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The diagnosis and management of delirium in infancy
Susan Beckwitt Turkel1, Julienne R Jacobson, C Jane Tavaré
1Departments of Psychiatry and Pediatrics, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA 90027, USA. sbturkel@usc.edu
Insights
Atypical antipsychotics effectively managed delirium symptoms in young children, with significant symptom reduction observed. These medications appeared safe and beneficial for pediatric patients experiencing delirium.
Area of Science:
- Pediatric Psychiatry
- Neuroscience
- Pharmacology
Background:
- Delirium management in very young children is understudied.
- Atypical antipsychotics show promise for delirium in older populations.
Purpose of the Study:
- To describe the use of atypical antipsychotics in infants and toddlers with delirium.
- To evaluate the safety and efficacy of these medications in a very young pediatric population.
Main Methods:
- Retrospective chart review of psychiatric inpatient consultations for children under 36 months with delirium.
- Calculation of Delirium Rating Scale (DRS) scores before and after treatment.
Main Results:
- Olanzapine and risperidone were used in 19 children (ages 7-30 months).
- Mean DRS scores significantly decreased (p<0.001) with treatment.
- No significant adverse side effects were reported.
Conclusions:
- Atypical antipsychotics appear effective and safe for managing delirium in infants and toddlers.
- Further randomized controlled trials are needed to confirm indications, risks, and benefits.
Objective:
Atypical antipsychotics have been documented to be effective in the management of delirium in adults and older children, but despite considerable need, their use has been less studied in the very young. A retrospective chart review was undertaken to describe the use of atypical antipsychotics in controlling symptoms of delirium in infants and toddlers.
Methods:
All psychiatric inpatient consultations performed during a 3 year period were reviewed to identify children <36 months old diagnosed with delirium. Delirium Rating Scale (DRS) scores were retrospectively calculated when the antipsychotic was initiated and discontinued, to confirm the diagnosis of delirium and evaluate symptom severity, and then to assess symptom response to pharmacologic intervention.
Results:
There were 10 boys and 9 girls in the study population (ages 7-30 months, mean 20.5 months). Olanzapine (n=16) and risperidone (n=3) were used, and length of treatment and response were comparable for both medications. Mean DRS scores decreased significantly (p<0.001) with antipsychotic administration, without significant adverse side effects.
Conclusions:
Although randomized placebo controlled studies are needed to better characterize the indications, risks, and benefits, these atypical antipsychotic medications appeared to be effective and safe for managing delirium symptoms in very young pediatric patients.
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