Levetiracetam is a second-generation anticonvulsant. Delirium is not a well-known adverse effect of the drug. We present the report of an 80-year-old woman with a history of schizophrenia for 45 years and memory impairment for two years, who presented with worsening of confused, disoriented behaviour with sundowning, after being started on Tab. Levetiracetam for late-onset seizures. Examination revealed disorientation, fluctuation in the level of consciousness, impaired attention and psychotic symptoms. Physical examination was normal, except for gait disturbance. Relevant blood, urine and CSF investigations were also normal. Neuroimaging showed diffuse atrophy and small vessel ischemic changes. No focus of infection or metabolic imbalances could be identified. The possibility of delirium due to levetiracetam was suspected and, on cross-titration with sodium valproate, her delirium cleared. This report highlights that levetiracetam can cause delirium in the elderly, which brings forth the need for close monitoring while prescribing medicines in this population.
Background: Alcohol use among college students is a major public health priority owing to its high prevalence and numerous negative outcomes. Most interventions targeting alcohol use among college students consider them as a homogenous entity. There is preliminary evidence from high-income countries that patterns of alcohol use differ across academic streams. This remains unstudied in India. Aims: To compare the prevalence and correlates of alcohol use among students enrolled in various collegiate educational streams (medical, nursing, engineering, arts and science, and others [law/fisheries]) in the state of Kerala, India. Settings and Design: This is a cross-sectional survey conducted among college students. Materials and Methods: 5784 students completed a self-administered questionnaire assessing alcohol use and its correlates in the psycho-social domains. Statiscal Analysis: Lifetime prevalence and severity of alcohol use was determined across examined academic streams. A multivariable logistic regression analysis was done separately for each course, to identify factors influencing alcohol use. Results: The lifetime prevalence of alcohol use varied between 10.6% among nursing students to 41.7% among students pursuing “other” stream (law/fisheries). Students pursuing medicine and nursing had a relatively lower proportion of hazardous users. Consistently across all academic streams, being male and using tobacco increased the risk, while those from the Muslim community had a lower risk of alcohol use. Other examined psychosocial correlates showed varying relationship across courses. Conclusion: The prevalence and psychosocial correlates of alcohol use vary among students pursuing various academic streams. This finding has public health importance as the incorporation of course level characteristics in intervention programs will improve effectiveness.
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