Antipsychotics for delirium

Lonergan, Edmund; Britton, Annette; Luxenberg, Jay S.; Wyller, Torgeir Bruun

doi:10.1002/14651858.cd005594.pub2

Cited by 275 publications

(151 citation statements)

References 32 publications

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“…The vast majority of clinical trials that have been conducted in the treatment of postoperative delirium have included antipsychotic agents. Several systematic reviews [44][45][46][47][48] have been carried out to determine if any significant differences exist between the first generation antipsychotics (e.g., haloperidol) and the newer second generation antipsychotics (e.g., olanzapine, risperidone). All systematic reviews have yielded similar conclusions.…”

Section: Treatment Of Established Deliriummentioning

confidence: 99%

“…La grande majorité des essais cliniques menés sur le traitement du delirium postopératoire ont inclus des antipsychotiques. Plusieurs analyses systématiques [44][45][46][47][48] ont été réalisées pour déterminer s'il existait des différences significatives entre les antipsychotiques de première génération (par exemple, l'halopéridol) et les antipsychotiques plus récents de deuxième génération (par exemple, l'olanzapine, la rispéridone). Toutes les analyses systématiques sont parvenues aux mêmes conclusions.…”

Section: Traitement D'un Delirium Installéunclassified

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Postoperative delirium: risk factors and management: Continuing Professional Development

Chaput

Bryson

2012

Can J Anesth/J Can Anesth

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Purpose Postoperative delirium often remains undiagnosed and therefore untreated. The purpose of this continuing professional development module is to identify patients at high risk of developing delirium following noncardiac surgery and to provide tools to aid in the diagnosis of delirium at the bedside. Optimal prevention and treatment strategies are recommended. Principal findings Delirium is characterized by an acute onset and a fluctuating course, inattention, disorganized thinking and an altered level of consciousness, and occurs in up to 40% of patients in the perioperative period. The pathophysiology of delirium is multifactorial, but it is believed to be related to inflammation, altered neurotransmission, and stress in the patient who has had surgery. Acetylcholine and dopamine appear to play a significant role. There is an increased risk of a poor outcome in patients who develop delirium, including a longer hospital stay and death. Surgical and patient factors play a significant role in predicting who will subsequently develop delirium. Prevention is much more effective than treatment in the management of delirium. The most effective prevention strategies include proactive geriatric assessment and care of the patient on a geriatrics surgical ward as well as prophylactic low-dose antipsychotic agents. From an anesthetic perspective, evidence in some surgical populations would support the use of regional techniques and minimal sedation. If delirium develops, treatment with lowdose oral antipsychotics appears to be most effective.Conclusions Delirium is a serious condition that must be recognized early and treated promptly to minimize deleterious outcomes. In order to institute prevention strategies and treat the condition effectively when it occurs, the anesthesiologist must be vigilant in identifying patients at risk and in screening for this condition. Objectives of this Continuing Professional Development (CPD) module:After reading this module, the reader should be able to:1. Define delirium in the context of other cognitive changes following non-cardiac surgery. 2. Understand the incidence and adverse outcomes associated with delirium. 3. List predisposing and precipitating factors of postoperative delirium and identify the patient at risk. 4. Explain the underlying pathophysiologic mechanisms believed to be implicated in causing delirium. 5. Formulate an anesthetic plan that minimizes the risk of developing postoperative delirium. 6. Devise a management plan to treat postoperative delirium most effectively while minimizing the adverse effects of treatment.Like other Western nations, Canada's population is aging rapidly. Over the past 50 years, the proportion of Canadians over the age of 65 has risen from 7.7% to 13.7%. A Statistics Canada estimates that the proportion of seniors will double 123Can J Anesth/J Can Anesth (2012) 59:304-320 DOI 10.1007 yet again by 2036 and will represent 23-25% of Canada's population. B This rapid demographic shift will impact anesthesiologists and hospitals ...

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Section: Treatment Of Established Deliriummentioning

confidence: 99%

Section: Traitement D'un Delirium Installéunclassified

Postoperative delirium: risk factors and management: Continuing Professional Development

Chaput

Bryson

2012

Can J Anesth/J Can Anesth

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“…Some recent studies have indicated that atypical antipsychotics can be used safely in patients who develop delirium (2,22). Especially olanzapine, risperidone, ziprasidone and quetiapine are notable atypical antipsychotics (27)(28)(29)(30)(31). Benzodiazepines are recommended for treatment of patients who develop delirium due to withdrawal of alcohol and benzodiazepine, and hepatic failure (2).…”

Section: Discussionmentioning

confidence: 99%

An evaluation of cases with delirium in a training hospital / Bir eğitim hastanesinde deliryumlu olguların değerlendirilmesi

Aslan¹,

Köroğlu²,

Celik³

et al. 2011

Dusunen Adam

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“…Whereas there is some evidence suggesting haloperidol may reduce delirium duration [72] and mortality [73], an overall dearth of data is emphasized in systematic reviews [74][75][76][77] concluding: 1) "there are no published double-blind, randomized, placebo-controlled trials to establish [the] efficacy or safety of any anti-psychotic medication in the management of delirium. Further study with well-designed clinical trials is required in this area" [75]; 2) "Better designed and larger studies evaluating adding anti-psychotic agents to nonpharmacological treatments are needed" [74]; 3) "Small studies of limited scope require further evidence before translation into specific recommendations for delirium treatment" [76].…”

Section: Anti-psychoticsmentioning

confidence: 99%

Pharmacological and Nonpharmacological Management of Delirium in Critically Ill Patients

2012

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Delirium is a common yet under-diagnosed syndrome of acute brain dysfunction, which is characterized by inattention, fluctuating mental status, altered level of consciousness, or disorganized thinking. Although our recognition of risk factors for delirium has progressed, our understanding of the underlying pathophysiologic mechanisms remains limited. Improvements in monitoring and assessment for delirium (particularly in the intensive care setting) have resulted in validated and reliable tools such as arousal scales and bedside delirium monitoring instruments. Once delirium is recognized and the modifiable risk factors are addressed, the next step in management (if delirium persists) is often pharmacological intervention. The sedatives, analgesics, and hypnotics most often used in the intensive care unit (ICU) to achieve patient comfort are all too frequently deliriogenic, resulting in a longer duration of ICU and hospital stay, and increased costs. Therefore, identification of safe and efficacious agents to reduce the incidence, duration, and severity of ICU delirium is a hot topic in critical care. Recognizing that there are no medications approved by the Food and Drug Administration (FDA) for the prevention or treatment of delirium, we chose anti-psychotics and alpha-2 agonists as the general pharmacological focus of this article because both were subjects of relatively recent data and ongoing clinical trials. Emerging pharmacological strategies for addressing delirium must be combined with nonpharmacological approaches (such as daily spontaneous awakening trials and spontaneous breathing trials) and early mobility (combined with the increasingly popular approach called: Awakening and Breathing Coordination, Delirium Monitoring, Early Mobility, and Exercise [ABCDE] of critical care) to develop evidence-based approaches that will ensure safer and faster recovery of the sickest patients in our healthcare system.

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Antipsychotics for delirium

Cited by 275 publications

References 32 publications

Postoperative delirium: risk factors and management: Continuing Professional Development

Postoperative delirium: risk factors and management: Continuing Professional Development

An evaluation of cases with delirium in a training hospital / Bir eğitim hastanesinde deliryumlu olguların değerlendirilmesi

Pharmacological and Nonpharmacological Management of Delirium in Critically Ill Patients

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