Quetiapine as treatment for delirium in critically ill children: A case series

Traube, Chani; Witcher, Robert; Mendez-Rico, Elena; Silver, Gabrielle

doi:10.3233/pic-13060

Cited by 12 publications

(12 citation statements)

References 30 publications

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“…Short-term pharmacological intervention may maximize the engagement in both cognitive-behavioral and physical therapies. There are some case reports of successful use of antipsychotic such as Quetiapine [83–85] and of effective cognitive rehabilitation [86] in patients with a post-surgical neuropsychiatric and neurobehavioral presentation with positive symptoms. To our knowledge, there is a lack of reports on drug trials for the negative counterpart.…”

Section: Resultsmentioning

confidence: 99%

Modafinil in the rehabilitation of a patient with post-surgical posterior fossa syndrome: a lesson to be learned?

et al. 2019

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Disorders of the cerebellum may present with motor, cognitive, behavioral and affective symptoms. There is a growing interest in developing neuroanatomical models of symptoms generation that involve the cerebellum and the cerebello-cortical connections. We describe an exciting first case report of successful use of Modafinil in an adult patient with post-operative posterior fossa syndrome. Following resection of a melanoma metastasis in the cerebellum the patient developed striking affective and behavioral symptoms in the form of withdrawn flat mood and disengagement. This neurobehavioral presentation severely impacted on his quality of life, independence, and ability to engage in the neuro-rehabilitative program. Pharmacological treatment with Modafinil ameliorated these emotional and behavioral aspects, and also fatigue. Treatment with Modafinil hence affected recovery and outcome for the patient. To our knowledge, this is the first description of a successful pharmacological intervention in an adult with post-surgical posterior fossa syndrome and negative neurobehavioral presentation. Our findings illustrate the variability of the presentation of post-operative posterior fossa syndrome in adults, and the importance of delivering targeted treatment to maximize the benefits of neurorehabilitation. The manuscript highlights the following points: 1. post-operative consequences currently under the wide umbrella of posterior fossa syndrome, can indeed manifest in adults; 2. a wide spectrum of neurobehavioral symptoms can occur, including a presentation with predominantly negative features; 3. the type of neurobehavioral presentation should guide the treatment choice with particular consideration of drugs that potentially modulate the cerebello-frontal connections; 4. Modafinil can be a candidate for effective treatment in presentations with predominantly negative behavioral symptoms.

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Section: Resultsmentioning

confidence: 99%

Modafinil in the rehabilitation of a patient with post-surgical posterior fossa syndrome: a lesson to be learned?

et al. 2019

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“…2,11 Pharmacological interventions include the use of antipsychotics such as quetiapine, which may be effective in managing F I G U R E 1 Suggested nonpharmacological interventions for the management of pediatric delirium symptoms associated with mixed or hyperactive delirium. 18,19 However, this is an off-label use, and these medications do not address the underlying cause of delirium. Currently, there are no FDA-approved medications for the treatment of this condition.…”

Section: Delirium In a Patient With Trisomy 21 Undergoing Chemotherap...mentioning

confidence: 99%

Delirium in a patient with trisomy 21 undergoing chemotherapy for high‐risk acute lymphoblastic leukemia

Quirós-Mata

Delaney

Russell

et al. 2022

Pediatric Blood & Cancer

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“…Demonstration of efficacy for the treatment of pediatric delirium with quetiapine showed improvement in symptoms 24 to 72 hours after initiation. [72][73][74] The largest study of quetiapine (n ¼ 50) used CAPD scores to diagnose delirium but only evaluated safety and did not assess posttreatment effects. 75 Although significant improvement in both DRS and CAPD scores after initiation of quetiapine have been observed, overall objective assessment of efficacy has occurred in only a small number of patients (n ¼ 32).…”

Section: Quetiapinementioning

confidence: 99%

“…75 Although significant improvement in both DRS and CAPD scores after initiation of quetiapine have been observed, overall objective assessment of efficacy has occurred in only a small number of patients (n ¼ 32). 61,[71][72][73][74] Similar to olanzapine, variability in dosing ranges from 1.3 to 8 mg/kg/ day, while most doses are initiated at 0.5 mg/kg/dose every 8 hours and titrated upward to achieve clinical effect over 2 to 3 days. 72,73,75 Reported adverse effects of quetiapine when used for pediatric delirium are limited to QTc prolongation (n ¼ 3) without development of torsade's de pointes.…”

Section: Quetiapinementioning

confidence: 99%

“…61,[71][72][73][74] Similar to olanzapine, variability in dosing ranges from 1.3 to 8 mg/kg/ day, while most doses are initiated at 0.5 mg/kg/dose every 8 hours and titrated upward to achieve clinical effect over 2 to 3 days. 72,73,75 Reported adverse effects of quetiapine when used for pediatric delirium are limited to QTc prolongation (n ¼ 3) without development of torsade's de pointes. 75 All three patients were receiving quetiapine doses at the higher end of the dosing range (3.3-6.3 mg/kg/day).…”

Section: Quetiapinementioning

confidence: 99%

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Assessment and Management of Delirium in the Pediatric Intensive Care Unit: A Review

Liviskie

McPherson

Luecke

2021

J Pediatr Intensive Care

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Many critically ill patients suffer from delirium which is associated with significant morbidity and mortality. There is a paucity of data about the incidence, symptoms, or treatment of delirium in the pediatric intensive care unit (PICU). Risk factors for delirium are common in the PICU including central nervous system immaturity, developmental delay, mechanical ventilation, and use of anticholinergic agents, corticosteroids, vasopressors, opioids, or benzodiazepines. Hypoactive delirium is the most common subtype in pediatric patients; however, hyperactive delirium has also been reported. Various screening tools are validated in the pediatric population, with the Cornell Assessment of Pediatric Delirium (CAPD) applicable to the largest age range and able to detect signs and symptoms consistent with both hypo- and hyperactive delirium. Treatment of delirium should always include identification and reversal of the underlying etiology, reserving pharmacologic management for those patients without symptom resolution, or with significant impact to medical care. Atypical antipsychotics (olanzapine, quetiapine, and risperidone) should be used first-line in patients requiring pharmacologic treatment owing to their apparent efficacy and low incidence of reported adverse effects. The choice of atypical antipsychotic should be based on adverse effect profile, available dosage forms, and consideration of medication interactions. Intravenous haloperidol may be a potential treatment option in patients unable to tolerate oral medications and with significant symptoms. However, given the high incidence of serious adverse effects with intravenous haloperidol, routine use should be avoided. Dexmedetomidine should be used when sedation is needed and when clinically appropriate, given the positive impact on delirium. Additional well-designed trials assessing screening and treatment of PICU delirium are needed.

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Quetiapine as treatment for delirium in critically ill children: A case series

Cited by 12 publications

References 30 publications

Modafinil in the rehabilitation of a patient with post-surgical posterior fossa syndrome: a lesson to be learned?

Modafinil in the rehabilitation of a patient with post-surgical posterior fossa syndrome: a lesson to be learned?

Delirium in a patient with trisomy 21 undergoing chemotherapy for high‐risk acute lymphoblastic leukemia

Assessment and Management of Delirium in the Pediatric Intensive Care Unit: A Review

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