International psychogeriatrics
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Review Case Reports
Benzodiazepine-induced and anticholinergic-induced delirium in the elderly.
Encompassing the range from subtle cognitive impairments to frank delirium, toxicity due to benzodiazepines and to anticholinergic-containing compounds is reviewed. For benzodiazepines, an extensive literature suggests that they impair immediate and delayed memory, psychomotor performance, and subjective complaints of station. ⋯ Toxicity from anticholinergic compounds, detected by anticholinergic drug levels, is significantly correlated with the presence and severity of delirium in a number of settings including postoperative patients and elderly nursing home residents. Possible means of identifying the syndrome by prediction of dose and type of medication, as well as by quantitative EEG, are reviewed.
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Delirium is the second most common psychiatric diagnosis among hospitalized elderly cancer patients. A variety of factors are known to cause delirium in cancer patients, and the most frequently observed are outlined. ⋯ Haloperidol is the most commonly prescribed drug for delirium in the cancer setting because of its low cardiovascular and anticholinergic effects. Cancer patients who are debilitated require a much lower starting dose than do the physically healthy.
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Postoperative delirium is a common syndrome that is often mistaken for other psychiatric conditions, particularly depression. Numerous investigators have found a clear convincing association between delirium and increased morbidity and mortality. ⋯ Lastly, areas demanding immediate further investigation are identified. In particular, outcome studies with particular emphasis on the role of age and prior drug exposure are urgently needed.
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This paper reviews the historical development of the American Psychiatric Association's Diagnostic and Statistical Manual. It presents some of the issues that the clinician has found difficult in applying DSM-III and DSM-III-R criteria for delirium. In addition it introduces some options for DSM-IV criteria for delirium based on several empirical studies. These options should be studied and debated carefully over the next year because in part, they represent radical departures from existing diagnostic criteria for delirium.
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Comparative Study
The concept of delirium in German-speaking psychiatry.