A prospective, open-label, flexible-dose study of quetiapine in the treatment of delirium.
ABSTRACT Delirium is an organic psychiatric syndrome characterized by fluctuating consciousness and impaired cognitive functioning. High-potency typical neuroleptics have traditionally been used as first-line drugs in the treatment of delirium. However, these drugs are frequently associated with undesirable adverse events including extrapyramidal symptoms (EPS). The purpose of the present open-label, flexible-dose study was to provide preliminary data on the usefulness and safety of quetiapine for patients with delirium.
Twelve patients with DSM-IV delirium were treated with flexible doses of open-label quetiapine (mean +/- SD dosage = 44.9 +/- 31.0 mg/day). To evaluate the usefulness and safety of quetiapine, scores from the Delirium Rating Scale, Japanese version, were assessed every day (for 1 outpatient, at least twice per week), and scores from the Mini-Mental State Examination, Japanese version, and the Drug-Induced Extrapyramidal Symptom Scale were assessed at baseline and after remission of delirium. Data were gathered from April to October 2001.
All patients achieved remission of delirium several days after starting quetiapine (mean +/- SD duration until remission = 4.8 +/- 3.5 days). Quetiapine treatment was well tolerated, and no clinically relevant change in EPS was detected.
Quetiapine may be a useful alternative to conventional neuroleptics in the treatment of delirium due to its rapid onset and relative lack of adverse events. Further double-blind, placebo-controlled studies are warranted.
Full-textDOI: · Available from: Takeshi Inoue, May 28, 2015
SourceAvailable from: Hyung-Jun Yoon
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ABSTRACT: Since the 1999 publication of the APA's Practice Guideline for the Treatment of Patients With Delirium (1), advances in the clinical neurosciences and other areas have contributed to the un-derstanding of delirium and have expanded options for its management. This guideline watch summarizes important elements of the incremental progress in this area. DETECTION The 1999 guideline noted that the presence of delirium is frequently undetected by clinicians until psychiatric consultation is obtained, often triggered by dangerous behaviors. In the years since 1999, many papers providing easily remembered strategies for clinical detection and man-agement of delirium have been published, not only in the psychiatric literature but also in journals that focus on critical care, pain management, oncology, medical-surgical nursing, substance abuse, and geriatric medicine. Despite this broadening literature base, it has been noted that many cases of delirium continue to be missed (2). Reasons for this underrecognition are varied but may include the absence of routine, systematic screening (3). Improved attention to and recognition of delirium should be motivated by its clinical importance (e.g., association with elevated mortality ). One step toward improved detection may be the use of instruments that have demonstrated sensitivity to the presence of delirium. Examples include the Delirium Rating Scale—Revised– 98 (5, 6), including a version for use with children (7); the Delirium Observation Screening Scale (8); and the Confusion Assessment Method for the Intensive Care Unit (9–11). Instru-ments have variable concordance with the diagnostic criteria detailed in DSM-IV, and each in-strument may be better suited to particular clinical contexts. The American Psychiatric Association (APA) practice guidelines are developed by expert work groups using an explicit methodology that includes rigorous review of available evidence, broad peer review of iterative drafts, and formal approval by the APA Assembly and Board of Trustees. APA practice guidelines are intended to assist psychiatrists in clinical decision making. They are not intended to be a standard of care. The ultimate judgment regarding a particular clinical procedure or treatment plan must be made by the psychiatrist in light of the clinical data presented by the patient and the diagnostic and treatment options available. Guideline watches summarize significant developments in practice since publication of an APA practice guideline. Watches may be authored and reviewed by experts associated with the original guideline development effort and are approved for publication by APA's Executive Committee on Practice Guidelines. Thus, watches represent opinion of the authors and approval of the Executive Committee but not policy of the APA.
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ABSTRACT: Quetiapine is regarded as an effective and safe treatment for delirium. An 82-year-old man presented with a 1-week history of violent behavior and dizziness accompanied by weakness on the left side of his body. He was diagnosed with acute cerebral cortical infarction and delirium associated with alcohol abuse. After quetiapine treatment, he complained of fever and coughed up sputum, whereas his aggressive behavior improved. His symptoms persisted despite empirical antibiotic treatment. All diagnostic tests for infectious causes were negative. High-resolution computed tomography revealed bilateral consolidations and ground-glass opacities with predominantly peribronchial and subpleural distributions. The primary differential diagnosis was drug-associated interstitial lung disease, and therefore, we discontinued quetiapine and began methylprednisolone treatment. His symptoms and radiologic findings significantly improved after receiving steroid therapy. We propose that clinicians need to be aware of the possibility that quetiapine is associated with lung injury.04/2014; 59(10). DOI:10.4187/respcare.02977