Ziprasidone Treatment of Delirium

Autor: Thomas L. Schwartz, Laura Leso
Rok vydání: 2002
Předmět:
Zdroj: Psychosomatics. 43:61-62
ISSN: 0033-3182
DOI: 10.1176/appi.psy.43.1.61
Popis: Received September 15, 2001; accepted September 24, 2001. From the Psychiatry Department, SUNY Upstate Medical University, Syracuse, New York. Address correspondence and reprint requests to Dr. Leso, Psychiatry Department, SUNY Upstate Medical University, 750 East Adams St, Syracuse, New York 13210. Copyright 2002 The Academy of Psychosomatic Medicine. Ziprasidone is the most recently available antipsychotic agent approved by the U.S. Food and Drug Administration that is chemically unrelated to the phenothiazine or butyrophenone antipsychotic chemical families. In vitro, ziprasidone exhibits high-affinity blockade of the dopamine D2 and D3 receptors; the serotonin 5HT2A, 5HT2C, and 5HTID receptors; and the l-adrenergic receptors. This pattern of receptor occupancy suggests a broad potential for therapeutic efficacy and minimal extrapyramidal and sedating side effects in the treatment of psychotic illness. Many antipsychotics have electrophysiologic effects that resemble those of class Ia antiarrhythmic agents. A prolongation in the QT interval may occur, with the potential to cause torsade de pointes and sudden death. Some antipsychotics carry a high risk for this event, including thioridazine, mesoridazine, pimozide, and droperidol. Of the new atypical agents, sertindole (withdrawn from the market) carried a substantial risk, followed by ziprasidone and risperidone. Quetiapine, clozapine, and olanzapine are believed to have negligible effects on the QT interval. Certain risk factors for QT prolongation and ventricular arrhythmias have been demonstrated, including hypokalemia, hypomagnesemia, bradycardia, congenital long QT syndrome, and any underlying cardiac pathology. We present the first known case of a patient with delirium successfully treated with ziprasidone. We outline some of the potential management issues involved in treating delirium with this agent.
Databáze: OpenAIRE
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