Can delirium relieve psychosis?

A delirium presages a poor prognosis in hospitalized patients, hut an incid ental delirium is a feature of some psychiatric treatments. We report five cases in which delirium preceded the relief of affective and psychotic symp toms of a major mental illness. The experience stimulated a review of the l iterature on delirium in psychiatric treatments. Five inpatients (aged 53 t o 69 years) with an exacerbation of chronic mental illness developed deliri a from medications (n = 4) and electrolyte disturbance (n = 1). The deliria were managed with medication washout or correction of electrolyte imbalanc e. The progress of the patients was noted clinically and summarized. The cl inical signs of delirium such as confusion, disorganized speech, sleep-wake cycle changes, and hallucinations persisted for 24 to 72 hours. As the del irium cleared, psychotic and affective symptoms improved or resolved. The i mprovements persisted for 1 to 5 months, with low doses of medications in t wo of the cases. A delirium may precede clinical improvement in affective a nd psychotic symptoms. Historically, some treatments for mental illness ind uce an incidental delirium (e,g,, electroconvulsive therapy [ECT] and insul in coma). Why a delirium should presage a beneficial effect on psychosis is unclear, but the emergence of delirium may herald a beneficial pathophysio logy. Copyright (C) 2000 by W.B. Saunders Company.