Risperidone in the Treatment of Delirium

Mittal, Dinesh; Jimerson, Nita; Neely, Emily P.; Johnson, William D.; Kennedy, Richard E.; Torres, Rafael A.; Nasrallah, Henry A.

doi:10.4088/jcp.v65n0510

Cited by 66 publications

(5 citation statements)

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“…Ten papers (five studies) 25,35,40,42,56–61 analysed functional recovery over time in the context of delirium, with nine (four studies) observing improvement. Boettger et al 25,56–61 .…”

Section: Resultsmentioning

confidence: 99%

“…Ten papers (five studies) 25,35,40,42,[56][57][58][59][60][61] analysed functional recovery over time in the context of delirium, with nine (four studies) observing improvement. Boettger et al 25,[56][57][58][59][60][61] analysed change in KPS scores over time and found an improvement in functional performance.…”

Section: Functional Abilitymentioning

confidence: 99%

“…In measurement of exposure, 26 papers were low risk whilst 13 papers were either unclear or high risk due to missing key information on how assessments were carried out and data were collected. 25,35,38,42,55,56,58,59,62,63,66,68,69 Only 10 papers were low risk in blinding of outcome measures, 5,20,44,46,48,51,55,66,67,70 with most papers presenting unclear risk due to a lack of clarity around blinding details. In terms of incomplete outcome data, 12 papers had high risk due to an absence of a published protocol.…”

Section: Risk Of Biasmentioning

confidence: 99%

“…Sixteen papers (15 studies) analysed change in general cognition in participants with delirium over time (≤7 days), with 12 papers (11 studies) reporting an improvement. [35][36][37][38][39][40][41][42][43][44][45][46] Of the two papers (two studies) that analysed longitudinal change but found no significant results, 47,48 one had a small sample size (N = 14) 47 and the other did not report the proportion of the sample who had a dementia diagnosis. 48 Two studies reported longitudinal change in general cognition beyond the 7-day timeframe.…”

Section: General Cognitionmentioning

confidence: 99%

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A systematic review of studies reporting on neuropsychological and functional domains used for assessment of recovery from delirium in acute hospital patients

McCartney

Noble

MacLullich

et al. 2023

Int J Geriat Psychiatry

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Objectives Assessing for recovery in delirium is essential in guiding ongoing investigation and treatment. Yet, there is little scrutiny and no research or clinical consensus on how recovery should be measured. We reviewed studies which used tests of neuropsychological domains and functional ability to track recovery of delirium longitudinally in acute hospital settings. Methods/Design We systematically searched databases (MEDLINE, PsycInfo, CINAHL, Embase, http://ClinicalTrials.gov, Cochrane Central Register of Controlled Trials), from inception to October 14th, 2022. Inclusion criteria were: adult acute hospital patients (≥18 years) diagnosed with delirium by a validated tool; 1+ repeat assessment using an assessment tool measuring domains of delirium/functional recovery ≤7 days from baseline. Two reviewers independently screened articles, performed data extraction, and assessed risk of bias. A narrative data synthesis was completed. Results From 6533 screened citations, we included 39 papers (reporting 32 studies), with 2370 participants with delirium. Studies reported 21 tools with an average of four repeat assessments including baseline (range 2–10 assessments within ≤7 days), measuring 15 specific domains. General cognition, functional ability, arousal, attention and psychotic features were most commonly assessed for longitudinal change. Risk of bias was moderate to high for most studies. Conclusions There was no standard approach for tracking change in specific domains of delirium. The methodological heterogeneity of studies was too high to draw firm conclusions on the effectiveness of assessment tools to measure delirium recovery. This highlights the need for standardised methods for assessing recovery from delirium.

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Section: Resultsmentioning

confidence: 99%

Section: Functional Abilitymentioning

confidence: 99%

Section: Risk Of Biasmentioning

confidence: 99%

Section: General Cognitionmentioning

confidence: 99%

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A systematic review of studies reporting on neuropsychological and functional domains used for assessment of recovery from delirium in acute hospital patients

McCartney

Noble

MacLullich

et al. 2023

Int J Geriat Psychiatry

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“…[52,54,55] Owing to their common mechanism of action of variable D 2 receptor blockade and concurrent blockade of the 5-hydroxytrptamine (5-HT) 2 receptor, they all carry less risk for sedation and EPSs than haloperidol and other high-potency typical antipsychotic agents. [54,55,64] Mittal and colleagues [65] treated 10 delirium patients with a mean dose of 0.75 mg/d of risperidone and found improvement in cognitive and behavioral symptoms; no patient experienced EPSs. Parellada and colleagues [66] treated 64 delirium patients with a mean dose of 2.6 mg/d of risperidone; 90% improved, and only 3% experienced adverse events, none of which was EPSs.…”

Section: Atypical Antipsychoticsmentioning

confidence: 99%

Delirium: Issues in diagnosis and management

2009

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Delirium is a disturbance of consciousness, cognition and perception that occurs frequently in medically ill patients. Although it is associated with increased morbidity and mortality, it is often not recognized and treated by physicians. Literature searches were conducted using MEDLINE with the following keywords/ phrases: delirium, acute confusion and management. Additional articles identifi ed by hand-searching in major journals of medicine and psychiatry, and a review of references cited within these sources supplemented the search. In this article, the available published literature regarding the diagnosis, prevention and treatment of delirium is systematically reviewed. Prevention and treatment strategies do not need to be complex or expensive but require well-coordinated interventions from multiple disciplines, including nursing, psychiatry, neurology and primary care, as well as the cooperation and signifi cant effort of family and friends. Atypical antipsychotic agents offer some advantages over haloperidol and in a limited number of studies appear safe and effective for delirium.

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Agitation and Delirium at the End of Life

2008

JAMA

172

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Delirium is the most common neuropsychiatric complication experienced by patients with advanced illness, occurring in up to 85% of patients in the last weeks of life. Using the case of Mr L, a 59-year-old man with metastatic lung cancer who developed an agitated delirium in the last week of life, we review the evaluation and management of delirium near the end of life. Although some studies have identified agitation as a central feature of delirium in 13% to 46% of patients, other studies have found up to 80% of patients near the end of life develop a hypoactive, nonagitated delirium. Both the agitated (hyperactive) and nonagitated (hypoactive) forms of delirium are harbingers of impending death and are associated with increased morbidity in patients who are terminally ill, causing distress for patients, family members, and staff. Delirium is a sign of significant physiological disturbance, usually involving multiple causes, including infection, organ failure, and medication adverse effects. Often these causes of delirium are not reversible in the dying patient, and this influences the outcomes of its management. Delirium can also significantly interfere with the recognition and control of other physical and psychological symptoms, such as pain. Unfortunately, delirium is often misdiagnosed or unrecognized and thus inappropriately treated or untreated in terminally ill patients. To manage delirium in terminally ill patients, clinicians must be able to diagnose it accurately, undertake appropriate assessment of underlying causes, and understand the benefits and risks of the available pharmacological and nonpharmacological interventions.

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Risperidone in the Treatment of Delirium

Cited by 66 publications

References 0 publications

A systematic review of studies reporting on neuropsychological and functional domains used for assessment of recovery from delirium in acute hospital patients

A systematic review of studies reporting on neuropsychological and functional domains used for assessment of recovery from delirium in acute hospital patients

Delirium: Issues in diagnosis and management

Agitation and Delirium at the End of Life

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