Objective: Delirium is one of the most common complications in patients admitted to intensive care units (ICUs). Delirium is a definite cause for more extended hospital stays, higher mortality rates, and possibly persistent cognitive decline in the future. Antipsychotics have been frequently evaluated as first drugs of choice, but the most appropriate, evidence-based treatment is yet to be discovered. This study aims to compare the efficacy of haloperidol and olanzapine in patients admitted to our toxicology ICU. Methods: This double-blind, randomized controlled clinical trial was undertaken on 35 ICU admitted patients with delirium in Loghman Hakim hospital in Tehran, Iran. The diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria for delirium, and clinical toxicologists included the patients according to the study’s inclusion and exclusion criteria. Patients received either haloperidol or olanzapine based on computerized randomization. The severity of delirium was measured with the Memorial Delirium Assessment Scale (MDAS) scoring on days 0 and 3 of ICU-admission. Results: The total sample size was 35 in which 16 patients received haloperidol, and 19 patients received olanzapine. The doses of haloperidol and olanzapine were 3 mg three times a day and 5 mg three times a day, respectively. There was no significant difference in baseline characteristics and the scores of MDAS between groups. Conclusion: Olanzapine and haloperidol have the same efficacy in the management of delirium in toxicology ICU-admitted patients. They can be interchangeably used for delirium treatment in these patients.

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Serotonin syndrome is a potentially life-threatening adverse drug reaction typically caused by a single or combination of two or more medications with serotonergic properties due to increased serotonin release. Our case is a 60-year-old drug-addict man who was admitted to the poisoning department of Loghman hospital with methadone poisoning. On the fifth day of hospitalization and after initiating the linezolid treatment for VAP, the patient began to run a fever with agitation, tremor, spontaneous clonus movement in the hands, and tachycardia.Due to patients' manifestations and after ruling out other diagnoses, serotonin syndrome was confirmed with the possibility of concomitant use of linezolid and methadone. Linezolid administration was promptly discontinued, and vancomycin therapy was initiated (1000 mg twice a day intravenously). Supportive therapies were performed. Finally, tremor, rigidity, and clonus movement disappeared within 48 h.

Background: Suicide is one of the most important psychological emergencies and it is necessary to deal with it. The goal of this study was to evaluate the frequency of suicide attempts, suicide re-attempt, and guesstimated risk factors in suicidal patients in the poisoning ward of Loghman Hakim Hospital. Methods: This study was performed on suicidal patients in Loghman Hakim hospital in 2021 (January to August). The suicide attempt and the type of mental disorder were confirmed by a psychiatrist and the data sheets were completed. The sample size was 500 cases based on previous similar studies. Results: Three hundred fifteen cases attempted suicide for the first time and 185 had a history of suicide. In both groups, the numbers of women were significantly more than men. In addition, 196 cases of the first group and 121 cases of the second group were under 30 years old and 65.1% of cases with first-time suicides and 62.2% of cases with suicide re-attempts were unemployed. In both groups, the most common drug for suicide was benzodiazepines (30.5% and 21.6%). Unfortunately, two patients died. Also, 67.6% in the first-time suicide attempt group and 57.3% in the suicide re-attempt group had adjustment disorder. No significant differences were observed between both groups in terms of gender, age, marital status, education, chronic disease, drug and habit history, employment status, diagnosed mental disorder, and type of drug used for the current suicide. Conclusion: Young age, unemployment, mental disorders (especially adjustment disorder), and female gender are the most important risk factors for a suicide attempt and re-attempt.