Article review: Delirium

Delirium is a clinical syndrome of acute and changing disturbance in attention and memory/perception over a short period resulting from an acute medical illness.

Typically seen in hospitalized patients, particularly patients who are mechanically ventilated in intensive care units.

Delirium is linked with increased cost of care arising from complications related to delirium and poorer outcomes.

Delirium is preventable in 30 to 40% of patients by interventions such as interactions with family and friends, early mobilization and improved sleep.

Medications that have been used to manage delirium include first-generation antipsychotic agent such as haloperidol and second-generation antipsychotics such as risperidone, olanzapine, quetiapine, or ziprasidone.

In USA, the FDA has no approved medication for delirium, however, antipsychotics are used to treat delirium especially in critically ill patients.

These antipsychotics have side effects, such as sedation, cardiac arrhythmias and extrapyramidal neurologic problems. When used in people with dementia over a long-term basis, there is an increase in mortality in this group.

In this systematic review of 14 randomised control trials of the use of antipsychotics in hospitalized patients with delirium, there was no evidence to support the use of antipsychotics for preventing delirium.

The authors noted that in postoperative patients, second-generation antipsychotics may lower delirium, but more research is needed in this area.

In this systematic review authors concluded that the treatment of delirium with antipsychotics did not improve outcome, but increased cardiac side effects with little evidence of extrapyramidal neurologic side effects. Ongoing research in this field is recommended.

For health education: Summary by Dr. Onuoha.

Reference:

http://Oh ES, Needham DM, Nikooie R, et al. Antipsychotics for Preventing Delirium in Hospitalized Adults: A Systematic Review. Ann Intern Med. 2019;171(7):474-484. doi:10.7326/M19-1859

Nikooie R, Neufeld KJ, Oh ES, et al. Antipsychotics for Treating Delirium in Hospitalized Adults: A Systematic Review. Ann Intern Med. 2019;171(7):485-495. doi:10.7326/M19-1860

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