Atypical Antipsychotics for the Treatment of ICU Delirium

Gilchrist, Neil A.; Asoh, Ifeoma; Greenberg, Bruce

doi:10.1177/0885066611403110

Cited by 34 publications

(19 citation statements)

References 67 publications

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“…Data regarding treatment interventions for HD are scarce. Although several studies have examined the use of antipsychotics for the management of delirium symptomatology [ 64 , 65 ], research on HD symptom management is limited. In a recent report it was found that symptoms of hypoactive delirious patients responded better than symptoms of hyperactive patients to the atypical antipsychotic aripiprazole [ 66 ].…”

Section: Discussionmentioning

confidence: 99%

Recent Insights on Prevalence and Corelations of Hypoactive Delirium

Peritogiannis¹,

Bolosi

Lixouriotis³

et al. 2015

Behavioural Neurology

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Delirium is a complex neuropsychiatric syndrome which is common in all medical settings. It often goes unrecognized due to difficulties in the detection of its hypoactive variant. This review aims to provide an up-to-date account on recent research on hypoactive delirium (HD). Thirty-eight studies, which were conducted in various clinical settings, including the Intensive Care Unit (ICU), were included in this review. Those studies involved recent research that has been published during the last 6 years. Prevalence of HD was found to vary considerably among different settings. HD seems to be more common in critically ill patients and less common in patients examined by consultation-liaison psychiatric services and in mixed patient populations. The presence of HD in ICU patients was associated with higher short- and long-term mortality and other adverse outcomes, but no such association was reported in other settings. Research on other possible associations of HD with clinical variables and on symptom presentation yielded inconclusive results, although there is some evidence for a possible association of HD with benzodiazepine use. There are several methodological issues that need to be addressed by future research. Future studies should examine HD in the primary care setting; treatment interventions should also be the objective of future research.

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Section: Discussionmentioning

confidence: 99%

Recent Insights on Prevalence and Corelations of Hypoactive Delirium

Peritogiannis¹,

Bolosi

Lixouriotis³

et al. 2015

Behavioural Neurology

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“…First‐generation antipsychotics primarily block postsynaptic D 2 receptors, whereas atypical antipsychotics also antagonize 5‐HT 2 receptors. Variable receptor affinity for α‐adrenergic, H 1 , and M 1 receptors by atypical antipsychotics also results in differences in adverse effects between these agents …”

Section: Use Of Antipsychotics In Patients With Ardsmentioning

confidence: 99%

Antipsychotics, Delirium, and Acute Respiratory Distress Syndrome: What Is the Link?

Torbic

Duggal

2018

Pharmacotherapy

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Acute respiratory distress syndrome (ARDS) is an acute inflammatory process that impairs the ability of the lungs to oxygenate and ultimately leads to respiratory failure. Patients who develop ARDS often have prolonged and complicated hospital courses putting them at risk for intensive care unit (ICU) delirium. Patients with ICU delirium often need chemical sedation, mechanical ventilation, prolonged duration of ICU and hospital stays, and they experience long-term cognitive impairment and increased mortality. In a patient with ARDS, ICU delirium further complicates the hospital course and increases the risk of morbidity and mortality. Antipsychotics are prescribed to decrease the severity and duration of ICU delirium, thus potentially decreasing their risk of morbidity and mortality. However, antipsychotics are associated with many adverse effects including respiratory failure. Given the long-term sequelae associated with the development of ICU delirium and the risks associated with antipsychotic use, clinicians must weigh the risks and benefits of antipsychotic use. This review investigates the interrelationship between ARDS, delirium, and antipsychotic use. In addition to discussing relevant studies evaluating antipsychotics for the prevention and treatment of delirium, we investigate safety concerns with the use of antipsychotics, especially as they relate to ARDS. Using the data compiled in this review, clinicians can make an informed decision about the use of antipsychotics for the prevention or treatment of delirium, with special consideration for their patients with ARDS. Future studies are needed to critically evaluate antipsychotic timing, dose, and duration for the prevention and treatment of ICU delirium and specifically evaluate the impact in special populations, particularly patients with ARDS.

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“…Studies regarding use of psychotropic medicine in delirium treatment are scarce and only one reported beneficial effect of quetiapine. When compared to other antipsychotics, quetiapine has shortened the duration of delirium and reduced agitation (Gilchrist et al 2012). Antipsychotics are regularly used to relieve delirium, which can last for several weeks.…”

Section: Psychiatric Aspects Of the Post-transplant Periodmentioning

confidence: 99%

Transplantation Psychiatry: An Overview

Medved

Hanžek

2019

Psychiat Danub

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Psychiatric consultation and evaluation is an important part of candidate selection for organ transplantation. Psychiatric assessment of patients undergoing transplantation procedure is done in pre-and post-transplantation periods, each one having its specifics. In the pre-transplantation period it is crucial to assess the patient's therapeutic adherence and the ability of understanding the treatment. The main prediction factor for short and long-term success is medical compliance for which thorough clarification of psychosocial support is needed. Symptoms of psychological exhaustion due to physical illness should be distinguished from psychiatric disorders. If a patient has a history of psychiatric illness, the risks of exacerbation or recurrence of a disease need to be evaluated. Pharmacokinetic and pharmacodynamics of psychotropic drugs resulting from to organ failure should be considered when deciding on treatment. Psychiatric assessment of the organ donor aims to clarify the psychological suitability and motivation. There are specific aspects of liver, kidney, heart and lung transplantation to keep in mind. Understanding psychosexual development is particularly important to children, before transplantation, as is the assessment of every family member. The consultation concludes with an overall evaluation of the patient's psychosocial strengths and limitations and recommended interventions to optimize the candidacy for transplantation. In the post-transplantation period potential psychological problems or psychiatric disorders must be identified and treated accordingly, in addition to psychiatric side effects of immunosuppressive therapy. The use of psychotropic drugs in the post-transplantation period requires knowledge of medication interactions. Overall, psychiatrists perform multiple roles in the transplantation team. The psychiatrists' goals are to meet the psychological needs of both patients and potential donors, evaluate candidates and to help other medical experts on the team with understanding underlying psychological mechanisms triggered by serious medical conditions and procedures. Finally, the most important purpose is optimal organ recruitment and recovery.

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Atypical Antipsychotics for the Treatment of ICU Delirium

Cited by 34 publications

References 67 publications

Recent Insights on Prevalence and Corelations of Hypoactive Delirium

Recent Insights on Prevalence and Corelations of Hypoactive Delirium

Antipsychotics, Delirium, and Acute Respiratory Distress Syndrome: What Is the Link?

Transplantation Psychiatry: An Overview

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