Atypical antipsychotics in the treatment of delirium

Abstract

). Selection criteria for review were prospective, controlled studies (comparison studies), using validated delirium rating scales as outcome measures. A total of six prospective, randomized controlled studies were included in the review. It was found that atypical antipsychotics are effective and safe in treating delirium, even though there seemed to be no difference between each agent. In particular, comparison studies with haloperidol showed that the efficacy of atypical antipsychotics was similar to that of low-dose haloperidol. It was concluded that atypical antipsychotics appear to be effective and tolerable in the management of delirium, even though the evidence is limited.

Yokukansan, a traditional Japanese medicine, decreases head-twitch behaviors and serotonin 2A receptors in the prefrontal cortex of isolation-stressed mice

“…In addition, polymorphisms within 5-HT 2A receptors have been reported to be associated with schizophrenic patients (Williams et al, 1996;Golimbet et al, 2007;Quednow et al, 2008) or BPSD of AD patients (Pritchard et al, 2008), who frequently exhibit hallucinations, delusions, and psychosis. In delirium, similar to schizophrenia and BPSD, atypical antipsychotic drugs such as olanzapine and quetiapine having a strong 5-HT 2A receptor antagonistic action, are usually used to treat the symptoms including hallucination, delusion, and excitation (Maneeton et al, 2013;Wang et al, 2013;Yoon et al, 2013). In animals, several hallucinogenic compounds such as lysergic acid diethylamide and mescaline, can induce the head-twitch response in normal mice (Corne et al, 1963;Corne and Pickering, 1967) or htr2A þ / þ but not htr2A À / À mice (González-Maeso et al, 2007).…”

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].…”

Psychosis in Later Life

“…43 Nonpharmacological management is the firstline and most effective management for delirium, and the most commonly employed strategy with proven effectiveness is the Hospital Elder Life Program, which involves reorientation, therapeutic activities, discontinuation or reduction of psychoactive drugs, ensuring appropriate hydration and nutrition, mobilization, promoting sleep, and addressing hearing and vision deficits. 43 Although Inouye and colleagues 43 conclude that across all studies reviewed, reproducible evidence of effectiveness has not been demonstrated for any pharmacological treatment, a review by Wang and colleagues 44 suggests that atypical antipsychotics are efficacious and have a similar efficacy to each other and to haloperidol. Many of the articles included in that review, however, admittedly have numerous limitations; as such, further research is required before drawing any firm conclusions.…”