Delirium is a serious and common problem in severely medically ill patients of all ages. It has been less addressed in children and adolescents. Treatment of delirium is predicated on addressing its underlying cause. The management of its symptoms depends on the off-label use of antipsychotics, while avoiding agents that precipitate or worsen delirium. Olanzapine, quetiapine, and risperidone are presently considered first-line drugs, usually replacing haloperidol. Other agents have shown promise, including melatonin to address the sleep disturbance characteristic of delirium, and dexmedetomidine, an α2-agonist, that may facilitate lower doses of benzodiazepines and opioids that may worsen delirium.
Sleep Architecture in Infants of Substance Abusing MothersThis longitudinal, year-long study compared sleep-wake state organization in two groups of infants: infants whose mothers abused substances during their pregnancies, and non-exposed, typically developing, age-matched comparison infants, to determine whether differences in sleep-wake state organization existed between the two groups. Seventeen infants of mothers who were participating in a parent-infant residential treatment program for substance abuse were enrolled. Their sleep-wake state organization over the first year of life was compared to that of 17 age-matched comparison infants. The intent was to follow each infant on 5 occasions over the first year of life using established methods of time-lapse videosomnography to record sleep-wake state organization. However, attrition in the substance-abusing group was problematic. Some sleep-wake variables (Active Sleep%, Quiet Sleep%, Awake%, number of nighttime
A 17-year-old African-American male developed neuroleptic malignant syndrome (NMS) with hyperthermia, autonomic instability, increased muscle tone, rhabdomyolysis, and obtundation after a maximum of 2 days of treatment with olanzapine and 1 day of treatment with divalproex sodium. Intensive care unit (ICU)-level care was required. Paranoid psychosis with catatonia was present after recovery from the NMS. Because of his continued psychotic symptoms following resolution of the NMS, the alternate atypical antipsychotic, clozapine, was started under close observation. Reports of NMS resulting from atypical antipsychotic agents are generally uncommon, and much more so in the child and adolescent population. However, these agents are frequently prescribed in this population and require due caution.
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