Harms versus benefits of antipsychotics in the prevention of delirium.

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Delirium is a transient and acute but reversible fluctuation disturbance in the level of cognition, attention and consciousness. Other names for delirium are toxic or metabolic encephalopathy or confusional state.

The cause can be any disorder or drug intolerance.

The diagnosis for delirium is clinical with the use of imaging and laboratory tests to identify the cause. Correcting the cause and other supportive measures are the approach to treating delirium.

Delirium can occur at any stage of life but mostly affects the elderly. Approximately 10% of the elderly patients in the hospital have hallucination and 15-50% experiences the condition at a particular time in their hospitalization. Delirium is also frequent after surgery, among ICU patients and nursing home residents.

It might also affect the younger people usually because of life-threatening systematic disorder or drug use.

Symptoms and Signs of Delirium

These are the primary signs that characterize the presence of fever:

Difficulties in maintaining, focusing or shifting attention

The level of consciousness fluctuates making the patients become disoriented to time, place and sometimes person. The patient might have hallucinations, paranoia and delusions. It is common for the patient to have confusion regarding their daily events and daily routines as well as changes in personality. Delirium might disorganize thinking and speech with exceptional rapidity, slurring, aphasic errors, neologisms or chaotic patterns. Symptoms of delirium keep fluctuating over minutes or hours. They might lessen as the day progresses but become worse at night.

Other symptoms

  • Irritability, hyperactivity, hyperalertness and agitation
  • Withdrawal, excess quietness and weariness
  • Extremely elderly people with delirium become withdrawn and quiet. People can mistake these changes for depression though some patients might alternate between both.
  • Distortion in sleeping and eating habits
  • Poor insight and impaired judgment because of the many cognitive disturbances.
  • A patient with delirium might have other signs and symptoms depending on the cause.

    Relationship between Delirium and Dementia

    It is essential to differentiate between dementia and delirium before prescribing antipsychotics as they are separate disorders, but sometimes they seem similar. Cognition is present in both, but the following helps in distinguishing them.

    Delirium mainly affects attention and occurs due to acute illness or toxicity after using a particular drug that sometimes becomes life-threatening but often is reversible.

    Dementia occurs because of the anatomic changes affecting the brain and mainly affects memory after a slower onset. It is irreversible.

    What Are Antipsychotics

    These are a group of medicine that physicians prescribe for treating mental health illnesses including those that occur due to a bipolar disorder such as mania that causes persons suffering from it to feel that they are in a state of elation or high. They also help to treat severe anxiety and depression. Antipsychotics are at times known as major tranquillizers. Antipsychotics are sold in form of capsules, tablets, depot injections (long-acting) and liquids. Pharmacists stock antipsychotics in various brand names. Antipsychotics are in two main types:

    Older antipsychotics: these are the well-established types also known as the first generation. They have been in use since the 1950s and until now, they are still in the market. The brands fitting to the older antipsychotics include:

    • Chlorpromazine
    • Haloperidol, , flupentixol,
    • Levomepromazine
    • Pericyazine
    • Perphenazine
    • uclopenthixol
    • Sulpiride

    Atypical or newer antipsychotics- these are the types of antipsychotic that manufacturers developed in the recent years compared to older forms. Although they are more modern, their shelf life is long since developers began manufacturing them in the 1970s. The purpose of developing them was to create products with fewer effects than the older type. However, they still have a few side effects. Some call them second-generation antipsychotics and they include these brands:

    • Amisulpride
    • Clozapine
    • Aripiprazole
    • Olanzapine
    • Risperidone
    • Quetiapine

    The choice of antipsychotic that a physician prescribes depend on the severity of the symptoms that require treatment and if the person has other health issues. Antipsychotic medicine has some differences. For instance, some have more sedating capabilities and might be better for individuals in dire need of relaxation. A specialist usually offers advice on the best type to take use for every case. It is difficult to tell the antipsychotics that will work in a manner that favors a person without the advice of a doctor. It helps to try another type if the first that a patient uses does not work well.

    There is a general observation that both older and newer antipsychotics work similarly. Some brands like clozapine are exceptional in producing better results than others. Unfortunate their strength can trigger various possible side effects, especially on the blood cells. It means that people who are taking this prescription require regular blood tests.

    In some cases, doctors can decide to use an injection of long-acting medicine (depot injection) after easing of the symptoms. The drug in depot injection releases slowly into the body. A patient should get it every 2-4 weeks. The injections help to prevent recurrence of symptoms and they are an advantage to the patients because they do have to memorize taking of tablets every day.

    Benefits of Antipsychotics in Prevention of Delirium

    Some people have reservations about the use of antipsychotics, but they benefit patients with delirium by doing the following;

    1. Altering the effect of certain body chemicals

    Antipsychotics change the functioning of certain substances that cause reactions that cause disorientation. They alter the effect of particular chemicals in the brain called serotonin, dopamine, acetylcholine and noradrenaline. These are the chemicals that cause an effect that changes the mood, emotions and behavior. Dopamine is the primary chemical that antipsychotics direct their force. An alteration of the effects by these chemicals in the brain helps to prevent or suppress the following from occurring:

    • Delusions which make a patient have ideas without any basis on reality

    • Hallucinations such as hearing non-existent noises
    • Extreme mood swings that have an association with bipolar disorder
    • Thought disorder

    Antipsychotic medications are a short-term treatment for bipolar disorders to help also help in controlling mania symptoms alongside delusions and hallucinations. These are the symptoms that occur during a severe depression or acute mania. Some even help in the treatment of bipolar depression and some of them have demonstrated their long-term ability to prevent future episodes or depression or mania that occurs due to bipolar disorder. General practitioners usually refrain from prescribing antipsychotics before consulting a psychiatry specialist.

    2.Creates a Calming effect

    Antipsychotics are off-label sedatives for the patients with bipolar disorders to manage insomnia, agitation or anxiety. Doctors prescribe them to stabilize the mood and decrease symptoms of mania until the full effect of mood stabilizers. Some antipsychotics can help to stabilize the moods, and as a result, patients can solely rely on them for long-term treatment if they so do not respond to or tolerate to anticonvulsants and lithium.

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