Two diabetic elderly patients on maintenance hemodialysis effectively treated for delirium using perospirone

Case 1 was an 83-year-old woman who was undergoing hemodialysis (HD) due to nephrosclerosis and cryoglobulinemia. She was admitted to our hospital for lumbago and developed delirium, including severe psychomotor excitation, 2 days later. Case 2 was a 77-year-old man who underwent HD due to rapidly progressive glomerulonephritis. Prolonged delirium developed 4 months after his admission, but improved completely 6 months later due to the administration of perospirone. Both patients had diabetes mellitus. Perospirone was continuously administered to both patients for the treatment of delirium as well as to prevent a relapse. No side effects, such as over-sedation, extrapyramidal symptoms, or dysphasia resulting from substantial drug accumulation were observed. Therefore, HD sessions were safely continued in both patients. Perospirone is considered the best atypical antipsychotic drug for the treatment of delirium in diabetic elderly patients on maintenance HD because of its short half-life, lower renal excretion than other antipsychotics, and minor sedative effect, as well as its safety for diabetic patients and the minimal activity of its major metabolites.