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Query: UMLS:C0011206 (delirium)
 5,996 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Delirium is a frequently encountered clinical syndrome which can pose serious problems for the physician and patient. Numerous etiological possibilities exist, and each case is usually associated with multiple causal factors. Although the pathophysiology is poorly understood, the clinical presentation is marked either by stupor and hypoarousal or agitation and hyperarousal. Both types of delirium must be treated by searching for and correcting reversible causative factors. In addition, medication may be quite efficacious in managing the clinical aspects of agitated delirium. Most cases of agitated delirium are either of the "sensory overload" or "sensory deprivation" type. The drug treatment of each is discussed with reference to their respective central nervous system physiological correlates.
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PMID:Treatment of delirium--a reappraisal. 3 37

In the course of 3 years we observed a considerable improvement of herpes zoster in 44 patients being treated with amantadine. The periods of pain and efflorescence were shortened to 1/3 of the values usually experienced and painful post-zoster complications did not occur. The therapeutic effect depends on a) beginning treatment with high doses as early as possible, b) combination of local and systemic administration of adamantine, c) continuation of treatment for several weeks with gradually reducing doses. Harmless side-effects which are easily controlled are dryness of mouth, slight fall in blood pressure and insignificant general stimulation. In old people half the standard dose should be given in the beginning and particular attention paid to symptoms of restlessness on account of a possible delirium. Severe disorders of renal function are a contraindication.
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PMID:[Improvement of zoster therapy by adamantine]. 30 38

Severe alcohol withdrawal developed in an abstinent chronic alcoholic man. Massive doses of benzodiazepines (2,335 mg of diazepam intravenously, 21,225 mg of oxazepam orally) achieved only marginal control of delirium and agitation. Analysis of multiple blood samples drawn during and after the withdrawal episode indicated, as expected, very high concentrations of diazepam and metabolites and of oxazepam. There was no evidence of an abnormal pharmacokinetic profile. Benzodiazepine resistance in withdrawing alcoholics probably reflects a receptor-site phenomenon rather than an abnormal drug disposition.
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PMID:Massive benzodiazepine requirements during acute alcohol withdrawal. 44 69

The emergency management of the agitated patient is a common medical problem. Agitated behavior is not a diagnosis but a descriptive term; the initial task of the physician involves determining the etiology of the behavioral disturbance and evaluating the possible contribution of organic factors. Such factors as age of onset, acuteness of onset, concurrent illness, evidence of delirium or dementia, or use of exogenous pharmacologic agents require careful evaluation. Agitated patients will generally fall into one of four diagnostic categories: agitation precipitated by drug intoxication, agitation precipitated by drug withdrawal, agitation precipitated by an organic brain syndrome, or agitation precipitated by a functional disorder. Appropriate pharmacological and psychological management techniques for these situations are discussed.
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PMID:The agitated patient. 45 96

Three patients presented with sudden visual impairment followed by agitated delirium one to three days later. Examination revealed marked agitation, dementia, and loss of vision. Computerised axial tomography demonstrated temporo-occipital infarctions. All recovered from the agitated state in four days to two months, but their visual impairment and dementia persisted one to four years later.
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PMID:Syndrome of agitated delirium and visual impairment: a manifestation of medial temporo-occipital infarction. 59 62

Digitalis is a ubiquitous drug in modern clinical medicine and digitoxicity is one of the more common iatrogenic disorders. Psychiatric problems are often overlooked as manifestations of digitalis excess and may range from mild disorientation, lethargy, or restlessness to full blown delirium. In this paper we discuss two patients who presented to a psychiatric inpatient unit and were later found to be digitoxic. Psychiatrists are advised to consider digitalis as a possible cause of mental abnormalities and are reminded that psychiatric signs may be the first indication of a potentially lethal drug toxicity. Psychiatric patients may also be at special risk for the development of digitoxicity because of erratic drug taking, electrolyte imbalance or increased autonomic tone.
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PMID:Digitalis delirium: psychiatric considerations. 70 Sep 28

The authors warn physicians that intoxication by Angel's Trumpet (Datura sauveolens) is becoming more frequent due to its use by adolescents and young adults as a legal, readily available hallucinogen. Ingestion of Angel's Trumpet flowers or a tea brewed from them results in an alkaloid-induced central nervous system anticholinergic syndrome characterized by symptoms such as fever, delirium, hallucinations, agitation, and persistent memory disturbances. Severe intoxication may cause flaccid paralysis, convulsions, and death. Treatment with intravenous physostigmine reverses the toxic effects of Angel's Trumpet.
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PMID:Angel's Trumpet psychosis: a central nervous system anticholinergic syndrome. 84 11

In 70 patients (maxillo-facial-, neurosurgical-, abdominal- and gynaecological operations) the technique of "analgetic anaesthesia" using high doses of fentanyl (0.025 mg/kg body weight) and naloxone as its antagonist (0.02 mg/kg body weight) has been employed. All patients were artificially ventilated with N2O/O2 in a 3:1 ratio. Muscle relaxation was achieved with pancuronium-bromide (0.08 mg/kg). The patients had no apparent heart or lung disease. The youngest patient was 4 years of age, the oldest 82 years of age (average age 48.9). The necessity for a reinjection of fentanyl (half the initial dose) was determined by continously monitoring heart rate. This variable appeared to be the most subtle index indicating a reduction in analgesia. Sufficient analgesia was maintained once the heart rate stayed 20% below preanaesthetic levels. At the end of the operation naloxone reversed the respiratory depression. There was no evidence indicating postoperative pain, which may have required administration of additional analgesics. If deep analgesia was maintained up to the last surgical procedures no emesis appeared in the post operative period. The incidence of emesis was higher 10% compared to the classical neuroleptanalgesia with droperidol this was often noted in cases where blood accumulated in the stomach (maxillo-facial operations) (70%). In 3% of all cases psychomotor agitation with delirium appeared right after the injection of naloxone. This lasted for about 15 minutes. We suspect that due to the sudden and powerful effect of naxolone, in replacing fentanyl from its receptor site, acute withdrawal symptoms may be precipitated.
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PMID:[High doses of fentanyl as the sole anaesthetic agent and naloxone as its antagonist (author's transl)]. 113 60

The authors report a case of delirium tremens in a 9-year-old American Indian boy, who was later found to have been drinking steadily for 3 years prior to his emergency admission for agitation and delirium. The authors suggest that the use of alcohol by children is an activity that may be more common than most physicians realize.
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PMID:Delirium tremens in a nine-year-old child. 116

Antidepressant withdrawal symptoms, following abrupt or gradual discontinuation of antidepressants, include general somatic distress (flu-like syndromes, gastro-intestinal disturbances, myalgias, headache, chills, weakness and rhinorrhea), anxiety, agitation, sleep disturbances, movement disorders, cardiac arrhythmias, delirium and manic reactions. Two cases of delirium, an hypomanic reaction and two general distress and movement disorders are reported. Cases 1 and 2 required admission to a general hospital. The etiology of the delirium was difficult to assess as long as the clinicians did not know that patients were taking antidepressants. Case 3 corresponds to the paradoxical activation following antidepressant interruption. Cases 4 and 5 constitutes light withdrawal syndromes. Most of cases are probably unrecognized. These cases reflect the importance in daily practice of the phenomena. It can be concluded from our study that: antidepressants must not be abruptly discontinued when a somatic disease appears. When a patient treated with a psychotropic drug develops delirium, the withdrawal of antidepressant must be suspected and the prescribing physician contacted to know what kind of psychoactive medication was prescribed.
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PMID:[Withdrawal syndrome from antidepressive drugs. Report of 5 cases]. 129 96


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