STUDY OF ETIOLOGY AND TREATMENT ON DELIRIUM

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The most frequent diagnosis of patients referred to the consultation liaison service (CLS) of Kurume University Hospital was delirium. The reason for this increase include in the number of delirious patients may have been due to the increased number of elderly patients who was hospitalized and increased need for hospitalization in emegency cases. We investigated the characteristics of patients with delirium who were identified and treated as part of the CLS to determine 60 patients. Delirium was diagosed in 34% in the CLS.Most patients with delirium were over 55 years of age and were postoperative patients ; findings inbcluded dehydration, disturbances of liver and renal, respiratory function, anemia, nutritional imbalnces, and setting of tube for IVH.The serum level of Na was significantly dectreased and urinary volume was increased during the delirious state compared with pre-delirious state. Undelying diseases of patients with delirium included in order of prevalence, malignancy, ce … More rebrovascular disease, digestive disorders, and other disorders.Until recently, neuroleptics such as haloperidol, oxypertine and tiapride were the principal drugs used in the treatment of derlirum in Japan. However, the use of neuroleptics sometimes caused oversedation, extrapyramidal symptoms, and other adverse side-effects. Therefore, we studied the effects of mianserin, (M) on delirium by assessing patients with Delirium Rating Scale as well as measurement of plasma concentration, free-MHPG and HVA concentraions. As a result, the plasma concentration of M reached a therapeutic level with 24 hr of the initiation of treatment. Based on the clinical results and on measurements of the plasma M concentrations, M can be considered effective in the treatment of delirium due to its rapid onset and few side-effects. M may offer an efficacy similar to that of haloperidol in the tretment of delirium while being safer. Although improvement in the delirious state and a decrease in the plasma free-MHPG concentration were observed after drug administration. The higher plasma free-MHPG concentration in the delirious state suggests the existence of a preparatory state whreby norepinephrine metabolism in involved in the appearance of abnormal behaviors associated with delirium. These data suggest that free-MHPG concentrations could potentially be used as a predictor of delirium. Less