The incidence of carbamate insecticide poisoning has increased gradually in recent years, and anticholinergic drugs are the specific antidotes. In 2020, the Peking University Third Hospital admitted a patient with carbamate insecticide poisoning, whose main clinical manifestations were dizziness, vomiting and blurred vision. During the treatment with penehyclidine hydrochloride, the patient developed delirium. This paper retrospectively analyzed the clinical data and treatment process of the patient to improve people's understanding of the side effects of penhyclidine hydrochloride in the treatment of insecticide poisoning.
Humans ; Insecticides ; Retrospective Studies ; Hydrochloric Acid ; Carbamates/therapeutic use* ; Delirium ; Poisoning/therapy* ; Organophosphate Poisoning/drug therapy*

OBJECTIVETo assess the medical community's awareness and practice regarding delirium in the intensive care unit (ICU).

METHODSOne hundred and ten predesigned questionnaires were distributed to ICU practitioners in the affiliated hospitals of Zhejiang University.

RESULTSA total of 105 valid questionnaires were collected. Totally, 55.3% of the clinicians considered that delirium was common in the ICU. Delirium was believed to be a significant or serious problem by 70.5% of respondents, and under-diagnosis was acknowledged by 56.2% of the respondents. The incidence of ICU delirium is even more under-estimated by the pediatric doctors compared with their counterparts in adult ICU (P less than 0.05). Primary disease of the brain (agreed by 82.1% of the respondents) was believed to be the most common risk factor for delirium. None of the ICU professionals screened delirium or used a specific tool for delirium assessment routinely. The vast majority (92.4%) of respondents had little knowledge on the diagnosis and the standard treatment of delirium.

CONCLUSIONSAlthough delirium is considered as a serious problem by a majority of the surveyed ICU professionals, it is still under-recognized in routine critical care practice. Data from this survey show a disconnection between the perceived significance of delirium and the current practices of monitoring and treatment in ICU in China.

Attitude of Health Personnel ; Delirium ; diagnosis ; epidemiology ; therapy ; Humans ; Incidence ; Intensive Care Units ; Risk Factors ; Surveys and Questionnaires

Delirium is an acute and fluctuating change in mental status, with inattention and altered levels of consciousness. It is a common comorbidity in intensive care units (ICU), resulting in delayed withdrawal of mechanical ventilation, prolonged length of stay in ICU, increased ICU mortality and impaired long-term cognitive function of the survivors. Narcotic or psychoactive medication is one of the major risk factors that contribute to ICU delirium. Surveys conducted in several countries indicated that delirium in ICU was inadequately monitored, underdiagnosed and lacked standardized treatment. In order to improve the prevention and treatment of ICU delirium, it is imperative that the ICU professionals should enrich their knowledge about this comorbidity, familiarize themselves with its screening and management, as well as standardize the administration of narcotic and psychoactive medications.
Delirium ; diagnosis ; epidemiology ; etiology ; therapy ; Humans ; Intensive Care Units ; Prognosis ; Risk Factors

We wished to establish an expert consensus on late stage of critical care (CC) management. The panel comprised 13 experts in CC medicine. Each statement was assessed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principle. Then, the Delphi method was adopted by 17 experts to reassess the following 28 statements. (1) ESCAPE has evolved from a strategy of delirium management to a strategy of late stage of CC management. (2) The new version of ESCAPE is a strategy for optimizing treatment and comprehensive care of critically ill patients (CIPs) after the rescue period, including early mobilization, early rehabilitation, nutritional support, sleep management, mental assessment, cognitive-function training, emotional support, and optimizing sedation and analgesia. (3) Disease assessment to determine the starting point of early mobilization, early rehabilitation, and early enteral nutrition. (4) Early mobilization has synergistic effects upon the recovery of organ function. (5) Early functional exercise and rehabilitation are important means to promote CIP recovery, and gives them a sense of future prospects. (6) Timely start of enteral nutrition is conducive to early mobilization and early rehabilitation. (7) The spontaneous breathing test should be started as soon as possible, and a weaning plan should be selected step-by-step. (8) The waking process of CIPs should be realized in a planned and purposeful way. (9) Establishment of a sleep-wake rhythm is the key to sleep management in post-CC management. (10) The spontaneous awakening trial, spontaneous breathing trial, and sleep management should be carried out together. (11) The depth of sedation should be adjusted dynamically in the late stage of CC period. (12) Standardized sedation assessment is the premise of rational sedation. (13) Appropriate sedative drugs should be selected according to the objectives of sedation and drug characteristics. (14) A goal-directed minimization strategy for sedation should be implemented. (15) The principle of analgesia must be mastered first. (16) Subjective assessment is preferred for analgesia assessment. (17) Opioid-based analgesic strategies should be selected step-by-step according to the characteristics of different drugs. (18) There must be rational use of non-opioid analgesics and non-drug-based analgesic measures. (19) Pay attention to evaluation of the psychological status of CIPs. (20) Cognitive function in CIPs cannot be ignored. (21) Delirium management should be based on non-drug-based measures and rational use of drugs. (22) Reset treatment can be considered for severe delirium. (23) Psychological assessment should be conducted as early as possible to screen-out high-risk groups with post-traumatic stress disorder. (24) Emotional support, flexible visiting, and environment management are important components of humanistic management in the intensive care unit (ICU). (25) Emotional support from medical teams and families should be promoted through"ICU diaries"and other forms. (26) Environmental management should be carried out by enriching environmental content, limiting environmental interference, and optimizing the environmental atmosphere. (27) Reasonable promotion of flexible visitation should be done on the basis of prevention of nosocomial infection. (28) ESCAPE is an excellent project for late stage of CC management.
Humans ; Consensus ; Critical Care/methods* ; Intensive Care Units ; Pain/drug therapy* ; Analgesics/therapeutic use* ; Delirium/therapy* ; Critical Illness

Electroconvulsive therapy (ECT) is sometimes indicated for the treatment of psychiatric disorders during pregnancy. We describe a patient at 17-26 weeks gestation who took twelve ECT treatments for her bipolar disorder. At third ECT, we changed the induction agent from thiopental sodium to propofol due to her post-ECT delirium. At ninth ECT, there was a brief fetal heart rate deceleration associated with maternal ECT. The patient gradually improved and was discharged in remission after twelve ECT treatments. A healthy boy was born by cesarean section at 38 weeks of gestation. We report this case with a brief review of the relevant literature.
Anesthesia ; Bipolar Disorder ; Cesarean Section ; Deceleration ; Delirium ; Electroconvulsive Therapy ; Female ; Heart Rate, Fetal ; Humans ; Pregnancy ; Propofol ; Thiopental

PURPOSE: This study analyzed the difference in survival time of patients with delirium according to sedative medication. METHODS: From January 2012 through December 2013, a retrospective cohort study was performed using the electronic medical records (EMR) of Pusan National University Hospital. Among 900 patients who died from cancer, we selected 240 who suffered delirium based on the EMR. The Nu-DESC delirium screening test was used to diagnose delirium. RESULTS: The median length of delirium period was five days. Delirium characteristics were dominated by inappropriate behaviors (35.0%). Sedatives were administered in 72.1% of the cases. The most frequently used sedative was haloperidol which was used in 59.6% of cases. The delirium period significantly differed by patients' age (F=3.96, P=0.021), cancer type (F=3.31, P=0.010), chemotherapy (t=−3.44 P=0.001). The average survival time was 16.85 days for the sedative medication group and 9.37 days for the non-medication group, which, however, was not significant (t=1.766, P=0.079). CONCLUSION: In this study, the use of sedatives did not affect patients' survival time. Thus, appropriate sedative medication can be positively recommended to comfort terminal cancer patients and their families.
Busan ; Cohort Studies* ; Delirium* ; Drug Therapy ; Electronic Health Records ; Haloperidol ; Humans ; Hypnotics and Sedatives ; Mass Screening ; Retrospective Studies* ; Survival Rate ; Terminally Ill*

Recently attention to the behavior and psychological symptoms of dementia (BPSD) is increasing repidly. Agitation is one of the BPSDs that contributes to the heavy burden on the caregiver and family. But, the definition of the agitation is controversial, and the rating scales for its measurements have limitations. We reviewed the literatures and our experiences to propose a rational strategy for controlling the agitating behaviors in the demented elderly. In the assessment of agitation in dementia, the top priority is a careful evaluation of the patient's medical, psychiatric, and environmental status. After pertinent medical conditions have been identified and managed, significant agitation may still be present and require intervention. Basically both behavior/environmental intervention and psychopharmacologic management are recommended in almost all situations. For patients with mild agitation, the clinician may consider implementing behavioral/environmental intervention singwarly. In severe agitation, however, pharmacologic approach is a preferred strategy, and can be administered according to the prevailing syndromes, such as psychosis, depression, delirium, anxiety, and so on. In practice high potency conventional antipsychotics and benzodiazepines are fregnently prescribed, but recently, drugs that have fewer long-term side effects, such as risperidone and divalproex are highly recommended. Due to the decreased pharmacokinetics and pharmacodynamics, drug dosages for the demented elderlies are much lower compared to younger patients. Side effects of the maintaining psychotropics should be monitored cautiously as well. Although some patients require long-term treatment, it is important to taper off and discontinue the medication periodically following a satisfactory improvement.
Aged ; Antipsychotic Agents ; Anxiety* ; Benzodiazepines ; Caregivers ; Delirium ; Dementia ; Depression ; Dihydroergotamine* ; Drug Therapy ; Humans ; Pharmacokinetics ; Psychotic Disorders ; Risperidone ; Valproic Acid ; Weights and Measures

Systemic steroids are highly effective for patients with moderate-to-severe asthma exacerbations. Steroid-induced psychosis is known to be one of the adverse effects of steroid therapy, although infrequent. However, there is no reliable method of predicting steroid psychosis. We experienced the case of a 40-year-old asthmatic man who had previously taken steroids without any psychological side effect, but became acutely delirious after receiving some doses of steroids, higher than the previous doses, under a condition of emotional stress. The mean dose of prednisolone administered was 82 mg/day (1.37 mg/kg/day) for 10 days but the patient had taken two courses of steroids (0.82 mg/kg/day and 0.5 mg/kg/day, respectively) for asthma exacerbations without any psychiatric episodes during the previous year.At this time, the patient was under a condition of emotional stress related to family reasons. The asthmatic exacerbation of this case may be precipitated from sudden emotional stress and the following treatment with a high dose of steroida should be used cautiously due to the possibility of psychotic side reactions.
Adult ; Asthma/drug therapy ; Case Report ; Delirium/*chemically induced ; Glucocorticoids, Synthetic/administration & dosage/*adverse effects ; Human ; Male ; Prednisolone/administration & dosage/*adverse effects

We present a case of delirium tremens lasting for five weeks in an alcohol-dependent individual. The patient required high-dose benzodiazepines, which is atypical and rare. The clinical presentation and management of this patient is discussed.
Adult ; Alcohol Withdrawal Delirium ; diagnosis ; drug therapy ; psychology ; Anti-Anxiety Agents ; therapeutic use ; Diagnosis, Differential ; Diazepam ; therapeutic use ; Humans ; Liver Cirrhosis ; diagnosis ; Male ; Mental Status Schedule

We report an elderly patient who developed severe delirium and extrapyramidal signs after initiation of lithium-olanzapine combination. On hospital admission, serum levels of lithium were found to be 3.0 mM/L which were far above toxic level. Immediate discontinuation of both drugs resulted in complete resolution of most of the symptoms except for perioral dyskinesia which persisted for three more months. We critically discussed the differential diagnosis of lithium intoxication and assessed confounding factors which induce delirium and extrapyramidal signs related with combination therapy of lithium and olanzapine.
Antipsychotic Agents/adverse effects/therapeutic use ; Basal Ganglia Diseases/*chemically induced ; Benzodiazepines/adverse effects/therapeutic use ; Bipolar Disorder/drug therapy ; Delirium/*chemically induced ; Drug Therapy, Combination ; Female ; Humans ; Lithium/*adverse effects/therapeutic use ; Middle Aged