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Burning mouth syndrome (BMS) causes idiopathic pain or a burning sensation in clinically normal oral mucosa. Burning mouth syndrome is a chronic disease with an unknown etiology. Burning mouth syndrome is also idiopathic, and a consensus regarding diagnosis/treatment has not been reached yet. Recent studies have supported the suggestion that BMS is a neuropathic pain disorder in which both the peripheral and central nervous systems are involved. Tricyclic antidepressants (nortriptyline and amitriptyline), serotonin-noradrenaline reuptake inhibitors (SNRIs) (duloxetine and milnacipran), and antiepileptic drugs, potential-dependent calcium channel α2δ subunit ligands (gabapentine and pregabalin), are currently recommended as the first-choice drugs for neuropathic pain. In this study, we report 5 patients with BMS in whom there was no response to SNRI (milnacipran or duloxetine), or administration was discontinued because of adverse reactions, but in whom pregabalin therapy markedly reduced or led to the disappearance of pain in a short period. Pregabalin, whose mechanism of action differs from that of SNRIs, may become a treatment option for BMS patients who are not responsive to or are resistant to SNRIs.

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Delirium develops through a multifactorial process and include multiple subtypes with different pathological factors. To refine the treatment and care for delirium, a more detailed examination of these subtypes is needed. Therefore, this study aimed to explore the factors affecting delirium in cases in which hallucinations are conspicuous. In total, 602 delirium cases referred to the psychiatry department at a general hospital between May 2015 and August 2020 were enrolled. The Delirium Rating Scale-revised-98 was used to assess perceptual disturbances and hallucinations in patients with delirium. Multiple regression analysis was applied to determine whether individual factors were associated with the hallucinations. A total of 156 patients with delirium (25.9%) experienced hallucinations, with visual hallucinations being the most common subtype. Alcohol drinking (p < 0.0005), benzodiazepine withdrawal (p = 0.004), and the use of angiotensin II receptor blockers (p = 0.007) or dopamine receptor agonists (p = 0.014) were found to be significantly associated with hallucinations in patients with delirium. The four factors detected in this study could all be reversible contributing factors derived from the use of or withdrawal from exogenous substances.

Significant outcomes: This is one of the largest studies investigating the risk factors for violence in patients with delirium in a general hospital. Current smoker status, older age, male gender, and use of intensive care units were identified as factors associated with violence in patients with delirium.Limitations: This was a retrospective study based on clinical practice at a single hospital. Further studies on this topic by other general hospitals will help establish the present results. Some of the factors that could be implicated in delirium-induced violence were not included in this study. These include: some medications, physical conditions such as pain, psychological conditions such as anxiety, use of uncomfortable and/or painful medical procedures such as urethral drainage tubes, and a history of behavioral disturbance.

Background The use of benzodiazepines (BZDs) causes delirium, especially in elderly people. For this reason, suvorexant has been recommended as the first‐line hypnotic in elderly patients. The aim of this study was to determine whether the first‐line use of suvorexant, instead of BZDs, decreases referrals for delirium in elderly patients. Methods Since May 2016 at Nagoya Ekisaikai Hospital, suvorexant has been recommended as the first‐line hypnotic instead of BZDs. In May 2017, suvorexant was adopted as the first‐line hypnotic. The number of delirium cases referred to psychiatry was compared among three consecutive periods: period A (May 2015–April 2016), during which BZDs were mainly used for insomnia; period B (May 2016–April 2017), during which the use of suvorexant was recommended instead of BZDs; and period C (May 2017–April 2018), during which suvorexant was principally adopted as the first‐line hypnotic for insomnia. Potential confounding factors that may affect the development of delirium were also examined during the three periods. Results The number of delirium referral cases in elderly patients in each period decreased, from 133 in period A to 86 in period B and 53 in period C. The rate of delirium referral cases decreased significantly every year (P = 9.02 × 10−10). Almost no significant confounding factors other than hypnotics were detected during the three periods. Conclusion The referrals for delirium in elderly patients decreased significantly after the hypnotic was changed from BZDs to suvorexant.

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