RESUMO
Background: Irritability, impulsivity, and agitation in elderly patients with dementia are highly prevalent and extremely burdening for patients, caregivers, and medical staff. In general hospitals, they have been one of the major problems that develop and disturb care and treatment. However, the mechanisms underlying these symptoms remain unclear, and there is no established treatment. In actual clinical practice, antipsychotic drugs and mood stabilizers have been mainly used as pharmacotherapies for these symptoms, but adverse effects of these drugs have often been problematic. Case Presentation: We report two valuable cases of elderly patients who were admitted to our hospital due to physical disorders and developed irritability, impulsivity, and agitation, which were effectively treated with guanfacine at very low doses and in a short period. Conclusion: The present cases suggest that guanfacine may be a therapeutic option for treating irritability, impulsivity, and agitation in elderly patients.
RESUMO
Paroxysmal sympathetic hyperactivity (PSH) is a clinical syndrome of episodic sympathetic hyperactivities following severe acquired brain injury. It is characterized by paroxysmal hyperthermia, tachycardia, hypertension, tachypnea, excessive diaphoresis, and specific posturing. Although the persistence of PSH increases the risk of several adverse events and worsens the prognosis, pharmacological treatments for PSH have not yet been clearly established. We report the valuable case of a 60-year-old man who developed PSH following hypoxic encephalopathy, which was effectively treated with a combination therapy of gabapentin and guanfacine. The present case suggests that combination therapy with gabapentin and guanfacine may be a therapeutic option for PSH.