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)

Psychiatric disorders induced by drugs are of most concern when they occur in the context of therapeutic use of a drug. Such iatrogenic psychiatric disturbances may interfere considerably with the treatment of the primary illness and may cause concern to patients, their relatives and the medical staff. Because many drugs are often used simultaneously in seriously ill patients, it may be difficult to be sure which drug may have been responsible. The best procedure is to remove those drugs which are most probable causes of the psychiatric disturbances as well as any drugs that are not truly essential for the treatment of the patient. Problems involved in evaluating the relationship between use of drugs and psychiatric disorders are considerable. Many reports are isolated cases and the denominators which might provide some idea of the potential risk are unknown. Many relationships are still controversial, such as the association of depression with sedatives, antihypertensives and oral contraceptives. Areas of uncertainty are great. Psychomotor impairment may be caused by a drug that can alter consciousness, or any drugs that can produce more delineated psychiatric syndromes. Sedative drugs are those most commonly associated with psychomotor impairment, and may include psychotherapeutic drugs, sedative antihistamines, narcotic analgesics and, of course, the widely used social drug, alcohol. Delirious states are most often associated with drugs that possess central anticholinergic actions. These include not only drugs clearly identified as anticholinergics, but also tricyclic antidepressants and anti-Parkinson drugs. Cimetidine, which is often used parenterally in seriously ill patients, is also a prominent cause. Delirium is most often seen in elderly patients and in those who have received rather large doses of drugs. The association of schizophrenic-like psychoses with dopaminomimetic drugs tends to support the prevailing dopamine hypothesis of schizophrenia. Levodopa, the dopamine precursor, and bromocriptine, a direct dopamine agonist, are examples of such relationships. Abuse of social drugs has also been thought to provide a useful model of schizophrenia. Hallucinogens are probably a rather poor model, abuse of amphetamines may provide a better model, and possibly the best is the psychotic state elicited by phencyclidine. Manic reactions are clinically difficult to differentiate from schizophrenic-like psychoses and are often produced by similar drugs. Corticosteroids may produce either manic or schizophrenic-like disorders, as well as occasionally confusion and depression.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Drug-induced psychiatric disorders and their management. 354 May 20

The rapid diagnosis and immediate intervention required in patients with serious drug overdose or poisoning makes toxicological screening of limited value to the emergency department physician. Instead, a careful clinical evaluation using the history, physical examination, and the more readily available laboratory tests may allow a tentative diagnosis and the initiation of life-saving treatment. Laboratory tests should include serum osmolality, electrolytes, glucose, BUN and an estimation of the anion and osmolar gaps. The ECG can also provide useful information. Clinical findings of important include altered blood pressure, pulse, respiration and body temperature, the presence of coma, agitation, delirium or psychosis, and muscular weakness. An ophthalmological examination is also of importance in the acutely poisoned patient. Oral burns or dysphagia may occur following ingestion of any strongly reactive substance, but the absence of oral burns does not preclude the possibility of oesophageal or stomach injury. Odours and skin colour may also contribute to the diagnosis. Comprehensive toxicology screening may not be immediately available, or may be inaccurate, thus adding little to the information obtained during the initial evaluation of the poisoned patient.
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PMID:Physical assessment and differential diagnosis of the poisoned patient. 354 6

A 53-year-old man with a 3-month addiction to approximately 5 mg/day of triazolam experienced psychosis and delirium following relatively abrupt withdrawal from the drug. In contrast to a previous report suggesting that triazolobenzodiazepine withdrawal may not respond to replacement doses of other benzodiazepines, this patient's withdrawal syndrome was effectively treated with lorazepam.
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PMID:A case of psychosis and delirium following withdrawal from triazolam. 355 32

Of 104 patients treated in a psychiatric hospital because of mental disturbances caused by an infection, almost one-half had been referred directly to the psychiatric hospital on account of their psychically abnormal behaviour. The infectious disease causing these disturbances was diagnosed only after their admission. In most of the cases the psychic abnormalities did not seem to be due to a physical cause, so that the somatic examination was frequently delayed. Pneumonic infections were most frequently seen, but there were also numerous other infections from all other disciplines of medicine. Clouding of consciousness developed rapidly in 84% of the patients during the course of inpatient treatment with an incidence that was almost fivefold that of the initial stage. Visual hallucinations (37%) were the most frequent productive-psychotic phenomenon. 45% of the patients presented with a delirious pattern and 4% with a psychosis resembling schizophrenia. In 35% of the patients treatment with psychotropic drugs proved necessary, whereas with the remaining 65% therapy remained antibiotic or generally somatic only. 18% of the patients died.
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PMID:[Infection-caused mental disorders. Are they still topical in the antibiotic era?]. 356 70

Sixty-three patients with the typical variant of delirium tremens were examined. The results showed a marked reduction (by 8.7 times) in levels of coenzyme A (CoA) in leukocytes, which was indicative of deficiency of the coenzymic form of pantothenic acid (PA). Changes in CoA concentrations in leukocytes observed at the height of psychosis in patients with alcoholic delirium as compared to other parameters of PA metabolism have great significance for the assessment of vitamin metabolism. PA deficiency was more expressed in cases of long-standing and massive alcoholization which induces an earlier development of psychosis. CoA levels in leukocytes may be used as a parameter of detoxication processes in patients with delirium tremens. The data obtained are considered as indication for administration of PA drugs in combined detoxifying therapy of alcoholic psychoses.
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PMID:[Decrease in the concentration of leukocyte acetylation coenzyme associated with vitamin precursor deficiency in patients with alcoholic delirium]. 357 15

The clinical structure of mental disorders was studied by quantitative analysis techniques in 353 patients with exogenous organic diseases of the brain. The author identified the leading psychoorganic syndrome, as well as mental disorders of psychotic, hypopsychotic and neurotic levels. Disturbances of psychotic and hypopsychotic levels were subdivided into ones that were more characteristic of organic brain lesion (epileptic, psychosensory and affective) and those less typical of such lesion (hallucinatory delirious, hypochondriac and obsessive). The clinical structure is presented graphically.
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PMID:[Structure of mental disorders of exogenous-organic etiology]. 357 34

Using clinical, biographic and social parameters the authors analyzed the results of long-term observation on a group of patients (n = 450) with epilepsy accompanied by psychotic disturbances. Prognostic signs of a favourable variant included the predominance of homogeneous attacks and an affective structure of psychotic disorders. In cases with a moderately severe variant paroxysmal manifestations were presented by an array of temporal and unfolded convulsive forms. Psychotic disorders of the hallucinatory-delirious type serve as signs of a late exacerbation of the epileptic process. An unfavourable variant was characterized by polymorphic attacks with predominance of postural and psychomotor components, frequent states of decompensation, an increase in signs of epileptic dementia and a wide spectrum of psychotic disturbances, ranging from overworship ideas to affective-delirious and catatonic-delirious psychoses.
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PMID:[Psychoses and dementia in epilepsy (clinical picture, syndromokinesis, prognosis)]. 363 Apr 88

The assessment of suicide risk is a central activity of the general hospital psychiatrist for patients admitted following a suicide attempt and others who are identified after admission as being potentially suicidal. While biologic and psychosocial measures have some long-term predictive value, there is no valid measure to predict acute suicide risk. The lack of a valid measure does not, however, relieve the clinician of the obligation to perform an appropriate assessment. Pertinent appellate case law decisions not that the evaluation and record keeping must be "adequate," though no definition for adequate standards is provided. This paper presents issues that are considered so fundamental for suicide assessment that failure to obtain and record such information would potentially constitute inadequate practice. These areas include: the patient's statement regarding current suicidal ideation and planning, the presence or absence of delirium, psychosis and depression, what the patient says it makes sense to do, confirmation by a third party, and global formulation. The guidelines in this paper are presented with the intention of establishing the basis for optimal clinical care and for minimizing legal vulnerability in the evaluation of the potentially suicidal patient in the general hospital.
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PMID:The assessment of suicide risk in the general hospital. 369 51

Out of 908 patients with sepsis treated at the Republican Antisepsis Center, 19 presented with different schizophrenia syndromes (2 with acute delirium, 3 with encephalic manifestations, 3 with the amentive-catatonic form, the remainder with the amentive-depressive form). In 6 patients, psychic disorders preceded fever, in 3 patients, both conditions occurred simultaneously, and 9 developed psychosis in the presence of fever. In all the patients, with the exception of one, the diagnosis of sepsis was supported by repeated isolation of hecocultures of S. epidermidis (14 cases) and S. aureus (4 cases). The patients received antisepsis treatment. Two patients died and the rest 17 patients were cured of sepsis. The schizophrenic syndrome disappeared. No relapses were recorded with the exception of one female patient, in whom both sepsis and psychic disorders recurred. Later on, however, she also recovered.
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PMID:[Schizophrenia syndromes caused by infection]. 371 38

All 150 psychiatric consultations performed upon patients hospitalized on the Surgery service at The Johns Hopkins Hospital during a period of two years were studied with particular attention to delirium which was found in 20.7 per cent of the patients. Delirium was the most common psychosis in elderly and postoperative patients. Mood disturbance was the most common reason given for request for psychiatric consultation (39.3 per cent). Delirium was diagnosed in 26.3 per cent of those patients. Delirium is a common syndrome and presents as altered consciousness with cognitive impairment. It is often not appreciated by the surgeon because of the impressive nature of associated symptoms which might be given undue emphasis. Assessment of consciousness and cognitive function should be performed promptly whenever psychiatric disorders are suspected.
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PMID:Delirium in surgical patients seen at psychiatric consultation. 373 7


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