Antipsychotics for delirium in the general hospital setting in consecutive 2453 inpatients: a prospective observational study

Abstract

ObjectiveAttention to risk of antipsychotics for older patients with delirium has been paid. A clinical question was whether risk of antipsychotics for older patients with delirium would exceed efficacy of those even in the general hospital setting.MethodsA prospective observational study proceeded over a 1-year period at 33 general hospitals, where at least one psychiatrist worked full time. Subjects were patients who developed delirium during their admission due to acute somatic diseases or surgery, and who received antipsychotics for delirium. The primary outcome was rates and kinds of serious adverse events.ResultsAmong 2834 patients who developed delirium, 2453 patients received antipsychotics, such as risperidone (34%), quetiapine (32%), and parenteral haloperidol (20%), for delirium. Out of 2453 patients, 22 serious adverse events (0.9%) were reported. Aspiration pneumonia was the most frequent (17 patients, 0.7%), followed by cardiovascular events (4 patients, 0.2%) and venous thromboembolism (1 patient, 0.0%). There was no patient with a fracture or intracranial injury due to a fall. No one died because of antipsychotic side effects. The mean Clinical Global Impressions—Improvement Scale score was 2.02 (SD 1.09). Delirium was resolved within 1 week in more than half of the patients (54%).ConclusionsIn the general hospital setting under management including fine dosage adjustment and early detection of side effects, risk of antipsychotics for older patients with delirium might be low, in contrast to antipsychotics for dementia in the nursing home or outpatient settings. A point may be not how to avoid using antipsychotics but how to monitor their risk.

Management of Delirium in Palliative Care: a Review

“…Atypical or second-generation APs are a class of drugs with a 5HT2A-D2 antagonism that conventional APs do not have, although the receptor-binding profiles of the atypical APs vary consistently between the single drugs [49]. The use of atypical APS is becoming more common in the treatment of delirium [50,51] with studies indicating that at least 50 % of patients receive atypical rather than typical APs [52] and supporting their use in palliative care [53]. Among these drugs, olanzapine has been shown to be useful and safe in delirium in several palliative care studies [54, 55•], with some variables (e.g., age >70 years, history of dementia, CNS spread of cancer and hypoxia as delirium etiologies, Bhypoactive^delirium, and Bsevere^intensity of delirium) predicting a poor response to olanzapine [56].…”

Consultation-Liaison Psychiatry in the General Hospital: the Experience of UK, Italy, and Japan

“…Elderly patients and patients who suffer from delirium, depression, anxiety disorder, and adjustment disorder in addition to their physical illness are becoming increasingly common in general hospitals in Japan, which complicates the medical treatment and care [69,70]. However, the number of psychiatrists working at general hospitals has been decreasing, which impacts on unmet needs for psychological care or psychiatric treatment for patients [71].…”

Preventive Effects of Suvorexant on Delirium

“…37 The ventral tegmental area contains both orexin-1 receptor and orexin-2 receptor messenger ribonucleic acids, 38 and dopaminergic cells of the ventral tegmental area have been shown to be activated by orexins through orexin-1 receptor. 39,40 An explanation for preventive effects of suvorexant on delirium can be associated with antidopaminergic activity like antipsychotics, which are clinically used for the treatment of delirium [41][42][43] and also documented to have effects on delirium prevention despite controversy. [5][6][7][8][9][10][11] It has been shown that administration of orexin-A increases the blood concentrations of corticotropin and corticosterone.…”