Delirium in COVID-19: psychopharmacology considerations
Introduction Delirium is characterized by fluctuating disturbance of consciousness, inattention, reduced awareness, hallucinations or delusions, occurring in 20% of hospital admissions. Central nervous system symptoms are the main form of neurologic injury in patients with COVID-19 and a significa...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2021-04-01
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| Series: | European Psychiatry |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933821007343/type/journal_article |
| _version_ | 1827754801022107648 |
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| author | M. Lemos J. Rema T. Reynolds De Sousa |
| author_facet | M. Lemos J. Rema T. Reynolds De Sousa |
| author_sort | M. Lemos |
| collection | DOAJ |
| description |
Introduction
Delirium is characterized by fluctuating disturbance of consciousness, inattention, reduced awareness, hallucinations or delusions, occurring in 20% of hospital admissions. Central nervous system symptoms are the main form of neurologic injury in patients with COVID-19 and a significant portion of these patients presents with delirium. COVID-19 infection’s course and symptoms, as well as patient comorbidities can facilitate its onset, which is exacerbated by the frequent need for higher doses of sedation to suppress severe cough.
Objectives
To summarize the most recent practices for management of delirium in COVID-19 infected patients, with emphasis on the psychopharmacology approach.
Methods
Selective literature review via PubMed search, using the terms “delirium, neurological disorders, psychopharmacology and COVID-19”.
Results
COVID-19 associated delirium can be presented in its hyperactive type with exuberant agitation, but also with additional clinical features such as rigidity, akinetic mutism, abulia and alogia. Psychopharmacological approaches may be needed for patients with agitation when there’s intractable stress or risk to self or others. In this group of patients, melatonin, alfa-2 agonists and low potency antipsychotics have been used as first line treatment. Trazodone, valproate, dopamine agonists, amantadine can be used. Other approaches such as correction of vitamin deficiencies and remdesivir can also play a role.
Conclusions
Delirium remains frequently unrecognized. In the pandemic context of COVID-19 it is important to consider this infection as a cause of delirium and mind the misdiagnosis as a psychiatric condition. One should look for atypical features and be more thoughtful about the psychopharmacological approach.
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| first_indexed | 2024-03-11T07:55:45Z |
| format | Article |
| id | doaj.art-73220d139c72444099229cbefb9ceff5 |
| institution | Directory Open Access Journal |
| issn | 0924-9338 1778-3585 |
| language | English |
| last_indexed | 2024-03-11T07:55:45Z |
| publishDate | 2021-04-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj.art-73220d139c72444099229cbefb9ceff52023-11-17T05:05:53ZengCambridge University PressEuropean Psychiatry0924-93381778-35852021-04-0164S273S27410.1192/j.eurpsy.2021.734Delirium in COVID-19: psychopharmacology considerationsM. Lemos0J. Rema1T. Reynolds De Sousa2Psychiatry, Centro Hospitalar Lisboa Norte, Lisboa, PortugalPsychiatry, Centro Hospitalar Lisboa Norte, Lisboa, PortugalPsychiatry, Centro Hospitalar Lisboa Norte, Lisboa, Portugal Introduction Delirium is characterized by fluctuating disturbance of consciousness, inattention, reduced awareness, hallucinations or delusions, occurring in 20% of hospital admissions. Central nervous system symptoms are the main form of neurologic injury in patients with COVID-19 and a significant portion of these patients presents with delirium. COVID-19 infection’s course and symptoms, as well as patient comorbidities can facilitate its onset, which is exacerbated by the frequent need for higher doses of sedation to suppress severe cough. Objectives To summarize the most recent practices for management of delirium in COVID-19 infected patients, with emphasis on the psychopharmacology approach. Methods Selective literature review via PubMed search, using the terms “delirium, neurological disorders, psychopharmacology and COVID-19”. Results COVID-19 associated delirium can be presented in its hyperactive type with exuberant agitation, but also with additional clinical features such as rigidity, akinetic mutism, abulia and alogia. Psychopharmacological approaches may be needed for patients with agitation when there’s intractable stress or risk to self or others. In this group of patients, melatonin, alfa-2 agonists and low potency antipsychotics have been used as first line treatment. Trazodone, valproate, dopamine agonists, amantadine can be used. Other approaches such as correction of vitamin deficiencies and remdesivir can also play a role. Conclusions Delirium remains frequently unrecognized. In the pandemic context of COVID-19 it is important to consider this infection as a cause of delirium and mind the misdiagnosis as a psychiatric condition. One should look for atypical features and be more thoughtful about the psychopharmacological approach. https://www.cambridge.org/core/product/identifier/S0924933821007343/type/journal_articledeliriumPsychopharmacologyCOVID-19neurological disorders |
| spellingShingle | M. Lemos J. Rema T. Reynolds De Sousa Delirium in COVID-19: psychopharmacology considerations European Psychiatry delirium Psychopharmacology COVID-19 neurological disorders |
| title | Delirium in COVID-19: psychopharmacology considerations |
| title_full | Delirium in COVID-19: psychopharmacology considerations |
| title_fullStr | Delirium in COVID-19: psychopharmacology considerations |
| title_full_unstemmed | Delirium in COVID-19: psychopharmacology considerations |
| title_short | Delirium in COVID-19: psychopharmacology considerations |
| title_sort | delirium in covid 19 psychopharmacology considerations |
| topic | delirium Psychopharmacology COVID-19 neurological disorders |
| url | https://www.cambridge.org/core/product/identifier/S0924933821007343/type/journal_article |
| work_keys_str_mv | AT mlemos deliriumincovid19psychopharmacologyconsiderations AT jrema deliriumincovid19psychopharmacologyconsiderations AT treynoldsdesousa deliriumincovid19psychopharmacologyconsiderations |