Adjunctive Valproic Acid in Management-Refractory Hyperactive Delirium: A Case Series and Rationale

Sher, Yelizaveta; Miller, Anne Catherine; Lolak, Sermsak; Ament, Andrea; Maldonado, José R.

doi:10.1176/appi.neuropsych.14080190

Cited by 35 publications

(33 citation statements)

References 20 publications

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“…In all, but one case, VPA was added as an adjunct when antipsychotics failed or were only partially effective. Delirium resolved in 13 episodes, and agitation improved in all (52).…”

Section: Relevant Clinical Studiesmentioning

confidence: 94%

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Valproic Acid for Treatment of Hyperactive or Mixed Delirium: Rationale and Literature Review

et al. 2015

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“…In all, but one case, VPA was added as an adjunct when antipsychotics failed or were only partially effective. Delirium resolved in 13 episodes, and agitation improved in all (52).…”

Section: Relevant Clinical Studiesmentioning

confidence: 94%

“…In our case series of treatment of hyperactive delirium with VPA, administration of meropenem adversely affected VPA's level and effectiveness in three patients. This resolved quickly when meropenem was discontinued (68).…”

Section: Considerations For Use Of Vpa In Delirium Managementmentioning

confidence: 99%

Valproic Acid for Treatment of Hyperactive or Mixed Delirium: Rationale and Literature Review

et al. 2015

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“…Valproate's impact on agitation was consistent and likely related to its ability to modulate GABA activity. Its effect on delirium was less consistent with resolution times of more than 9 days, if at all, in one study . Some hypothesized that valproate can be used to treat delirium due to its biochemical, antiinflammatory, antioxidant, and transcriptional/neurotrophic effects .…”

Section: Valproatementioning

confidence: 96%

“…In a more recent study published in 2015, valproate was administered to 15 adult patients with hyperactive delirium (16 cases with 12 patients in the ICU [aged 25–87 years]) . The average dose of valproate on days 1–4 was 1133–1258 mg/day given in 2–3 divided doses (route of administration not reported).…”

Section: Valproatementioning

confidence: 99%

“…17 In a more recent study published in 2015, valproate was administered to 15 adult patients with hyperactive delirium (16 cases with 12 patients in the ICU [aged 25-87 years]). 18 The average dose of valproate on days 1-4 was 1133-1258 mg/day given in 2-3 divided doses (route of administration not reported). Hyperactive delirium based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria resolved in nine (56%) cases within 4 days and in four (25%) cases in more than 9 days.…”

Section: Pharmacologic Characteristicsmentioning

confidence: 99%

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Repurposing Valproate, Enteral Clonidine, and Phenobarbital for Comfort in Adult ICU Patients: A Literature Review with Practical Considerations

et al. 2017

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Provision of adequate sedation is a fundamental part of caring for critically ill patients. Propofol, dexmedetomidine, and benzodiazepines are the most commonly administered sedative medications for adult patients in the intensive care unit (ICU). These agents are limited by adverse effects, need for a monitored environment for safe administration, and lack of universal effectiveness. Increased interest has recently been expressed about repurposing older pharmacologic agents for patient comfort in the ICU. Valproate, enteral clonidine, and phenobarbital are three agents with increasing evidence supporting their use. Potential benefits associated with their utilization are cost minimization and safe administration after transition out of the ICU. This literature review describes the historical context, pharmacologic characteristics, supportive data, and practical considerations associated with the administration of these agents for comfort in critically ill adult patients.

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Drug Treatment of Other Psychiatric Conditions

2021

The Maudsley Prescribing Guidelines in Psychiatry

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Borderline personality disorder (BPD) is common in psychiatric settings, affecting 20% of community psychiatric patients. Common co‐morbid conditions affecting patients with BPD include affective disorders anxiety spectrum disorders, eating disorders, and drug and alcohol misuse, and the lifetime risk of having at least one co‐morbid mental disorder approaches 100%. Although classified as a personality disorder, several aspects of BPD have been assumed to be responsive to drug treatment. Drug treatments are often used during periods of crisis when symptoms can be severe, distressing and potentially life‐threatening. Psychiatric conditions often coexist with eating disorders, and this may in part explain the benefit sometimes seen with medication. Drugs have limited activity in anorexia nervosa, and none is currently licensed for this condition. Delirium is a common neuropsychiatric condition that presents in medical and surgical settings and is known by various names including organic brain syndrome, intensive care psychosis and acute confusional state.

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Adjunctive Valproic Acid in Management-Refractory Hyperactive Delirium: A Case Series and Rationale

Cited by 35 publications

References 20 publications

Valproic Acid for Treatment of Hyperactive or Mixed Delirium: Rationale and Literature Review

Valproic Acid for Treatment of Hyperactive or Mixed Delirium: Rationale and Literature Review

Repurposing Valproate, Enteral Clonidine, and Phenobarbital for Comfort in Adult ICU Patients: A Literature Review with Practical Considerations

Drug Treatment of Other Psychiatric Conditions

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