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I agree with Dr. Nasrallah’s assertions that a single psychotropic can treat different disorders (“Parsimonious pharmacotherapy,” From the Editor, Current Psychiatry, May 2011, p. 12-16). During my consultation-liaison fellowship at MD Anderson Cancer Center, different forms of delirium were a daily occurrence in our hospitalized patients. A low dose of psychotropic—usually quetiapine—proved effective in controlling delirium; in acute and severe cases, low-dose IV haloperidol helped control agitation and psychosis.
Low-dose quetiapine also was beneficial in treating comorbidities such as increased anxiety, depression, pain, and insomnia, with minimal side effects. Because most of our patients suffered from several medical conditions and powerful, multiple-medication chemotherapies, in most cases psychotropic polypharmacy was contraindicated and avoided at all costs.
Corey Roman, MD
Psychiatrist, private practice