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Case report: Hyperactive delirium after a single dose of zolpidem administered additionally to psychopharmacotherapy including clozapine

The non-benzodiazepine hypnotic zolpidem is frequently administered as a short term psychopharmacotherapy for insomnia. Although it is well-established in a broad clinical routine and often well-tolerated, severe delirium and complex sleep behavior were reported in rare cases. Hereby, it remains unc...

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Autores principales: Preiss, Maximilian, Rabl, Ulrich, Popper, Valentin, Watzal, Victoria, Treiber, Michael, Ivkic, Dominik, Praschak-Rieder, Nicole, Naderi-Heiden, Angela, Fugger, Gernot, Frey, Richard, Rujescu, Dan, Bartova, Lucie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10413097/
https://www.ncbi.nlm.nih.gov/pubmed/37575586
http://dx.doi.org/10.3389/fpsyt.2023.1204009
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author Preiss, Maximilian
Rabl, Ulrich
Popper, Valentin
Watzal, Victoria
Treiber, Michael
Ivkic, Dominik
Praschak-Rieder, Nicole
Naderi-Heiden, Angela
Fugger, Gernot
Frey, Richard
Rujescu, Dan
Bartova, Lucie
author_facet Preiss, Maximilian
Rabl, Ulrich
Popper, Valentin
Watzal, Victoria
Treiber, Michael
Ivkic, Dominik
Praschak-Rieder, Nicole
Naderi-Heiden, Angela
Fugger, Gernot
Frey, Richard
Rujescu, Dan
Bartova, Lucie
author_sort Preiss, Maximilian
collection PubMed
description The non-benzodiazepine hypnotic zolpidem is frequently administered as a short term psychopharmacotherapy for insomnia. Although it is well-established in a broad clinical routine and often well-tolerated, severe delirium and complex sleep behavior were reported in rare cases. Hereby, it remains unclear whether zolpidem's potential for delirium might be enhanced when combined with further psychopharmacotherapeutics. The present case report portrays a young male Caucasian inpatient with schizoaffective disorder, who was admitted due to severe hyperactive delirium after a single dose of zolpidem 10 mg that was administered in addition to already established psychopharmacotherapy including clozapine 200 mg/day, aripiprazole 15 mg/day and cariprazine 4.5 mg/day. In detail, disorientation, agitation, confabulations, bizarre behavior, and anterograde amnesia occurred shortly after ingestion of zolpidem and gained in intensity within a couple of hours. Once zolpidem was discontinued, the abovementioned symptoms subsided completely and did not reoccur. Since a clear temporal association could be drawn between the intake of zolpidem and the onset of hyperactive delirium, the present clinical experience should serve as a cautionary note for combining potent sedative-hypnotics and substances with anticholinergic properties, even in young adults in a good general condition. Moreover, our case argues for the necessity of further research into the pathomechanism of the interaction potential of non-benzodiazepines as zolpidem, especially with substances exerting anticholinergic properties, which are known for their potential to precipitate delirium. Therefore, the metabolic pathways of the concurrently administered substances should be further taken into account.
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spelling pubmed-104130972023-08-11 Case report: Hyperactive delirium after a single dose of zolpidem administered additionally to psychopharmacotherapy including clozapine Preiss, Maximilian Rabl, Ulrich Popper, Valentin Watzal, Victoria Treiber, Michael Ivkic, Dominik Praschak-Rieder, Nicole Naderi-Heiden, Angela Fugger, Gernot Frey, Richard Rujescu, Dan Bartova, Lucie Front Psychiatry Psychiatry The non-benzodiazepine hypnotic zolpidem is frequently administered as a short term psychopharmacotherapy for insomnia. Although it is well-established in a broad clinical routine and often well-tolerated, severe delirium and complex sleep behavior were reported in rare cases. Hereby, it remains unclear whether zolpidem's potential for delirium might be enhanced when combined with further psychopharmacotherapeutics. The present case report portrays a young male Caucasian inpatient with schizoaffective disorder, who was admitted due to severe hyperactive delirium after a single dose of zolpidem 10 mg that was administered in addition to already established psychopharmacotherapy including clozapine 200 mg/day, aripiprazole 15 mg/day and cariprazine 4.5 mg/day. In detail, disorientation, agitation, confabulations, bizarre behavior, and anterograde amnesia occurred shortly after ingestion of zolpidem and gained in intensity within a couple of hours. Once zolpidem was discontinued, the abovementioned symptoms subsided completely and did not reoccur. Since a clear temporal association could be drawn between the intake of zolpidem and the onset of hyperactive delirium, the present clinical experience should serve as a cautionary note for combining potent sedative-hypnotics and substances with anticholinergic properties, even in young adults in a good general condition. Moreover, our case argues for the necessity of further research into the pathomechanism of the interaction potential of non-benzodiazepines as zolpidem, especially with substances exerting anticholinergic properties, which are known for their potential to precipitate delirium. Therefore, the metabolic pathways of the concurrently administered substances should be further taken into account. Frontiers Media S.A. 2023-07-27 /pmc/articles/PMC10413097/ /pubmed/37575586 http://dx.doi.org/10.3389/fpsyt.2023.1204009 Text en Copyright © 2023 Preiss, Rabl, Popper, Watzal, Treiber, Ivkic, Praschak-Rieder, Naderi-Heiden, Fugger, Frey, Rujescu and Bartova. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Preiss, Maximilian
Rabl, Ulrich
Popper, Valentin
Watzal, Victoria
Treiber, Michael
Ivkic, Dominik
Praschak-Rieder, Nicole
Naderi-Heiden, Angela
Fugger, Gernot
Frey, Richard
Rujescu, Dan
Bartova, Lucie
Case report: Hyperactive delirium after a single dose of zolpidem administered additionally to psychopharmacotherapy including clozapine
title Case report: Hyperactive delirium after a single dose of zolpidem administered additionally to psychopharmacotherapy including clozapine
title_full Case report: Hyperactive delirium after a single dose of zolpidem administered additionally to psychopharmacotherapy including clozapine
title_fullStr Case report: Hyperactive delirium after a single dose of zolpidem administered additionally to psychopharmacotherapy including clozapine
title_full_unstemmed Case report: Hyperactive delirium after a single dose of zolpidem administered additionally to psychopharmacotherapy including clozapine
title_short Case report: Hyperactive delirium after a single dose of zolpidem administered additionally to psychopharmacotherapy including clozapine
title_sort case report: hyperactive delirium after a single dose of zolpidem administered additionally to psychopharmacotherapy including clozapine
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10413097/
https://www.ncbi.nlm.nih.gov/pubmed/37575586
http://dx.doi.org/10.3389/fpsyt.2023.1204009
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