Palliative and Supportive Care

Review Articles

An update on the use of antipsychotics in the treatment of delirium

Yesne Alici-Evcimena1 and William Breitbarta2a3 c1

a1 Department of Psychiatry, Section on Geriatric Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania

a2 Weill Medical College of Cornell University, New York, New York

a3 Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York

ABSTRACT

Objective: Delirium is the most common neuropsychiatric complication of medical illness, a medical emergency that needs to be identified and treated vigorously. Delirium is too frequently underdiagnosed and untreated in the medical setting, which leads to increased morbidity and mortality, interference in the management of symptoms such as pain, an increased length of hospitalization, increased health care costs, and distress for patients and their caregivers (Inouye, 2006; Breitbart et al., 2002a, 2002b). In this article, we present an update of the use of antipsychotics in management of delirium based on the available literature and our own clinical experience.

Methods: We reviewed the current literature on the role of antipsychotics in the management of delirium using standard computer-based search methods (e.g., PubMed).

Results: Antipsychotic medications, including the new atypical antipsychotics, have been demonstrated to effectively manage a wide spectrum of the symptoms of delirium and are an essential component in the multimodal approach to managing delirium.

Significance of results: The standard approach to managing delirium includes identification and elimination of factors contributing to the delirium in addition to pharmacological and nonpharmacological treatment interventions (Trzepacz et al., 1999). Newer atypical antipsychotics can play an important role in the management of the symptoms of delirium.

(Received September 10 2007)

(Accepted October 16 2007)

Correspondence:

c1 Address correspondence and reprint requests to: Yesne Alici-Evcimen, Department of Psychiatry, Section on Geriatric Psychiatry, University of Pennsylvania, 3615 Chestnut Street, 2nd floor, Philadelphia, PA, 19104. E-mail: yesnea@yahoo.com