Rapid reversal of digitalis delirium using digoxin immune Fab therapy

A fulminant psychiatric disturbance, as the sole noncardiac manifestation of digitalis toxicity, emerged in a 85-year-old woman during treatment for congestive heart failure. Described more than a century ago as "digitalis delirium," the disorder is characterized by severe agitation, delusional thinking, assaultive behavior, and even death. Digoxin immune Fab therapy was begun because of the fulminant psychiatric manifestations of this toxic state and the clear danger of self-inflicted physical harm. Within 3 h of therapy, a complete and spectacular resolution of all mental symptoms was observed.