RESUMO
In this case report we describe a life-threatening episode of delirium in a 51-year-old man. The condition was triggered by an abrupt withdrawal of benzodiazepines. The patient had been taking multiple sedatives for several years but a large proportion of the drugs were not available in Denmark. His general practitioner substituted and prescribed oxazepam and zolpidem for ten days. Afterwards the patient did not have access to benzodiazepines and developed a severe benzodiazepine withdrawal delirium. He was treated with diazepam and olanzapine with gradual dose reduction.
Assuntos
Delirium por Abstinência Alcoólica , Delírio , Síndrome de Abstinência a Substâncias , Delirium por Abstinência Alcoólica/tratamento farmacológico , Benzodiazepinas/efeitos adversos , Delírio/induzido quimicamente , Delírio/tratamento farmacológico , Diazepam/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Oxazepam/uso terapêutico , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Síndrome de Abstinência a Substâncias/etiologiaRESUMO
BACKGROUND: Despite concerns about rising treatment of psychiatric patients with psychotropic medications and declining treatment with psychotherapy, actual treatment profiles of psychiatric patients are largely unknown. AIMS: To describe patterns in the treatment of patients in a large psychiatric university hospital department. METHODS: A descriptive mapping of treatment of in- and outpatients in a psychiatric department at Aarhus University Hospital Risskov, Denmark. Information was collected by healthcare staff using a 25-item survey form. The p-value was calculated with a chi-squared test and p < 0.05 was considered significant. The study was preceded by a pilot study on 41 patients. RESULTS: Over a 1 month period, a total of 343 consecutive patients were assessed and hereof 200 were included in the age range 18-90 years (mean 53.76); 86 men and 114 women. One-hundred and eighty-eight patients (94%) used psychotropic medication, 37 (19%) as monotherapy, and 148 (74%) in combination with non-pharmacological therapy. Ninety-seven (49%) had psychotherapy and 104 (52%) social support. Among inpatients, 21 (64%) had physical therapy, and 10 (30%) electroconvulsive therapy. In total, 163 (82%) had non-pharmacological therapy. Fifty-two (26%) patients had monotherapy, and 148 (74%) polytherapy. Mean number of treatment modalities used per patient was 2.07 for all patients and 3.23 for inpatients. CONCLUSIONS: In this department, polytherapy including non-pharmacological modalities is applied widely across all settings and patient categories. However, psychotropic medication clearly dominates as the most frequently applied treatment.
Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais Universitários , Transtornos Mentais/terapia , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada/estatística & dados numéricos , Dinamarca , Eletroconvulsoterapia/estatística & dados numéricos , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Modalidades de Fisioterapia/estatística & dados numéricos , Projetos Piloto , Psicoterapia/estatística & dados numéricos , Psicotrópicos/uso terapêutico , Apoio Social , Adulto JovemRESUMO
Traditionally, haloperidol has been the recommended antipsychotic drug for pharmacological treatment of delirium, which is a frequent complication in the critical care setting. Due to a less frequent occurrence of extrapyramidal adverse effects, second-generation antipsychotic drugs have been evaluated. In the present paper we review the current randomized prospective studies of second-generation antipsychotics as treatment for delirium in hospitalized patients and conclude that so far the evidence in favour of these drugs compared with haloperidol is still sparse.
Assuntos
Antipsicóticos/uso terapêutico , Delírio/tratamento farmacológico , Amissulprida , Benzodiazepinas/uso terapêutico , Medicina Baseada em Evidências , Humanos , Olanzapina , Piperazinas/uso terapêutico , Fumarato de Quetiapina/uso terapêutico , Risperidona/uso terapêutico , Sulpirida/análogos & derivados , Sulpirida/uso terapêutico , Tiazóis/uso terapêuticoRESUMO
Traditionally, haloperidol has been the recommended antipsychotic drug for pharmacological treatment of delirium, which is a frequent complication in the critical care setting. Due to a less frequent occurrence of extrapyramidal adverse effects, second-generation antipsychotic drugs have been evaluated. In the present paper we review the current randomized prospective studies of second-generation antipsychotics as treatment for delirium in hospitalized patients and conclude that so far the evidence in favour of these drugs compared with haloperidol is still sparse.