Delirium among children and adolescents in an urban sub-Saharan African setting

Abstract

Objectives The purpose of this study is to describe the demographic and clinical profile, mortality rates, and effectiveness of a multifaceted treatment approach in hospitalized children and adolescents with delirium referred to psychiatry. Methods We report a series of 23 children and adolescents prospectively diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, delirium after referral to a consultation–liaison psychiatry service based in a large, regional, dedicated children's hospital in South Africa. Results Children and adolescents with delirium referred to psychiatrists appear to represent a subgroup of delirious patients with a high risk of mortality, an underrepresentation of hypoactive cases, and complex, multifactorial, and often uncertain etiologies. A significant minority of these cases may be managed without the use of psychotropic medications. Uncontrolled data provide supportive evidence for the moderate effectiveness of both haloperidol and risperidone in childhood delirium when explicit criteria guiding the use of antipsychotic medications are utilized. Conclusions Delirium is an important and underresearched disorder in children and adolescents. Although the evidence base for the use of antipsychotic medications in childhood delirium remains relatively slim, tentative threshold criteria for the use of such medications are suggested by this study. Controlled studies comparing different antipsychotic medications with each other and with nonpharmacological strategies are urgently required.