Does plasma free-3-methoxy-4-hydroxyphenyl (ethylene) glycol increase in the delirious state? A comparison of the effects of mianserin and haloperidol on delirium

Delirium

“…Except in cases of delirium caused by alcohol or sedative hypnotic withdrawal, neuroleptics are the treatment of choice, resulting in improvement before elucidation of the underlying cause. 60 Haloperidol in doses of 0.5 to 10 mg a day (intramuscularly or intravenously) improves most symptoms of delirium and is especially effective in the control of more severely disturbed and aggressive patients. Meagher 61 suggested up to 100 mg of haloperidol intravenously for over 24 hours-a regimen that has been criticised and is certainly inappropriate for older patients.…”

Regular review: Delirium: optimising management

“…Neuroleptics ameliorate a range of symptoms, are effective both in patients with a hyperactive or hypoactive clinical profile, and generally improve cognition. 2 21 22 The onset of their action is rapid: improvement is usually evident within hours or days and thus occurs before underlying causes are treated 23. Neuroleptics are superior to benzodiazepines in treating delirium that has been caused by factors other than alcohol withdrawal or sedative hypnotics 2.…”

“…Low dose oral haloperidol (1 mg to 10 mg/day) improves symptoms in most patients 21 – 23. Information on drug treatment in highly disturbed patients comes from studies of patients with general agitation rather than patients with delirium.…”

“…This effect was independent of the mood altering actions of the drugs. 23 36 Other reports have advocated the use of light therapy,37 but the usefulness of this treatment needs to be more fully evaluated before it is used routinely.…”

Delirium: the role of psychiatry

“…The Delirium Rating Scale (DRS; Trzepacz et al, 1998) is the most widely used to date and, although it requires interpretation by a skilled clinician of information from multiple clinical sources, it has the significant advantage of distinguishing between the disturbances of delirium and dementia. Scores have been shown to predict duration of delirium episode, correlate with frequency of complications and reflect improving clinical state linked to successful drug treatment (Rutherford et al, 1991;Wada & Yamaguchi, 1993;Nakamura et al, 1997). The revised version (DRS-98;Trzepacz et al, 2000) incorporates more detailed cognitive assessment (including specific items for disturbances of attention, thought processes and language function) and has separate items for both reduced and increased motor activity.…”