Psychosomatics
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Delirium is an organic psychiatric syndrome characterized by fluctuating consciousness and impaired cognitive functioning. Eleven delirious patients were treated with olanzapine (dosage mean +/- standard deviation [SD]: 8.2 +/- 3.4 mg qhs), and 11 delirious control patients were treated with haloperidol (dosage mean +/- SD: 5.1 +/- 3.5 mg qhs). ⋯ Five of the 11 olanzapine patients showed significant improvement (> 50% score reduction) on the Delirium Rating Scale (DRS) and no patients had side effects, whereas 6 of the 11 control subjects showed improvement on the DRS and 5 had extrapyramidal symptoms or excessive sedation. Olanzapine may be a useful alternative to haloperidol in the treatment of delirium in hospitalized patients.
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Appropriate selection of an antidepressant agent in medically ill patients requires a careful risk-benefit assessment matching the pharmacokinetic and pharmacodynamic properties of the drug being considered against the patient's physiological vulnerabilities, potential for drug interactions, and primary symptoms of the patient's depression. While in the past antidepressant drug selection was limited by the almost sole availability of the tricyclic antidepressants, newer drugs such as selective serotonin reuptake inhibitors, bupropion, and venlafaxine have vastly simplified treating depression in the medically ill. In refractory cases of depression in patients with medical illness, electroconvulsive therapy can be used with appropriate anesthetic management.
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Patients with delirium, dementia, depression, and schizophrenia were administered a newly developed test designed to identify delirium in an intensive care unit (ICU) setting. Two alternate forms of the Cognitive Test for Delirium (CTD) were highly correlated. ⋯ In a follow-up study, the Mini-Mental State Exam could not be administered to 42% of the ICU patients who completed the CTD. Early identification of delirium with the CTD may lead to timely treatment of specific etiologic conditions and a reduction in mortality and morbidity.