Delirium in critically ill patients: Epidemiology, pathophysiology, diagnosis and management

Drugs

Volumn 72, Issue 11, 2012, Pages 1457-1471

  Zaal, Irene J ^a   Slooter, Arjen J C ^a  

^a UNIVERSITY MEDICAL CENTER UTRECHT   (Netherlands)

Author keywords

Antipsychotics; Benzodiazepines; Cholinesterase inhibitors; Critical illness; Delirium; Dexmedetomidine; Haloperidol; Ketamine; Methylphenidate; Olanzapine; Opioid analgesics; Quetiapine; Rivastigmine

Indexed keywords

BENZODIAZEPINE; CLONIDINE; CYTOKINE; DEXMEDETOMIDINE; DONEPEZIL; HALOPERIDOL; KETAMINE; LORAZEPAM; MELATONIN; METHYLPHENIDATE; MIDAZOLAM; MORPHINE; NEUROLEPTIC AGENT; NEUROTRANSMITTER; OLANZAPINE; PLACEBO; PROPOFOL; QUETIAPINE; RISPERIDONE; RIVASTIGMINE; ZIPRASIDONE;

ADD ON THERAPY; ADVERSE OUTCOME; AKATHISIA; ARTICLE; ARTIFICIAL VENTILATION; CLINICAL ASSESSMENT TOOL; COGNITIVE DEFECT; CONTINUOUS INFUSION; CRITICALLY ILL PATIENT; DELIRIUM; DELIRIUM TREMENS; DISEASE SEVERITY; DSM-IV; EXTRAPYRAMIDAL SYMPTOM; HIGH RISK PATIENT; HUMAN; HYPOTENSION; INTENSIVE CARE PSYCHOSIS; INTENSIVE CARE UNIT; LOW DRUG DOSE; NEUROLEPTIC MALIGNANT SYNDROME; PARKINSONISM; PATHOPHYSIOLOGY; PHYSIOTHERAPY; POSTOPERATIVE DELIRIUM; PROGNOSIS; PROPHYLAXIS; QT PROLONGATION; RIGIDITY; RISK FACTOR; SCREENING TEST; SEDATION; SIDE EFFECT; TARDIVE DYSKINESIA; TORSADE DES POINTES; TREATMENT OUTCOME;

CRITICAL ILLNESS; DELIRIUM; HUMANS; INTENSIVE CARE; INTENSIVE CARE UNITS; RISK FACTORS;

EID: 84864261575     PISSN: 00126667     EISSN: 11791950     Source Type: Journal    
DOI: 10.2165/11635520-000000000-00000     Document Type: Article

References (115)

1. Adamis D, Treloar A, Martin FC, et al. A brief review of the history of delirium as a mental disorder. Hist Psychiatry 2007 Dec; 18 (72 Pt 4): 459-69
2. Meagher D. Motor subtypes of delirium: past, present and future. Int Rev Psychiatry 2009 Feb; 21 (1): 59-73
3. Morandi A, Jackson JC, Ely EW. Delirium in the intensive care unit. Int Rev Psychiatry 2009 Feb; 21 (1): 43-58
4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Revision. Washington, DC: American Psychiatric Association, 2000: 135-47
5. American Psychiatric Association. Practice guideline for the treatment of patients with delirium. Am J Psychiatry 1999 May; 156 (5 Suppl.): 1-20
6. Ouimet S, Riker R, Bergeon N, et al. Subsyndromal delirium in the ICU: evidence for a disease spectrum [published erratum appears in Intensive Care Med 2007 Sep; 33 (8): 1677]. Intensive Care Med 2007 Jun; 33 (6): 1007-13
7. Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ 2004 Jun 19; 328 (7454): 1490
8. van Eijk MM, Slooter AJ. Delirium in intensive care unit patients. Semin Cardiothorac Vasc Anesth 2010 Jun; 14 (2): 141-7
9. Bergeron N, Dubois MJ, Dumont M, et al. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med 2001May; 27 (5): 859-64 (Pubitemid 32480514)
10. Ely EW, Girard TD, Shintani AK, et al. Apolipoprotein E4 polymorphism as a genetic predisposition to delirium in critically ill patients. Crit Care Med 2007 Jan; 35 (1): 112-7 (Pubitemid 46035685)
11. Pandharipande P, Shintani A, Peterson J, et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology 2006 Jan; 104 (1): 21-6
12. Roberts B, Rickard CM, Rajbhandari D, et al. Multicentre study of delirium in ICU patients using a simple screening tool. Aust Crit Care 2005 Feb; 18 (1): 6, 8-4
13. Balas MC, Happ MB, Yang W, et al. Outcomes associated with delirium in older patients in surgical ICUs. Chest 2009 Jan; 135 (1): 18-25
14. Angus DC, Kelley MA, Schmitz RJ, et al. Caring for the critically ill patient: current and projected workforce requirements for care of the critically ill and patients with pulmonary disease. Can we meet the requirements of an aging population? JAMA 2000; 284 (21): 2762-70
15. Ely EW, Gautam S, Margolin R, et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 2001 Dec; 27 (12): 1892-900 (Pubitemid 33145075)
16. Pisani MA, Murphy TE, Araujo KL, et al. Benzodiazepine and opioid use and the duration of intensive care unit delirium in an older population. Crit Care Med 2009 Jan; 37 (1): 177-83
17. van Eijk MM, van Marum RJ, Klijn IA, et al. Comparison of delirium assessment tools in a mixed intensive care unit. Crit Care Med 2009 Jun; 37 (6): 1881-5
18. Heymann A, Radtke F, Schiemann A, et al. Delayed treatment of delirium increases mortality rate in intensive care unit patients. J Int Med Res 2010 Sep; 38 (5): 1584-95
19. Young J, Murthy L, Westby M, et al. Diagnosis, prevention, and management of delirium: summary of NICE guidance. BMJ 2010; 341: c3704
20. Martin J, Heymann A, Basell K, et al. Evidence and consensus- based German guidelines for the management of analgesia, sedation and delirium in intensive care-short version. Ger Med Sci 2010; 8: Doc02
21. Jacobi J, Fraser GL, Coursin DB, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002 Jan; 30 (1): 119-41 (Pubitemid 34112188)
22. Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 2001; 286 (21): 2703-10 (Pubitemid 33135077)
23. Luetz A, Heymann A, Radtke FM, et al. Different assessment tools for intensive care unit delirium: which score to use? Crit Care Med 2010 Feb; 38 (2): 409-18
24. Neto AS, Nassar Jr AP, Cardoso SO, et al. Delirium screening in critically ill patients: a systematic review and meta-analysis. Crit Care Med 2012 Jun; 40 (6): 1946-51
25. van Eijk MM, van den Boogaard M, van Marum RJ, et al. Routine use of the confusion assessment method for the intensive care unit: a multicenter study. Am J Respir Crit Care Med 2011 Aug 1; 184 (3): 340-4
26. Peterson JF, Pun BT, Dittus RS, et al. Delirium and its motoric subtypes: a study of 614 critically ill patients. J Am Geriatr Soc 2006 Mar; 54 (3): 479-84 (Pubitemid 43327161)
27. Pandharipande P, Cotton BA, Shintani A, et al. Motoric subtypes of delirium in mechanically ventilated surgical and trauma intensive care unit patients. Intensive Care Med 2007 Oct; 33 910): 1726-31 (Pubitemid 47476638)
28. Steiner LA. Postoperative delirium. Part 1: pathophysiology and risk factors. Eur J Anaesthesiol 2011 Sep; 28 (9): 628-36
29. Hshieh TT, Fong TG, Marcantonio ER, et al. Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence. J Gerontol A Biol Sci Med Sci 2008 Jul; 63 (7): 764-72
30. Han L, McCusker J, Cole M, et al. Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. Arch Intern Med 2001 Apr 23; 161 (8): 1099-105 (Pubitemid 32685536)
31. van Gool WA, van de Beek D, Eikelenboom P. Systemic infection and delirium: when cytokines and acetylcholine collide. Lancet 2010 Feb 27; 375 (9716): 773-5
32. Trzepacz PT. Update on the neuropathogenesis of delirium. Dement Geriatr Cogn Disord 1999 Sep; 10 (5): 330-4 (Pubitemid 29403589)
33. Trzepacz PT. Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Semin Clin Neuropsychiatry 2000 Apr; 5 (2): 132-48
34. Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA 2009 Feb 4; 301 (5): 489-99
35. Janz DR, Abel TW, Jackson JC, et al. Brain autopsy findings in intensive care unit patients previously suffering from delirium: a pilot study. J Crit Care 2010 Sep; 25 (3): 538-12
36. Iacobone E, Bailly-Salin J, Polito A, et al. Sepsis-associated encephalopathy and its differential diagnosis. Crit Care Med 2009 Oct; 37 (10 Suppl.): S331-6
37. Kruis RW, Vlasveld FA, Van DD. The (un)importance of cerebral microemboli. Semin Cardiothorac Vasc Anesth 2010 Jun; 14 (2): 111-8
38. Morandi A, Jackson JC. Delirium in the intensive care unit: a review. Neurol Clin 2011 Nov; 29 (4): 749-63
39. van den Boogaard M, Kox M, Quinn KL, et al. Biomarkers associated with delirium in critically ill patients and their relation with long-term subjective cognitive dysfunction; indications for different pathways governing delirium in inflamed and non-inflamed patients. Crit Care 2011 Dec 29; 15 (6): R297
40. McGrane S, Girard TD, Thompson JL, et al. Procalcitonin and C-reactive protein levels at admission as predictors of duration of acute brain dysfunction in critically ill patients. Crit Care 2011; 15 (2): R78
41. de Rooij SE, van Munster BC, Korevaar JC, et al. Cytokines and acute phase response in delirium. J Psychosom Res 2007 May; 62 (5): 521-5 (Pubitemid 46635470)
42. Maclullich AM, Ferguson KJ, Miller T, et al. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res 2008 Sep; 65 (3): 229-38
43. Lupien SJ, Maheu F, Tu M, et al. The effects of stress and stress hormones on human cognition: implications for the field of brain and cognition. Brain Cogn 2007 Dec; 65 (3): 209-37 (Pubitemid 350051538)
44. Mu DL, Wang DX, Li LH, et al. High serum cortisol level is associated with increased risk of delirium after coronary artery bypass graft surgery: a prospective cohort study. Crit Care 2010; 14 (6): R238
45. Trzepacz PT. The neuropathogenesis of delirium: a need to focus our research. Psychosomatics 1994 Jul; 35 (4): 374-91 (Pubitemid 24206400)
46. DeBellis R, Smith BS, Choi S, et al. Management of delirium tremens. J Intensive Care Med 2005 May; 20 (3): 164-73 (Pubitemid 43086469)
47. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons: predictive model and interrelationship with baseline vulnerability. JAMA 1996 Mar 20; 275 (11): 852-7 (Pubitemid 26087222)
48. McNicoll L, Pisani MA, Zhang Y, et al. Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc 2003 May; 51 (5): 591-8 (Pubitemid 36541421)
49. Pisani MA, Murphy TE, Van Ness PH, et al. Characteristics associated with delirium in older patients in a medical intensive care unit. Arch Intern Med 2007 Aug 13; 167(15): 1629-34 (Pubitemid 47280343)
50. Boogaard M, Pickkers P, Slooter AJ, et al. Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: observational multicentre study. BMJ 2012; 344: e420
51. Aldemir M, Ozen S, Kara IH, et al. Predisposing factors for delirium in the surgical intensive care unit. Crit Care 2001 Oct; 5 (5): 265-70 (Pubitemid 32976334)
52. Van Rompaey B, Elseviers MM, Schuurmans MJ, et al. Risk factors for delirium in intensive care patients: a prospective cohort study. Crit Care 2009; 13 (3): R77
53. Ouimet S, Kavanagh BP, Gottfried SB, et al. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 2007 Jan; 33 (1): 66-73 (Pubitemid 46115471)
54. Lin SM, Liu CY, Wang CH, et al. The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med 2004 Nov; 32 (11): 2254-9
55. Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291 (14): 1753-62 (Pubitemid 38489897)
56. Kishi Y, Iwasaki Y, Takezawa K, et al. Delirium in critical care unit patients admitted through an emergency room. Gen Hosp Psychiatry 1995 Sep; 17 (5): 371-9
57. Milbrandt EB, Deppen S, Harrison PL, et al. Costs associated with delirium in mechanically ventilated patients. Crit Care Med 2004 Apr; 32 (4): 955-62 (Pubitemid 38471515)
58. Pisani MA, Kong SY, Kasl SV, et al. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med 2009 Dec 1; 180 (11): 1092-7
59. van den Boogaard M, Schoonhoven L, Evers AW, et al. Delirium in critically ill patients: impact on long-term health-related quality of life and cognitive functioning. Crit Care Med 2012 Jan; 40 (1): 112-8
60. Balas MC, Deutschman CS, Sullivan-Marx EM, et al. Delirium in older patients in surgical intensive care units. J Nurs Scholarsh 2007; 39 (2): 147-54
61. Dubois MJ, Bergeron N, Dumont M, et al. Delirium in an intensive care unit: a study of risk factors. Intensive Care Med 2001 Aug; 27 (8): 1297-304 (Pubitemid 32758927)
62. Cole M, McCusker J, Dendukuri N, et al. The prognostic significance of subsyndromal delirium in elderly medical inpatients. J Am Geriatr Soc 2003 Jun; 51 (6): 754-60 (Pubitemid 36693423)
63. van Eijk MM, Slooter AJ. Duration of ICU delirium, severity of the underlying disease, and mortality. Am J Respir Crit Care Med 2010 Feb 15; 181 (4): 419-20
64. van den BoogaardM, Pickkers P, van der Hoeven H, et al. Implementation of a delirium assessment tool in the ICU can influence haloperidol use. Crit Care 2009; 13 (4): R131
65. Riekerk B, Pen EJ, Hofhuis JG, et al. Limitations and practicalities of CAM-ICU implementation, a delirium scoring system, in a Dutch intensive care unit. Intensive Crit Care Nurs 2009 Oct; 25 (5): 242-9
66. Weinert CR, Mann HJ. The science of implementation: changing the practice of critical care. Curr Opin Crit Care 2008 Aug; 14 (4): 460-5
67. Tabet N, Howard R. Non-pharmacological interventions in the prevention of delirium. Age Ageing 2009 Jul; 38 (4): 374-9
68. Marcantonio ER, Flacker JM, Wright RJ, et al. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 2001 May; 49 (5): 516-22 (Pubitemid 32525020)
69. Inouye SK, Bogardus Jr ST, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999; 340 (9): 669-76 (Pubitemid 29110750)
70. Immers HE, Schuurmans MJ, van de Bijl JJ. Recognition of delirium in ICU patients: a diagnostic study of the NEECHAM confusion scale in ICU patients. BMC Nurs 2005 Dec 13; 4: 7
71. Van Rompaey B, Elseviers MM, Van Drom W, et al. The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients. Critical Care 2012 May 4; 16: R73
72. Zaal IJ, Peelen LM, Spruyt CF, et al. Nursing environment and delirium in ICU patients [abstract no. P334]. Critical Care 2011 Mar 11; 15 Suppl. 1: P334. Plus poster presented at the 31st International Symposium on Intensive Care and Emergency Medicine; 2011 Mar 22-25; Brussels
73. Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009 May 30; 373 (9678): 1874-82
74. Needham DM, Korupolu R, Zanni JM, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil 2010 Apr; 91 (4): 536-42
75. Gamberini M, Bolliger D, Lurati Buse GA, et al. Rivastigmine for the prevention of postoperative delirium in elderly patients undergoing elective cardiac surgery: a randomized controlled trial. Crit Care Med 2009 May; 37 (5): 1762-8
76. Hudetz JA, Patterson KM, Iqbal Z, et al.Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2009 Oct; 23 (5): 651-7
77. Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 2007 Dec 12; 298 (22): 2644-53 (Pubitemid 350254956)
78. Prakanrattana U, Prapaitrakool S. Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery. Anaesth Intensive Care 2007 Oct; 35 (5): 714-9 (Pubitemid 47572095)
79. Wang W, Li HL, Wang DX, et al. Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial. Crit Care Med 2012 Mar; 40 (3): 731-9
80. Devlin JW, Roberts RJ, Fong JJ, et al. Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo- controlled pilot study. Crit Care Med 2010 Feb; 38 (2): 419-27
81. Girard TD, Pandharipande PP, Carson SS, et al. Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebocontrolled trial. Crit Care Med 2010 Feb; 38 (2): 428-37
82. Skrobik YK, Bergeron N, Dumont M, et al. Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Med 2004 Mar; 30 (3): 444-9 (Pubitemid 38375619)
83. van Eijk MM, Roes KC, Honing ML, et al. Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomized trial. Lancet 2010 Nov 27; 376 (9755): 1829-37
84. Campbell N, Boustani MA, Ayub A, et al. Pharmacological management of delirium in hospitalized adults: a systematic evidence review. J Gen Intern Med 2009 Jul; 24 (7): 848-53
85. Bourne RS, Tahir TA, Borthwick M, et al. Drug treatment of delirium: past, present and future. J Psychosom Res 2008 Sep; 65 (3): 273-82
86. Tabet N, Howard R. Pharmacological treatment for the prevention of delirium: review of current evidence. Int J Geriatr Psychiatry 2009 Oct; 24 (10): 1037-44
87. Bourne RS, Mills GH. Melatonin: possible implications for the postoperative and critically ill patient. Intensive Care Med 2006 Mar; 32 (3): 371-9 (Pubitemid 43289645)
88. Hanania M, Kitain E. Melatonin for treatment and prevention of postoperative delirium. Anesth Analg 2002 Feb; 94 (2): 338-9 (Pubitemid 34106824)
89. Gaudreau JD, Gagnon P, Roy MA, et al. Association between psychoactive medications and delirium in hospitalized patients: a critical review. Psychosomatics 2005 Jul; 46 (4): 302-16 (Pubitemid 41472628)
90. Clegg A, Young JB. Which medications to avoid in people at risk of delirium: a systematic review. Age Ageing 2011 Jan; 40 (1): 23-9
91. Tune LE. Anticholinergic effects of medication in elderly patients. J Clin Psychiatry 2001; 62 Suppl. 21: 11-4 (Pubitemid 32937572)
92. Marcantonio ER, Goldman L, Mangione CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA 1994 Jan 12; 271 (2): 134-9 (Pubitemid 24020590)
93. Pandharipande P, Cotton BA, Shintani A, et al. Prevalence and Risk Factors for Development of Delirium in Surgical and Trauma Intensive Care Unit Patients. J Trauma 2008 Jul; 65 (1): 34-41
94. Morrison RS, Magaziner J, Gilbert M, et al. Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci 2003 Jan; 58 (1): 76-81 (Pubitemid 36110059)
95. Shehabi Y, Grant P, Wolfenden H, et al. Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine- DEXCOM Study). Anesthesiology 2009 Nov; 111 (5): 1075-84
96. Jakob SM, Ruokonen E, Grounds RM, et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA 2012 Mar 21; 307 (11): 1151-60
97. Kress JP, Pohlman AS, O'Connor MF, et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342 (20): 1471-7 (Pubitemid 30318270)
98. Ely EW, Baker AM, Dunagan DP, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996 Dec 19; 335 (25): 1864-9 (Pubitemid 26419193)
99. Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomized controlled trial. Lancet 2008 Jan 12; 371 (9607): 126-34
100. Morandi A, Brummel NE, Ely EW. Sedation, delirium and mechanical ventilation: the 'ABCDE' approach. Curr Opin Crit Care 2011 Feb; 17 (1): 43-9
101. Skrobik Y, Ahern S, Leblanc M, et al. Protocolized intensive care unit management of analgesia, sedation, and delirium improves analgesia and subsyndromal delirium rates. Anesth Analg 2010 Aug; 111 (2): 451-63
102. Seitz DP, Gill SS, van Zyl LT. Antipsychotics in the treatment of delirium: a systematic review. J Clin Psychiatry 2007 Jan; 68 (1): 11-21 (Pubitemid 46220119)
103. Flaherty JH, Gonzales JP, Dong B. Antipsychotics in the treatment of delirium in older hospitalized adults: a systematic review. JAmGeriatr Soc 2011 Nov; 59 Suppl. 2: S269-76
104. Lundstrom M, Edlund A, Karlsson S, et al. A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. J Am Geriatr Soc 2005 Apr; 53 (4): 622-8 (Pubitemid 41623484)
105. Reade MC, O'Sullivan K, Bates S, et al. Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial. Crit Care 2009; 13 (3): R75
106. Kapur S, Seeman P. Does fast dissociation from the dopamine d(2) receptor explain the action of atypical antipsychotics? A new hypothesis. Am J Psychiatry 2001 Mar; 158 (3): 360-9 (Pubitemid 32205190)
107. Devlin JW, Bhat S, Roberts RJ, et al. Current perceptions and practices surrounding the recognition and treatment of delirium in the intensive care unit: a survey of 250 critical care pharmacists from eight states. Ann Pharmacother 2011 Oct; 45 (10): 1217-29
108. Swan JT, Fitousis K, Hall JB, et al. Antipsychotic use and diagnosis of delirium in the intensive care unit. Crit Care 2012 May 16; 16 (3): R84
109. Riker RR, Fraser GL, Richen P. Movement disorders associated with withdrawal from high-dose intravenous haloperidol therapy in delirious ICU patients. Chest 1997 Jun; 111 (6): 1778-81 (Pubitemid 27260121)
110. Fischer P. Successful treatment of nonanticholinergic delirium with a cholinesterase inhibitor. J Clin Psychopharmacol 2001 Feb; 21 (1): 118 (Pubitemid 32096766)
111. Oldenbeuving AW, de Kort PL, Jansen BP, et al. A pilot study of rivastigmine in the treatment of delirium after stroke: a safe alternative. BMC Neurol 2008; 8: 34
112. Overshott R, Vernon M, Morris J, et al. Rivastigmine in the treatment of delirium in older people: a pilot study. Int Psychogeriatr 2010 Aug; 22 (5): 812-8
113. Marcantonio ER, Palihnich K, Appleton P, et al. Pilot randomized trial of donepezil hydrochloride for delirium after hip fracture. J Am Geriatr Soc 2011 Nov; 59 Suppl. 2: S282-8
114. Gagnon B, Low G, Schreier G. Methylphenidate hydrochloride improves cognitive function in patients with advanced cancer and hypoactive delirium: a prospective clinical study. J Psychiatry Neurosci 2005 Mar; 30 (2): 100-7
115. Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol 2007 May; 6 (5): 442-55 (Pubitemid 46551868)