Treatment
Of Delirium Two examples: Treatment is
directed against the underlying cause. For instance, consider a 25-year old man
who is a known diabetic who has just finished a strenuous 3 hour hike without
taking the time to have a snack. He had taken the normal morning insulin dose,
and blood tests now confirmed low blood sugar(hypoglycemia). This patient
will likely recover very quickly from his delirium following glucose injections
and a carbohydrate meal. On the other hand an elderly woman who was picked
up by police for jaywalking and was noted to be in a delirium, was found on blood
tests to be extremely hypothyroid. Her thyroid gland does not produce enough thyroid
hormone and she will need to take replacement thyroid hormones for the rest of
her life. In her case a few days are needed for the thyroid hormones to work.
However, this woman could leave the hospital within a few days on hormone
replacement, with her delirium disappeared. Infection has to be treated
with antibiotics, brain lesions may have to take time to heal in case of a stroke.
On the other hand fast action may be needed in the case of an ischemic stroke
where swift treatment with tissue plasminogen activator may be able to reopen
a clogged artery and allow normal blood flow again to the affected brain area.
Every situation has to be treated individually and appropriately. Drugs
used to treat delirium: The psychiatrist will use a number
of different drugs to control difficult situations where a psychiatric condition
is the reason for the delirium. As these patients are usually in the elderly age
group the function of the kidneys and liver as the major drug eliminiation organs
is slowed down compared to earlier in life. According to Dr. Marie Geizer (assistant
professor of psychiatry at UBC, Ref. 16) this means that the physician has to
be more careful about the dosages used. Going "low and slow" is the
guiding principle. It is best to use one medication at a time. Here are a few
comments regarding some of the more common psychotropic drugs used.
| Drugs used
for delirium treatment | | Name
of drug: | Effect
on patient: | | Neuroleptic
drugs (haloperidol, loxapine, riperidone, chlorpromazine etc.) | Used
for acute psychosis with destructive behavior for rapid tranquilization. *SE:
muscle rigidity, tardive dyskinesia |
| Anticonvulsants
(carbamazepine, gabapentin) | Used
for toning down agression. SE: falls, sedation |
| Benzodiazepines
(alprazolan, chlordiazepoxide,oxazepam, lorazepam) | The
shorter acting ones are better as they do not accumulate as much. SE: confusion,
falls, sedation, urinary incontinence. |
| Antidepressants
(trazodone, fluoxetine, paroxetine, venlaflaxine, etc.) | For
depression. SE: drug interactions have to be watched for, cardiotoxic side effects
also | These are only a few examples of the more frequently used
drugs in the elderly who are having delirium problems. Benzodiazepines are the
most abused drugs by the nursing personnel. The doctor will often leave a "prn
dose" for benzodiazepines in case of agitation. The nurse is then entitled
to use his/her own judgement in administering this drug when it seems indicated.
However, when several of these doses are administered, withdrawal symptoms may
present as "agitation" and this may be treated again with more benzodiazepines.
The patient, particularly when frail, may get oversedated, fall and fracture a
hip. This happens not infrequently in nursing homes, not with the intent to do
so, but it happens nevertheless. Treatment without the use
of drugs: Geriatricians (physicians who specialize in the
medical needs of the elderly) tell us that one should always attempt to use non-drug
methods to treat symptoms first. Agitation can often be tackled by isolating the
patient in a quiet room with soothing background music. Family can get more involved
including grandchildren, when it is safe to do so. This social interaction changes
the scene. Walking with the patient to "abreact" anger and frustrations
can be helpful. It may require more staffing, which goes against the movement
to cut back hospital budgets... Detoxification: Books like
"Breakthrough" (Ref.17) by Suzanne Somers have reviewed newer insights
of antiaging medicine. This points out the importance of detoxifying the body
from heavy metals like mercury, lead and cadmium. Many cases of delirium or dementia
may in part be due to heavy metal poisoning. Hormone levels should be carefully
checked to ensure that they are in balance. When detoxification has been
done, it is important to build up the metabolism by nutritional
supplements. |
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