An Evaluation of Adverse Drug Reactions Associated With Antipsychotic Use for the Treatment of Delirium in the Intensive Care Unit

Hale, Genevieve M; Kane‐Gill, Sandra L.; Groetzinger, Lara; Smithburger, Pamela L.

doi:10.1177/0897190014566313

Cited by 26 publications

(17 citation statements)

References 34 publications

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“…QTc prolongation was the most observed ADR. [9] In our study, 126 suspected ADRs occurred attributed to antipsychotic drug use. Tremors were the most observed ADR.…”

Section: Discussionmentioning

confidence: 65%

An Evaluation of Impact on Quality of Life in Patients on Antipsychotic Therapy at a Tertiary Care Centre

Ellabathini¹,

Gaddameedi²

2018

jemds

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BACKGROUND Antipsychotic drugs utilisation is expanding step by step due to lifestyle changes and increased stress in day-today along with psychiatric disorders. Prevalence of Adverse Drug Reactions (ADRs) with antipsychotic drugs is high, which is influencing the quality-of-life of patients more than the underlying disease. Hence, this study was taken up to assess Impact on Quality-of-life in patients using antipsychotics. MATERIALS AND METHODS A prospective observational study was carried out in the Department of Psychiatry at Erragadda Hospital, Hyderabad for 6 months. A total of 189 patients on Antipsychotics were enrolled and Baseline Quality-of-life (WHOQOL-BREF) scale was recorded. On a fixed day in a week they were screened for ADRs, 126 adverse drug reactions (ADRs) occurred. ADRs were monitored using causality assessment scale of Naranjo algorithm. The WHOQOL-BREF scale was used to study the quality-of-life. RESULTS The physical and psychological domain scores of WHO-QOL BREF decrease in patients with ADRs compared to without ADRs. Of the total 189 patients, 126 ADRs occurred. Adverse drug events were mostly with olanzapine (83) followed by risperidone (71) owing to high usage in the government hospital. Majority of the events were classified as probable (34). CONCLUSION The study provides information on the influence of Quality-of-life patients on antipsychotics due to ADRs. Psychiatrists and other health care professionals treating psychiatric patients ought to have information about the possible ADRs and their influence on Quality-of-life following antipsychotic medication and thus should keep an active vigil to prevent, treat and alleviate the adverse health effects due to ADRs.

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“…QTc prolongation was the most observed ADR. [9] In our study, 126 suspected ADRs occurred attributed to antipsychotic drug use. Tremors were the most observed ADR.…”

Section: Discussionmentioning

confidence: 65%

An Evaluation of Impact on Quality of Life in Patients on Antipsychotic Therapy at a Tertiary Care Centre

Ellabathini¹,

Gaddameedi²

2018

jemds

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“…In the treatment of schizophrenia, atypical antipsychotics have an improved safety profile compared to haloperidol [36], and this finding seems to hold true in ICU delirium literature as well [15,37]. However, evidence of their efficacy in treating ICU delirium is mixed.…”

Section: Treatmentmentioning

confidence: 81%

ICU Delirium: Diagnosis, Risk Factors, and Management

Heeder

Azocar

Tsai

2015

Curr Anesthesiol Rep

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Intensive care unit delirium is a complex problem associated with significant negative consequences on patient outcomes. Delirium is also known as acute brain dysfunction, reflecting the evolving paradigm that it is a manifestation of acute organ dysfunction in the setting of neurotransmitter imbalances, inflammation, and metabolic derangements. In recent years, strides have been made towards better understanding its management, although much work remains to be done. Here we review the current state of knowledge regarding diagnosis, pathophysiology, risk factors, prevention, and management as supported by recent literature and the 2013 clinical practice guidelines on pain, agitation, and delirium.

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“…26 All atypical antipsychotics show similar cardiac risks and need for monitoring in adult studies. Several studies, [33][34][35] including a systemic review and meta-analysis of the effects of 9 antipsychotics on QTc prolongation in children and adolescents, found no difference compared with placebo. 34 However, each instance should be evaluated individually to balance the unique risks for arrhythmia against that from untreated delirium, such as respiratory compromise and brain anoxia.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Delirium in Critically Ill Infants: Case Report and Review

Brahmbhatt

Whitgob

2016

Pediatrics

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Delirium in children is common but not widely understood by pediatric practitioners, often leading to underdiagnosis and lack of treatment. This presents a significant challenge in the young patients in the PICU who are most at risk for delirium and in whom the core features of delirium are difficult to assess and treat. However, because of the potential increased morbidity and mortality associated with untreated delirium in adults and children, it remains important to address it promptly. The literature for delirium in this age group is limited. Here we present the case of an infant with multiple underlying medical risk factors who exhibited waxing and waning motor restlessness with disrupted sleep-wake cycles contributing significantly to destabilization of vital parameters. Making a diagnosis of delirium was key to guiding further treatment. After appropriate environmental interventions are implemented and underlying medical causes are addressed, antipsychotic medications, although not Food and Drug Administration–approved in infants, are the mainstay of pharmacotherapy for delirium in older age groups. They may lengthen corrected QT interval (QTc) intervals, presenting a challenge in infants who frequently have other coexisting risks for QTc prolongation, as in our case. The risk from QTc prolongation needs to be balanced against that from untreated delirium. Low doses of risperidone were successfully used in this patient and without side effects or worsening of QTc interval. This case illustrates the importance of increased recognition of delirium in children, including infants, and the role for cautious consideration of atypical antipsychotics in the very young.

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An Evaluation of Adverse Drug Reactions Associated With Antipsychotic Use for the Treatment of Delirium in the Intensive Care Unit

Abstract: ADRs were observed in 18% of patients having delirium treated with antipsychotics with about half considered severe or harmful. A risk versus benefit assessment is needed before initiating antipsychotic therapy in ICU patients.

Cited by 26 publications

References 34 publications

An Evaluation of Impact on Quality of Life in Patients on Antipsychotic Therapy at a Tertiary Care Centre

An Evaluation of Impact on Quality of Life in Patients on Antipsychotic Therapy at a Tertiary Care Centre

ICU Delirium: Diagnosis, Risk Factors, and Management

Diagnosis and Management of Delirium in Critically Ill Infants: Case Report and Review

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