS is a rare but potentially fatal adverse drug reaction that occurs in situations that make diagnosis difficult. Dramatic, favorable responses can be achieved with early diagnosis and appropriate treatment.
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PMID:Diagnosis and treatment of neuroleptic malignant syndrome. 324 Jun 62


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