Delirium Caused by Intramuscular Administration of Biperiden
2010; American Psychiatric Association Publishing; Volume: 22; Issue: 2 Linguagem: Inglês
10.1176/jnp.2010.22.2.247.e15
ISSN1545-7222
Autores Tópico(s)Psychosomatic Disorders and Their Treatments
ResumoBack to table of contents Previous article Next article LETTERFull AccessDelirium Caused by Intramuscular Administration of BiperidenYutaka Shinohara M.D.,Yutaka Shinohara M.D.,Published Online:1 Apr 2010https://doi.org/10.1176/jnp.2010.22.2.247.e15AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: A 63-year-old woman was admitted to the internal medicine ward to undergo chemotherapy for metastatic hepatoma of unknown primary origin. On admission, she experienced chest and lower back pain, and was given a normal dosage fentanyl patch. On day three of hospitalization, she became talkative and restless, wandering the halls of the ward, and began to complain of anxiety. The physician began a daily regimen of 5 mg IV haloperidol. Her mental status did not improve by day seven, so psychiatry was consulted. The patient complained of an abnormal feeling in her mouth due to thirst. The patient was agitated and restless, was continuously moving around, and would often wander around the hospital. She complained that the restlessness began after being prescribed the fentanyl patch 10 days prior. The patient was orientated only to date and self. From this presentation, a diagnosis of acathisia was surmised. Haloperidol was discontinued and 2 mg/day of cloxazolam was prescribed. In Japan, cloxazolam is prescribed for its antianxiety effects, similar to lorazepam.However, on day eight the patient was still wandering around the hospital ward, and the psychiatrist administered 5 mg of biperiden intramuscularly. No improvement of the patient's tendency to wander was observed immediately following the injection, and she became increasingly disoriented. She confused the hospital with her own home and her visiting daughter for a neighbor. She was clearly suffering from delirium; however, her delirium improved the following day. This case suggests that in cancer patients, administration of biperiden intensifies the cholinergic activity of sedatives such as fentanyl, and may lead to delirium. Delirium induced by biperiden 1 was known well, and we were able to show a real case here. Department of Psychiatry, Tokai University Hachioji Hospital, Tokyo, JapanReference1. Hewer W, Biedert S: Delirium syndrome in biperiden poisoning. Fortschr Neurol Psychiatr 1988; 56:133–136Google Scholar FiguresReferencesCited byDetailsCited byAnalysis of the Incidence and Risk Factors of Postoperative Delirium in Patients With Degenerative Cervical MyelopathyNeurospine, Vol. 19, No. 2Imputabilité des traitements anticholinergiques dans l'exacerbation d'épisodes psychotiques : à propos d'un cas de surdosage en tropatépineLa Revue de Médecine Interne, Vol. 42, No. 2Current Drug Safety, Vol. 14, No. 1Pediatric Practice and Research, Vol. 3, No. 1Biperiden-Induced Delirium in an Adolescent PatientJournal of Child and Adolescent Psychopharmacology, Vol. 21, No. 5 Volume 22Issue 2 Spring, 2010Pages 247.e15-247.e15 Metrics PDF download History Published online 1 April 2010 Published in print 1 April 2010
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