( delirium ) 15%- ( extrapyramidal syndrome ) risperidone olanzapine ( extrapyramidal side effect ) olanzapine ( Delirium Rating Scale, DRS )

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1 Olanzapine 30% ( delirium 5%- Haloperidol ( extrapyramidal syndrome risperidone ( extrapyramidal side effect ( Delirium Rating Scale, DRS ( Delirium ( Olanzapine ( Delirium Rating Scale, DRS ( delirium ( DSM-IV ( 2 5%~30% ( 45

2 49 3 ( prevalence rates 4%-56% 32% 4 6 ( /08/28 ( bil. legs and L't hand pitting edema ( Prostate cancer s/p OP 9/09/03 ( DSM-IV Haloperidol ( coherent speech 2.9 meq/l 09 meq/l 0.0 gm/dl ( Ht 30.5 % 66 ( colon cancer s/p and C/T with bone and liver metastasis 92/04/26 92/05/0 ( DRS 26 ( CGI 6 5mg 9/09/04 ( DRS 26 ( CGI 6 0 mg 9/09/05 ( DRS 6 ( CGI 3 9/22 sundown syndrome 92/04/26 ( ( Hb 0.6 gm/dl ( HT 30.4% ( WBC 2300 / l ( 2 ( albumin 3 gm/dl ( alkaline phosphatase 433 IU/L ( total cholesterol 489 mg/dl ( uric acid 9.2 mg/dl DSM-IV ( Delirium Rating Scale, DRS ( Clinical Global Impression, CGI 6 5mg 2 ( DRS 9 ( CGI /04/23 ( colon cancer s/p and with ovarian and lung metastasis s/p pneumectomy ( metastatic urethral cancer 92/05/0 ( irrelevant answer 92/05/0 ( DRS 2 ( CGI 5 5mg 92/05/02 ( DRS 5 ( CGI

3 50 3 ( extrapyramidal side effect ( dementia ( hyperaroused clozapine D2 ( 4 ( 5 ( 2 ( 3 9 ( clozapine ( pharmacokinetics % ( 6 ( ( 2 ( 3 ( 4 ( 5 P450 ( pharmacodynamics 5-HT2a D2 M H 5-HT2c 5-HT3 5-HT6 alpha D D4 5-HT butyrophenone chlorpromazine droperidol 0 haloperidol 982 thienobenzodiazepine risperidone sertindole quetiapine ziprasidone alpha2 PET D2 clozapine risperidone ( extrapyramidal side effect ( tardive dyskinesia ( neuroleptic malignant syndrome risperidone ( dopamine D2 antagonist 2 ( schizophrenia ( tardive dyskinesia ( extrapyramidal side effect ( mood disorder ( substance induced psychosis

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5 52 Olanzapine for the Treatment of Delirium in Hospitalized Patients Chen-Ju Lin, Chun-Kai Fang, Hong-Wen Chen, and Yuen-Liang Lai Department of Psychiatry, Mackay Memorial Hospital, Department of Hospice Palliative Medicine, Mackay Memorial Hospital Delirium is a common and often serious neuropsychiatric complication in hospitalized patients with medical illness. Delirium is a syndrome of disturbed consciousness, cognition, and perception that develops over a short period of time and tends to fluctuate during the course of the day. From the previous study, the prevalence of delirium has been estimated from 5% to 30% among hospitalized patients. The standard approach to managing delirium in the medically ill includes a search for underlying causes, correction of those factors, and management of the symptoms of delirium. The palliative therapy is trying to control the agitated behavior. The management of the symptoms of delirium involves the use of both nonpharmacological and pharmacological interventions. Nonpharmacological or supportive interventions alone are often not effective in controlling the symptoms of delirium, and symptomatic treatment with neuroleptics or antipsychotic medications is necessary. Haloperidol, a first-generation antipsychotics, is the first choice for delirium treatment, which has little cardiac or respiratory side effect and few anticholinergic effects. The major disadvantage of the use of first generation antipsychotics includes the development of extrapyramidal side effect and etc. Second-generation antipsychotics such as risperidone and result in lower incidence of extrapyramidal and related side effects. Our case report presents three delirium case treated by and by the great improvement in DRS within the first 3 days of treatment. Hope this experience can provide you another thinking process to treat delirium hospitalized patients. ( J Intern Med Taiwan 2005; 6: 48-52