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Subtypes of Pediatric Delirium: A Treatment Algorithm

Received January 2, 2006; revised May 5, 2006; accepted May 24, 2006. From the Division of Child and Adolescent Psychiatry, Stanford Univ. School of Medicine, Lucile Salter Packard Children’s Hospital, Palo Alto, CA. Send correspondence and reprint requests to Niranjan Karnik, M.D., Ph.D., Div. of Child and Adolescent Psychiatry, Stanford Univ. School of Medicine, 401 Quarry Rd., Palo Alto, CA 94305. e-mail: nkarnik{at}stanford.edu

Delirium in adult populations of hospitalized patients has been well characterized into hyperactive, hypoactive, and mixed subtypes. The degree to which these subtypes apply to pediatric populations has yet to be fully demonstrated. In this case report, the authors present two cases of delirium that serve as examples of the hyperactive and hypoactive/mixed types and then discuss treatment. They find marked differences in the response of different delirium subtypes to haloperidol and risperidone and theorize as to the neurochemical pathways by which these pharmacological agents might work. This framework provides an algorithm for the treatment of pediatric delirium.

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