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steroid-induced delirium

Tomoyuki Otsuka, Yukinao Sakai, Dai Ohno, Shuichi Tsuruoka
A 61-year-old man with bilateral purpura of the lower limbs and subsequent edema, was hospitalization after renal dysfunction developed. The presence of hepatitis C virus (HCV) RNA and cryoglobulin and the finding of membranoproliferative glomerulonephritis on renal biopsy led to a diagnosis of HCV-related glomerulonephritis due to cryoglobulinemia. Because of the pre-existence of nephrotic syndrome and the continuously increasing serum level of creatinine, treatment with cryofiltration, interferon, and steroids was started...
2015: Journal of Nippon Medical School, Nippon Ika Daigaku Zasshi
Se-Jin Kim, Sang-Don Han, Jung Yeon Lee, Gyu Rak Chon
Quetiapine is regarded as an effective and safe treatment for delirium. An 82-year-old man presented with a 1-week history of violent behavior and dizziness accompanied by weakness on the left side of his body. He was diagnosed with acute cerebral cortical infarction and delirium associated with alcohol abuse. After quetiapine treatment, he complained of fever and coughed up sputum, whereas his aggressive behavior improved. His symptoms persisted despite empirical antibiotic treatment. All diagnostic tests for infectious causes were negative...
October 2014: Respiratory Care
Jason M Moss, Debra W Kemp, Jamie N Brown
Steroid psychosis has been well described with oral glucocorticoids, however, our search of the literature did not identify an association between delirium and the combination of inhaled glucocorticoids and long-acting beta-agonists. We describe the occurrence of delirium with the combination of an inhaled glucocorticoid and bronchodilator. An elderly male described confusion and hallucinations within 1 week after initiation of budesonide/formoterol for chronic obstructive pulmonary disease. The combination inhaler was discontinued with resolution of symptoms...
February 2014: Journal of Pharmacy Practice
Nicolas Adam, Stanislas Kandelman, Jean Mantz, Fabrice Chrétien, Tarek Sharshar
Systemic infection is often revealed by or associated with brain dysfunction, which is characterized by alteration of consciousness, ranging from delirium to coma, seizure or focal neurological signs. Its pathophysiology involves an ischemic process, secondary to impairment of cerebral perfusion and its determinants and a neuroinflammatory process that includes endothelial activation, alteration of the blood-brain barrier and passage of neurotoxic mediators. Microcirculatory dysfunction is common to these two processes...
February 2013: Expert Review of Anti-infective Therapy
A Robles Bayón, F Gude Sampedro
INTRODUCTION: Some treatments are inappropriate for patients with cognitive decline. We analyse their use in 500 patients and present a literature review. DEVELOPMENT: Benzodiazepines produce dependence, and reduce attention, memory, and motor ability. They can cause disinhibition or aggressive behaviour, facilitate the appearance of delirium, and increase accident and mortality rates in people older than 60. In subjects over 65, low systolic blood pressure is associated with cognitive decline...
November 2014: Neurología: Publicación Oficial de la Sociedad Española de Neurología
Christine K O'Neil, Joseph T Hanlon, Zachary A Marcum
BACKGROUND: Osteoarthritis (OA) is the most common cause of disability in older adults, and although analgesic use can be helpful, it can also result in adverse drug events. OBJECTIVE: To review the recent literature to describe potential adverse drug events associated with analgesics commonly used by older adults with OA. METHODS: To identify articles for this review, a systematic search of the English-language literature from January 2001 to June 2012 was conducted using PubMed, MEDLINE, EBSCO, and the Cochrane Database of Systematic Reviews for publications related to the medical management of OA...
December 2012: American Journal of Geriatric Pharmacotherapy
Heather A Kenna, Amy W Poon, C Paula de los Angeles, Lorrin M Koran
Corticosteroids are widely used in modern medicine but can result in troubling psychiatric side-effects. Physicians and other medical professionals should be aware of the potential for these side-effects, possible means of prevention, and efficacious treatments. Herein, we review adult case report data published during the past quarter-century on adverse corticosteroid-induced psychiatric effects, and present a case of corticosteroid-induced psychotic depression. PubMed and PsychLit databases were searched using the terms 'corticosteroids', 'steroids', and the generic names of corticosteroid medications with terms for psychiatric symptoms or syndromes, including psychosis, mania, hypomania, depression, apathy, anxiety, panic, depersonalization, delirium, confusion, hallucinations, delusions, paranoia, cognitive impairment and dementia...
October 2011: Psychiatry and Clinical Neurosciences
Myrthe I M E Koster, Mark H de Jong, Marees Th Derksen, Arthur R Van Gool
A 30-year-old woman, 33 weeks pregnant, without a significant psychiatric history, was admitted for treatment of premature labour. She was treated with betamethasone intramuscularly, with a total dose of 24 mg divided over 2 days, and nifedipine orally with beneficial effect on the contractions. However, within 24 h after completion of tocolytic treatment, she developed a psychosis with delusions and hallucinations necessitating readmission, first to an obstetric ward, later to a psychiatric ward. At least part of this episode may be characterized as delirium...
2011: Nederlands Tijdschrift Voor Geneeskunde
Colm Cunningham
It is widely accepted that inflammation plays some role in the progression of chronic neurodegenerative diseases such as AD (Alzheimer's disease), but its precise role remains elusive. It has been known for many years that systemic inflammatory insults can signal to the brain to induce changes in CNS (central nervous system) function, typically grouped under the syndrome of sickness behaviour. These changes are mediated via systemic and CNS cytokine and prostaglandin synthesis. When patients with dementia suffer similar systemic inflammatory insults, delirium is a frequent consequence...
August 2011: Biochemical Society Transactions
Allen G Ross, Donald P McManus, Jeremy Farrar, Richard J Hunstman, Darren J Gray, Yue-Sheng Li
Schistosomiasis (bilharzia) is a neglected tropical disease caused by digenetic trematode platyhelminths of the genus Schistosoma. Neuroschistosomiasis is one of the most severe clinical outcomes associated with schistosome infection. Neurological complications early during the course of infection are thought to occur through in situ egg deposition following aberrant migration of adult worms to the brain or spinal cord. The presence of eggs in the CNS induces a cell-mediated Th2-driven periovular granulomatous reaction...
January 2012: Journal of Neurology
Clare White, Mary Ann McCann, Neil Jackson
Terminal restlessness is a term frequently used to refer to a clinical spectrum of unsettled behaviors in the last few days of life. Because there are many similarities between the clinical pictures observed in terminal restlessness and delirium, we postulate that at times what is referred to as terminal restlessness may actually be an acute delirium sometimes caused by medication used for symptom control. It is important therefore to consider the causes for this distressing clinical entity, treat it appropriately, and ensure the treatment provided does not increase its severity...
April 2007: Journal of Palliative Medicine
Charles André, Jorge A Jaber-Filho, Rafael M A Bento, Lúcia M P Damasceno, Francisco R Aquino-Neto
OBJECTIVE: To describe a case of marijuana-induced delirium and the techniques used to detect psychoactive agents and metabolites in urine. METHODS: A case of delirium following involuntary ingestion of cannabis is described. A urine sample was analyzed applying various chemical procedures, using high-resolution gas chromatography coupled with mass spectrometry technique. 11-Nor-delta9-tetrahydrocannabinol-9-carboxylic acid was quantified by the methodology for steroids and cannabis...
April 2006: CNS Spectrums
Burak Sade, Kumar Budur, Dae Kyu Lee, Kathleen Franco, Joung H Lee
BACKGROUND: Postoperative onset of acute major depression in a patient with no previous history of psychiatric disorder is highly unexpected after skull base surgery. CASE DESCRIPTION: A 38-year-old woman with no previous physical or mental illness presented with a 3-month history of left ear pain, short-term memory disturbance, and motor dysphasia. Magnetic resonance imaging revealed a large extraaxial tumor in the left middle fossa. Left temporal craniotomy was performed, achieving complete tumor resection...
March 2006: Surgical Neurology
David B Weiss, Jarl Dyrud, Robert M House, Thomas P Beresford
Psychiatric symptoms are common to many autoimmune disorders. Patients often will have mood disorders, anxiety, cognitive deficits, delirium, and psychosis. These symptoms may reflect the direct or indirect effect of the autoimmune disorder on the central nervous system, may be related to medications used to treat the disorder, or may be a direct psychologic impact from suffering with the autoimmune disorder. Accurately recognizing the psychiatric component and generating a differential diagnosis is a complex task for the treating physician...
September 2005: Current Treatment Options in Neurology
K Alagiakrishnan, C A Wiens
Drugs have been associated with the development of delirium in the elderly. Successful treatment of delirium depends on identifying the reversible contributing factors, and drugs are the most common reversible cause of delirium. Anticholinergic medications, benzodiazepines, and narcotics in high doses are common causes of drug induced delirium. This article provides an approach for clinicians to prevent, recognise, and manage drug induced delirium. It also reviews the mechanisms for this condition, especially the neurotransmitter imbalances involving acetylcholine, dopamine, and gamma aminobutyric acid and discusses the age related changes that may contribute to altered pharmacological effects which have a role in delirium...
July 2004: Postgraduate Medical Journal
François Sirois
This review is built upon a time-framed perspective to unfold the growth of evidence and the shifting of focus from primary affective short-term reactions to later findings of cognitive deficits and possible permanent impairment linked to steroid treatment. An incidence related to dosage has been documented and delirium and withdrawal symptoms have been reported in later studies. A hypothesis of sensitization process with multiple course of steroids has been proposed with the reporting of recurrent cases. The issue of individual risk appears unsettled while management of psychiatric reactions to steroids has shifted toward prophylactic use of lithium...
January 2003: General Hospital Psychiatry
Kester I. Crosse, Frank A. Anania
Alcoholic hepatitis is a common clinical problem confronting gastroenterologists and hepatologists alike. The fundamental issue regarding treatment of this disease is its recognition on the part of the physician. Chronic alcohol abuse, fever, leukocytosis, jaundice, and encephalopathy are key symptoms and signs that should prompt consideration of this diagnosis. Nutrition and abstinence from alcohol are the cornerstones of therapy. In addition, management of seriously ill, hospitalized patients should include prophylaxis for withdrawal and delirium tremens...
December 2002: Current Treatment Options in Gastroenterology
Youngil I Koh, Inseon S Choi, Il-Seon Shin, Seo-Na Hong, Yeo-Kyeoung Kim, Myoung-Ki Sim
Systemic steroids are highly effective for patients with moderate-to-severe asthma exacerbations. Steroid-induced psychosis is known to be one of the adverse effects of steroid therapy, although infrequent. However, there is no reliable method of predicting steroid psychosis. We experienced the case of a 40-year-old asthmatic man who had previously taken steroids without any psychological side effect, but became acutely delirious after receiving some doses of steroids, higher than the previous doses, under a condition of emotional stress...
June 2002: Korean Journal of Internal Medicine
T Morita, Y Tei, J Tsunoda, S Inoue, S Chihara
Delirium is a common complication in terminally ill cancer patients. Identification of underlying pathologies and prediction of clinical features may improve effective symptom alleviation. This study aims to clarify precipitating factors and their associations with clinical features of terminal delirium. Consecutive hospice inpatients who developed delirium were prospectively evaluated following a structured protocol. Among 237 patients followed until death, 245 episodes of delirium were identified in 213 patients...
December 2001: Journal of Pain and Symptom Management
C A Jenkins, E Bruera
Because of their variety of uses, corticosteroids are frequently prescribed in advanced cancer patients. Two patients who developed neuropsychiatric complications on corticosteroids and their subsequent management are described. The first patient, who had a known history of steroid-induced psychotic depression, required corticosteroids to treat recurrent brain edema from a malignant meningioma. The patient was managed by using low-dose corticosteroids and concomitant haloperidol. The second patient was prescribed corticosteroids for a constellation of symptoms, including pain and nausea from a possible bowel obstruction, and developed a severe delirium that required discontinuation of the corticosteroids...
April 2000: Journal of Pain and Symptom Management
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