![]() ![]() In an updated meta-analysis of antipsychotic treatment in patients with delirium the authors identified 15 studies for the systematic review (total n=949 patients, amisulpride=20, aripiprazole=8, chlorpromazine=13, haloperidol=316, intramuscular olanzapine or haloperidol injection=62, olanzapine=144, quetiapine=125, risperidone=124 and ziprasidone=32). British guidelines by the “National Institute for Health and Clinical Excellence” advise 2010 haloperidol or olanzapine. Evidence is weaker for the atypical antipsychotics, but their use is controversial. Reversible acetylcholinesterase inhibitor agents such as physostigmine can be used as an antidote in life-threatening cases of an anticholinergic delirium.Īntipsychotics, particularly haloperidol, are the most commonly used drugs for delirium and the most studied. For example: the specific treatment options of autoimmune encephalitis are corticosteroids. ![]() The treatment for delirium with medications depends on its cause therapy should be initiated promptly. Treatment of delirium involves two main strategies: first, treatment of the underlying presumed acute cause or causes, secondly, optimizing conditions with adequate oxygenation and hydration. Drug-induced delirium is a common matter in the elderly, and anticholinergics, together with a number of different drugs, may significantly contribute to the delirium onset, especially in demented people. In addition, the authors should mention that an unexplained delirium can be associated with an autoimmune encephalitis (diffuse or localized as in limbic, brainstem, or basal ganglia) or with anticholinergic drug-induced problems. However, if delirium is due to benzodiazepine withdrawal there are other consequences. Benzodiazepines themselves can cause delirium or worsen it. Sometimes it`s complicated to differentiate, especially with benzodiazepines (paradox reaction, intoxication or withdrawal). I think the authors should add exactly these underlying diseases - for example alcohol dependence and the withdrawal complications, drugs administered during treatment of a disease or withdrawal from drugs. Delirium is not a disease, but a set of symptoms. The understanding of the underlying pathophysiologic mechanisms remains limited. It`s excellent that the authors described the different categories of behavior with hypoactive, hyperactive or mixed subtypes and the different core features of delirium, because delirium is a common yet underdiagnosed syndrome of acute brain dysfunction the prevalence increases with age especially among hospitalized elderly persons. In the past years there has been a shift from several medical definitions to the definition of a delirium as an organically caused acute confusional state (ICD-10, DSM-IV, and DSM- 5). Delirium is one of the oldest forms of disorder in Psychopathology and Psychiatry (described by Hippocrates). ![]()
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