Delirium during clozapine treatment: Incidence and associated risk factors

Pharmacopsychiatry

Volumn 36, Issue 4, 2003, Pages 156-160

  Centorrino, Franca ^a,b   Albert, M J ^a,b   Drago Ferrante, G ^a,b   Koukopoulos, A E ^a,b   Berry, J M ^a,b   Baldessarini, R J ^a,b  

^a HARVARD MEDICAL SCHOOL   (United States)

^b MASSACHUSETTS GENERAL HOSPITAL   (United States)

Author keywords

Anticholinergic; Clozapine; Delirium

Indexed keywords

ANTICONVULSIVE AGENT; ANTIDEPRESSANT AGENT; BENZODIAZEPINE DERIVATIVE; CHOLINERGIC RECEPTOR BLOCKING AGENT; CLOZAPINE; LITHIUM; LORAZEPAM; MUSCARINIC RECEPTOR BLOCKING AGENT; NEUROLEPTIC AGENT;

ADULT; AGING; ANTICHOLINERGIC EFFECT; ARTICLE; BIPOLAR DISORDER; COMORBIDITY; CONTROLLED STUDY; DELIRIUM; DEMENTIA; DISEASE ASSOCIATION; DISEASE PREDISPOSITION; DISEASE SEVERITY; FEMALE; HEALTH CARE COST; HOSPITAL PATIENT; HOSPITALIZATION; HUMAN; INCIDENCE; LENGTH OF STAY; LOGISTIC REGRESSION ANALYSIS; MAJOR CLINICAL STUDY; MAJOR DEPRESSION; MALE; MEDICAL RECORD; PRIORITY JOURNAL; RISK ASSESSMENT; RISK FACTOR; SCHIZOAFFECTIVE PSYCHOSIS; SCHIZOPHRENIA; SEX DIFFERENCE; TREATMENT OUTCOME;

ADULT; ANTIPSYCHOTIC AGENTS; CLOZAPINE; DELIRIUM; FEMALE; HOSPITALS, PSYCHIATRIC; HUMANS; MALE; MULTIVARIATE ANALYSIS; PSYCHOTIC DISORDERS; RETROSPECTIVE STUDIES;

EID: 0042878584     PISSN: 01763679     EISSN: None     Source Type: Journal    
DOI: 10.1055/s-2003-41201     Document Type: Article

References (40)

1. American Psychiatric Association: Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association, 1994
2. Baldessarini RJ. Drugs and the treatment of psychiatric disorders: Antipsychotic and antianxiety agents. Chapt 18 in Goodman and Gilman's The Pharmacological Basis of Therapeutics, ninth edition. Edited by Hardman JG, Limbird LE, Molinoff PB, Ruddon RW, Gilman AG, New York: McGraw-Hill, 1996: pp 399-430
3. Baldessarini RJ, Frankenburg FR. Clozapine. A novel antipsychotic agent. N Engl J Med 1991; 324: 746-754
4. Baldessarini RJ, Tarazi FI. Drugs and the treatment of psychiatric disorders: Antipsychotic and antimanic agents. Chapt 20 in Goodman and Gilman's The Pharmacologic Basis of Therapeutics. Edited by Hardman JG, Limbird LE, Molinoff PB, Ruddon RW, Gilman AG. New York, NY: McGraw-Hill, 2001: pp 485-520
5. Berggren D, Gustafson Y, Eriksson B, Bucht G, Hansson LI, Reiz S, Winblad B. Postoperative confusion after anesthesia in elderly patients with femoral neck fractures. Anesthesia Analgesia 1987; 66: 497-504
6. Breitbart W, Marotta R, Platt MM, Weisman H, Derevenco M, Grau C, Corbera K, Raymond S, Lund S, Jacobson P. A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am J Psychiatry 1996; 153: 231-237
7. Byerly MJ, Weber MT, Brooks DL, Snow LR, Worley MA, Lescouflair E. Antipsychotic medications and the elderly: effects on cognition and implications for use. Drugs Aging 2001; 18(1): 45-61
8. Caine ED, Lyness JM. Delirium, Dementia and other amnestic and cognitive disorders. Chapt 10 in Kaplan & Sadock's Comprehensive Textbook of Psychiatry, seventh edition, vol 1. Edited by Sadock BJ, Sadock VA. Baltimore: Lippincott Williams & Wilkins, 1999: pp 854-923
9. Carter J, Thrasher S, Thornicroft G. Cognitive impairment and clozapine. Br J Psychiatry 1994; 164: 132-133
10. Centorrino F, Eakin M, Bahk W-M, Kelleher JP, Goren JL, Salvatore P, Egli S, Baldessarini RJ. Inpatient antipsychotic drug use in 1998: Comparisons to 1993 and 1989. Am J Psychiatry Nov, 2002: in press
11. Centorrino F, Price BH, Tuttle M, Bahk W-M, Hennen J, Albert M, Baldessarini RJ. EEG abnormalities during treatment with typical and atypical antipsychotics. Am J Psychiatry 2002; 159: 109-115
12. Chong SA, Remington G. Clozapine augmentation: safety and efficacy. Schizophrenia Bull 2000; 26: 421-440
13. Cobb CD, Anderson CB, Seidel DR. Possible interaction between clozapine and lorazepam. Am J Psychiatry 1991; 148: 1606-1607
14. Fann JR. The epidemiology of delirium: a review of studies and methodological issues. Semin Clin Neuropsychiatry 2000; 5(2): 64-74
15. Folstein MF, Bassett SS, Romanoski AJ, Nestadt G. The epidemiology of delirium in the community: the Eastern Baltimore Mental Health Survey. Int Psychogeriatrics 1991; 3: 169-176
16. Francis J. Drug-induced delirium. CNS Drugs 1996; 5: 103-114
17. Gaertner HJ, Fischer E, Hoss J. Side effects of clozapine. Psychopharmacology 1989; 99 (Suppl): S97-100
18. Gardner DM, Baldessarini RJ, Benzo J, Zarate CA Jr, Tohen M, Switching between clozapine and risperidone treatment. Can J Psychiatry 1997; 42: 430-431
19. Granacher RP, Baldessarini RJ, Physostigmine. Its use in acute anticholinergic syndrome with antidepressant and antiparkinson drugs. Arch Gen Psychiatry 1975; 32: 375-380
20. Grohmann R, Ruther E, Sassim N, Schmidt LG. Adverse effects of clozapine. Psychopharmacology 1989; 99 (Suppl): S101-104
21. Itil T, Fink M. Anticholinergic drug-induced delirium: experimental modification, quantitative EEG and behavioral correlations. J Nerv Ment Dis 1966; 143: 492-507
22. Jackson CW, Markowitz JS, Brewerton TD. Delirium associated with clozapine and benzodiazepine combinations. Ann Clin Psychiatry 1995; 7: 139-141
23. Kane J, Honigfeld G, Singer J, Meltzer H. Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988; 45: 789-796
24. Lipowski ZJ. Update on delirium. Psychiatr Clin No Am 1992; 15: 335-346
25. Lu ML, Lane HY, Chen KP, Jann MW, Su MH, Chang WH. Fluvoxamine reduces the clozapine dosage needed in refractory schizophrenic patients. J Clin Psychiatry 2000; 61: 594-599
26. Naber D, Holzbach R, Perro C, Hippius H. Clinical management of clozapine patients in relation to efficacy and side-effects. Br J Psychiatry 1992; 160 (Suppl 17): 54-59
27. Olesen OV, Linnet K. Fluvoxamine-clozapine drug interaction: Inhibition in vitro of five cytochrome P450 isoforms involved in clozapine metabolism. J Clin Psychopharmacol 2000; 20: 35-42
28. Procyshyn RM, Thompson D, Tse G, Pharmacoeconomics of clozapine, risperidone and olanzapine: A review of the literature. CNS Drugs 2000; 13: 47-76
29. Schmidt LG, Grohmann R, Strauss A, Spiess-Kiefer C, Lindmeier D, Müller-Oerlinghausen B. Epidemiology of toxic delirium due to psychotropic drugs in psychiatric hospitals. Compr Psychiatry 1987; 28: 242-249
30. Schuster P, Gabriel E, Kufferle B, Strobl G, Karobath M. Reversal by physostigmine of clozapine-induced delirium. Clin Toxicol 1977; 10: 437-441
31. Smith LW, Dimsdale JE. Postcardiotomy delirium: Conclusions after 25 years. Am J Psychiatry 1989; 146: 452-458
32. Stahl SM. Antipsychotic polypharmacy: Therapeutic option or dirty little secret? J Clin Psychiatry 1999; 60: 425-426
33. Szymanski S, Jody D, Leipzig R, Masiar S, Lieberman J. Anticholinergic delirium caused by retreatment with clozapine. Am J Psychiatry 1991; 148: 1752-1753
34. Taylor D, Lewis S, Delirium. J Neurol Neurosurg Psychiatry 1993; 56: 742-751
35. Trzepacz PT, Brown TM, Stoudemire A. Treatments of psychiatric disorders: Substance-induced delirium. In Treatments of Psychiatric Disorders, vol 1. Edited by Gabbard GO. Washington, DC: American Psychiatric Press. 1995: pp 445-478
36. Viner MW, Escobar JI. An apparent neurotoxicity associated with clozapine. J Clin Psychiatry 1994; 55: 38-39
37. Wahlbeck K, Cheine M, Essali A, Adams C. Evidence of clozapine's effectiveness in schizophrenia: A systematic review and meta-analysis of randomized trials. Am J Psychiatry 1999; 156: 990-999
38. Wilkins-Ho M, Hollander Y. Toxic delirium with low-dose clozapine. Can J Psychiatry 1997; 42: 429-430
39. Young CR, Bowers MB Jr, Mazure CM. Management of the adverse effects of clozapine. Schizophrenia Bull 1998; 24: 381-390
40. Zarate CA Jr., Tohen M, Baldessarini RJ. Clozapine in severe mood disorders. J Clin Psychiatry 1995; 56: 411-417