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Editorial
Canadian Journal of Psychiatry: New Editor and New Policies
Joel Paris, MD
(PDF)

Guest Editorial
Risk Assessment in Psychiatric Practice
Kenneth Hashman, MD, FRCPC, DABPN
(PDF)

In Review
The Canadian Contribution to Violence Risk Assessment: History and Implications for Current Psychiatric Practice
Hy Bloom, LLB, MD, Christopher Webster, PhD, Stephen Hucker, MB, Karen De Freitas, MD
(PDF)

The Clinical Use of Risk Assessment
Graham D Glancy, MB, ChB, FRCPsych, FRCPC, Gary Chaimowitz, MB, ChB, FRCPC
(PDF)

The State of Contemporary Risk Assessment Research
Michael A Norko, MD, Madelon V Baranoski, PhD
(PDF)

Review Paper
Community Treatment Orders: Profile of a Canadian Experience
Ann-Marie A O’Brien, MSW, RSW, Susan J Farrell, PhD, CPsych*
(PDF)

International Dosage Differences in Fluoxetine Clinical Trials
Scott Patten, MD, Andrea Cipriani, MD, Paolo Brambilla, MD3, Michela Nosè, MD, Corrado Barbui, MD
(PDF)

Original Research
Panic-Agoraphobic Spectrum and Light Sensitivity in a General Population Sample in Italy
Letizia Bossini, MD, Mirko Martinucci, MD, Katia Paolini, MD, Paolo Castrogiovanni, MD
(PDF)

Psychotic Disorders Clinic and First-Episode Psychosis: A Program Evaluation
Suzanne Archie, MD, FRCPC, Jane Hamilton Wilson, RN, Kevin Woodward, BSc, Heather Hobbs, RN, Shelley Osborne, RN, Jean McNiven, RN
(PDF)

Screening for Mild Cognitive Impairment: Comparing the SMMSE and the ABCS
D William Molloy, MB, MRCPI, FRCPC, Timothy IM Standish, David L Lewis, PhD
(PDF)

Attention-Deficit Hyperactivity Disorder With and Without Obsessive–Compulsive Behaviours: Clinical Characteristics, Cognitive Assessment, and Risk Factors
Paul Daniel Arnold, MD, FRCPC, Abel Ickowicz, MD, FRCPC, Shirley Chen, MD, MPH, Russell Schachar, MD, FRCPC
(PDF)

Brief Communication
Validation de la version française de l’inventaire de détresse péritraumatique
Louis Jehel, MD, PhD, Alain Brunet, PhD, Sabrina Paterniti, MD, PhD, Julien D Guelfi, MD, Pr
(PDF)

Book Reviews
(PDF)

The Confinement of the Insane: International Perspectives, 1800–1965
Review by
Laurence Jerome, MD

Suicide in Children and Adolescents
Review by
Paul S Links, MD, FRCPC

Letters to the Editor
(PDF)

A Novel Form of Treatment Resistance in Anorexia Nervosa

Capgras Syndrome in the Modern Era: Self Misidentification on an ID Picture

Effectiveness of Risperidone in Delirium

Family-Oriented Rehabilitation for Unexplained Chronic Pain

Hypokalemia from Risperidone and Quetiapine Overdose

A Renewed Interest in Day Treatment

Quetiapine Therapy for Corticosteroid-Induced Mania

Letters to the Editor

Effectiveness of Risperidone in Delirium

Dear Editor: Delirium is a common and complex neuropsychiatric syndrome seen frequently in medical settings. If untreated, it is associated with high mortality (1). Apart from a multifaceted interdisciplinary approach involving environmental strategies, antipsychotic medication remains the cornerstone of treatment (1). Among these drugs, the typical antipsychotic haloperidol has been the drug of choice, mainly owing to its lack of anticholinergic (1) and minimal hemodynamic and respiratory side effects (2). Over the last decade, however, evidence has emerged for the use of second generation antipsychotics like risperidone—but only in the form of case reports and case series (3,4). We report our experience in treating 7 cases of delirium with risperidone.

To identify the target group, we screened case notes of all patients with a diagnosis of delirium seen over a 4-year period. Seven patients who had delirium when assessed were treated with risperidone.

The demographic profile was as follows: the patients’ mean age was 32 years (range 24 to 67 years); 60% were men, and 40% were women; they had on average 6 years of education; and 70% had low socioeconomic status. There was only 1 elderly woman (aged 67 years) with past cardiac problems and current hypoactive delirium. The rest of the sample had no past cardiac problems and presented with hyperactive delirium. The mean duration of delirium before initiation of treatment was 5.29 days (range 1 to 15 days, with the maximum for the elderly woman). All subjects were treated with environmental measures, correction of the underlying cause, and risperidone. The dosages of risperidone were as follows: average starting and maximum dosage was 1.14 mg daily (range 0.5 to 2.0 mg daily); the average dosage through the period of treatment was 1.07 mg daily (range 0.5 to 1.5 mg daily). All patients were closely monitored (at least once every 48 hours.) No subject developed observable extrapyramidal or any other serious side effects. All patients, except for the elderly woman, were either significantly improved or recovered at the last follow-up. This small, open-label, retrospective case series demonstrates that risperidone in low doages is effective and safe for treating delirium.

Risperidone possesses certain advantages over haloperidol, specifically, fewer extrapyramidal and cardiac side effects, including a reduced propensity to cause QT prolong- ation (5). This profile, along with a low- dosage regime, gives it a unique advantage over haloperidol. However, the current lack of an available intravenous parenteral formulation, as well as the lack of a large database on risperidone use in treating delirium, may preclude its use as a standard or textbook treatment modality. Controlled, double-blind, prospective studies are warranted to establish the efficacy of risperidone as a useful alternative to haloperidol in treating delirium.

Funding and Support

None of the authors have financial or personal connections to drug companies nor did they have any sources of funding and support for this research.

References

1. Meagher DJ. Delirium: optimizing management. BMJ 2001;322:144–9.

2. Winawer N. Postoperative delirium. Med Clin North Am 2001; 5:1229–39.

3. Schwartz TL, Masand PS. The role of atypical antipsychotics in the treatment of delirium. Psychosomatics 2002;43:171–4.

4. Horikawa N, Yamazaki T, Miyamoto K, Kurosawa A, Oiso H, Matsumoto F, and others. Treatment for delirium with risperidone: results of a prospective open trial with 10 patients. Gen Hosp Psychiatry 2003;25:289–92.

5. Drici MD, Wang WX, Liu XK, Woosley RL, Flockhart DA. Prolongation of QT interval in isolated feline hearts by antipsychotic drugs. J Clin Psychopharmacol 1998;18:477–81.

Nitin Gupta, MD,
Burton upon Trent, UK
Parveen Sharma, MD,
Surendra K Mattoo, MD,
Chandigarh, India