RESUMO
Delirium can be conceptualized as an acute decline in cognitive function that typically lasts from hours to a few days. Prolonged delirium can also affect patients with multiple predisposing and/or precipitating factors. In clinical practice, prolonged delirium is often unrecognized, and can be misdiagnosed as other psychiatric disorders. We describe a case of a 59-year-old male presenting with behavioral and cognitive symptoms that was first misdiagnosed as a mood disorder in a general hospital setting. After prolonged delirium due to multiple factors was confirmed, the patient was treated accordingly with symptomatic management. He evolved with progressive improvement of his clinical status. Early diagnosis and management of prolonged delirium are important to improve patient prognosis and avoid iatrogenic measures.
Delirium pode ser conceituado como o declínio agudo na função cognitiva que geralmente dura de horas a dias. O delírio prolongado também pode afetar pacientes com múltiplos fatores predisponentes e/ou precipitantes. Na prática clínica, o delírio prolongado é muitas vezes não reconhecido, e pode ser diagnosticado como outros transtornos psiquiátricos. Aqui, descrevemos o caso de um homem de 59 anos apresentando sintomas comportamentais e cognitivos que foi diagnosticado inicialmente com transtorno de humor em um hospital geral. Após ser diagnosticado delirium prolongado devido a múltiplos fatores, o paciente foi tratado de acordo, evoluindo com melhora progressiva do seu estado clínico. O diagnóstico e o manejo precoces do delirium prolongado são importantes para melhorar o prognóstico do paciente e evitar medidas iatrogênicas.
RESUMO
ABSTRACT Delirium can be conceptualized as an acute decline in cognitive function that typically lasts from hours to a few days. Prolonged delirium can also affect patients with multiple predisposing and/or precipitating factors. In clinical practice, prolonged delirium is often unrecognized, and can be misdiagnosed as other psychiatric disorders. We describe a case of a 59-year-old male presenting with behavioral and cognitive symptoms that was first misdiagnosed as a mood disorder in a general hospital setting. After prolonged delirium due to multiple factors was confirmed, the patient was treated accordingly with symptomatic management. He evolved with progressive improvement of his clinical status. Early diagnosis and management of prolonged delirium are important to improve patient prognosis and avoid iatrogenic measures.
RESUMO Delirium pode ser conceituado como o declínio agudo na função cognitiva que geralmente dura de horas a dias. O delírio prolongado também pode afetar pacientes com múltiplos fatores predisponentes e/ou precipitantes. Na prática clínica, o delírio prolongado é muitas vezes não reconhecido, e pode ser diagnosticado como outros transtornos psiquiátricos. Aqui, descrevemos o caso de um homem de 59 anos apresentando sintomas comportamentais e cognitivos que foi diagnosticado inicialmente com transtorno de humor em um hospital geral. Após ser diagnosticado delirium prolongado devido a múltiplos fatores, o paciente foi tratado de acordo, evoluindo com melhora progressiva do seu estado clínico. O diagnóstico e o manejo precoces do delirium prolongado são importantes para melhorar o prognóstico do paciente e evitar medidas iatrogênicas.
Assuntos
Humanos , Transtornos do Humor , Delírio , Hospitais GeraisRESUMO
BACKGROUND: Akathisia continues to be a significant challenge in current neurological and psychiatric practice. Prompt and accurate detection is often difficult and there is a lack of consensus concerning the neurobiological basis of akathisia. No definitive treatment has been established for akathisia despite numerous preclinical and clinical studies.] Method: We reviewed antipsychotic-induced akathisia including its clinical presentation, proposed underlying pathophysiology, current and under investigation therapeutic strategies. CONCLUSION: Despite the initial promise that second generation antipsychotics would be devoid of akathisia effects, this has not been confirmed. Currently, there are limited therapeutic options for the clinical practice and the evidence supporting the most widely used treatments (beta blockers, anticholinergic drugs) is still absent or inconsistent.
