Antipsychotics for the Prevention and Treatment of Delirium

Neufeld, Karin J.; Oh, Esther S.; Wilson, Lisa M; Nikooie, Roozbeh; Zhang, Allen; Koneru, Mounica; Balagani, Amulya; Singu, Sriharsha; Aldabain, Louay; Robinson, Karen A.

doi:10.23970/ahrqepccer219

Cited by 16 publications

(13 citation statements)

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“…The American Geriatric Society Beers criteria for inappropriate medications in older adults can help identify many of these medications [116] (Table 3). In the area of delirium prevention, there is substantial interest in the role of antipsychotics; however, efficacy data are equivocal [117]. More specifically, a recent RCT examined the use of haloperidol for delirium prophylaxis showed no decrease in delirium incidence and no improvement in overall mortality [118].…”

Section: Prevention and Management Of Poor Sleep And Deliriummentioning

confidence: 99%

“…Subsequently, another RCT examining the effect of haloperidol or ziprasidone versus placebo on ICU delirium found no difference in delirium-free days [21]. While recent guidelines make no recommendation regarding antipsychotics for the prevention or treatment of delirium [117], these medications may be reasonable to administer in the setting of agitation with the risk of staff or patient harm.…”

Section: Prevention and Management Of Poor Sleep And Deliriummentioning

confidence: 99%

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Sleep and Delirium in Older Adults

Farasat

Dorsch

Pearce

et al. 2020

Curr Sleep Medicine Rep

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Purpose of Review Poor sleep and delirium are common in older patients but recognition and management are challenging, particularly in the intensive care unit (ICU) setting. The purpose of this review is to highlight current research on these conditions, their interrelationship , modes of measurement, and current approaches to management. Recent Findings Sleep deprivation and delirium are closely linked, with shared clinical characteristics, risk factors, and neurochemical abnormalities. Acetylcholine and dopamine are important neurochemicals in the regulation of sleep and wakefulness and their dysregulation has been implicated in development of delirium. In the hospital setting, poor sleep and delirium are associated with adverse outcomes; non-pharmacological interventions are recommended, but tend to be resource intensive and hindered by a lack of reliable sleep measurement tools. Delirium is easier to identify, with validated tools available in both ICU and non-ICU settings; however, an optimal treatment approach remains unclear. Antipsychotics are used widely to prevent and treat delirium, although the efficacy data are equivocal. Bundled non-pharmacologic approaches represent a promising framework for prevention and management. Summary Poor sleep and delirium are common problems in older patients. While these phenomena appear linked, a causal relationship is not clearly established. At present, there are no established sleep-focused guidelines for preventing or treating delirium. Novel interventions are needed that address poor sleep and delirium, particularly in older adults.

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Section: Prevention and Management Of Poor Sleep And Deliriummentioning

confidence: 99%

Section: Prevention and Management Of Poor Sleep And Deliriummentioning

confidence: 99%

Sleep and Delirium in Older Adults

Farasat

Dorsch

Pearce

et al. 2020

Curr Sleep Medicine Rep

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show abstract

“…Animal and in vitro studies received *, narrative review **, observational studies (cohort and case-control) ***, randomized-controlled studies ****, meta-analysis and systematic reviews *****. By searching most relevant studies available in the peer-reviewed literature, it emerged that many clinical trials failed to reduce significantly the duration of delirium in different settings [37], for example, the ICU [38], or critically ill adults [39], etc., and it is accepted worldwide that, if necessary, antipsychotics should be used at the lowest dosage, for the minimal necessary time, and, especially, antipsychotics with lower anticholinergic effect should be preferred, such as haloperidol [40].…”

Section: Treatment Of Delirium Based On Toxicity And/or Side-effectsmentioning

confidence: 99%

Treatment of Delirium in Older Persons: What We Should Not Do!

Lauretani

Bellelli

Pelà

et al. 2020

IJMS

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The presentation of common acute diseases in older age is often referred to as “atypical”. Frequently, the symptoms are neither single nor tissue related. In most cases, the onset of symptoms and diseases is the expression of a diminished reserve with a failure of the body system and imbalance of brain function. Delirium is one of the main devastating and prevalent atypical symptoms and could be considered as a geriatric syndrome. It encompasses an array of neuropsychiatric symptoms and represents a disarrangement of the cerebral function in response to one or more stressors. The most recent definition, reported in the DSM-V, depicts delirium as a clear disturbance in attention and awareness. The deficit is to be developed in a relatively short time period (usually hours or days). The attention disorder must be associated with another cognitive impairment in memory, orientation, language, visual-spatial or perception abilities. For the treatment, it is imperative to remove the potential causes of delirium before prescribing drugs. Even a non-pharmacological approach to reducing the precipitating causes should be identified and planned. When we are forced to approach the pharmacological treatment of hyperactive delirium in older persons, we should select highly cost-effective drugs. High attention should be devoted to the correct balance between improvement of psychiatric symptoms and occurrence of side effects. Clinicians should be guided in the correct choice of drugs following cluster symptoms presentation, excluding drugs that could potentially produce complications rather than advantages. In this brief point-of-view, we propose a novel pharmacological flow-chart of treatment in relation to the basic clusters of diseases of an older patient acutely admitted to the hospital and, in particular, we emphasize “What We Should Not Do!”, with the intention of avoiding possible side effects of drugs used.

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“…There are also reports in the literature that prove the ineffectiveness of the pharmacological prophylaxis of POD with antipsychotic drugs, both typical and second generation neuroleptics [ 60 ]. This shows that the problem is unresolved on a scientific level.…”

Section: Prevention Of Deliriummentioning

confidence: 99%

Antipsychotic Drugs in Prevention of Postoperative Delirium—What Is Known in 2020?

Pluta

Dziech

Czempik

et al. 2020

IJERPH

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Delirium is one of the most frequently reported neuropsychiatric complications in the perioperative period, especially in the population of elderly patients who often suffer from numerous comorbidities undergoing extensive or urgent surgery. It can affect up to 80% of patients who require hospitalization in an intensive care setting postoperatively. Delirium increases mortality, morbidity, length of hospital stay, and cost of treatment. An episode of delirium in the acute phase may lower the general quality of life and increases the risk of cognitive decline long-term. Since pharmacological treatment of delirium is not highly effective, focus of research has shifted towards developing preventive strategies. We aimed to perform a review of the topic based on the most recent literature. We conclude that, based on the available data, it seems impossible to make strong recommendations for using antipsychotic drugs in prophylaxis. Further research should answer the question what, if any, benefit patients receive from the pharmacological prevention of delirium, and which agents should be used.

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Antipsychotics for the Prevention and Treatment of Delirium

Cited by 16 publications

References 0 publications

Sleep and Delirium in Older Adults

Sleep and Delirium in Older Adults

Treatment of Delirium in Older Persons: What We Should Not Do!

Antipsychotic Drugs in Prevention of Postoperative Delirium—What Is Known in 2020?

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