TITLE:
Delirium in Patients with Substance Abuse: A Case-Series
AUTHORS:
Carla Gramaglia, Sabrina Gili, Alessandro Feggi, Eleonora Gattoni, Patrizia Zeppegno
KEYWORDS:
Delirium, Agitation, Psychosis, Substance Abuse
JOURNAL NAME:
Open Journal of Psychiatry,
Vol.4 No.3,
June
27,
2014
ABSTRACT: Severe agitation in
patients with delirium may be difficult for clinicians’ management because of
problems of differential diagnosis and treatment. Regrettably, theory and
guidelines concerning this issue may fail to cover the incredible complexity of
clinical practice. Our aim is to describe three cases of delirium from our
real-life clinical experience, with a specific focus on their complexity as far
as differential diagnosis and psychopharmacological treatment are concerned. In
clinical practice, as shown by the three cases we describe, the etiology of
delirium is various and mixed, lab analysis are not specific and it is not
possible to exactly assess which kind of substances were used by patients. New
drugs and smart drugs are not yet detectable by our urine analysis, and their
effects, interaction with prescription drugs and pharmacokinetics are not well
known. With the aim to obtain a successful sedation and to calm the patient, in
our cases, we needed to use a pharmacological combined approach
(benzodiazepines, first and second generation antipsychotics) with different
routes of administration and, when inevitable, physical restraint.