Hostname: page-component-7c8c6479df-5xszh Total loading time: 0 Render date: 2024-03-28T09:26:50.651Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  23 May 2008

Yesne Alici-Evcimen
Affiliation:
Department of Psychiatry, Section on Geriatric Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
William Breitbart*
Affiliation:
Weill Medical College of Cornell University, New York, New York Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York
*
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

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.

Type
Review Articles
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Al-Khatib, S.M., LaPointe, N.M., Kramer, J.M., et al. (2003). What clinicians should know about the QT interval. JAMA 289, 21202127.Google Scholar
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association.Google Scholar
Boettger, S. & Breitbart, W. (2005). Atypical antipsychotics in the management of delirium: A review of the empirical literature. Palliative & Supportive Care, 3, 227237.Google Scholar
Breitbart, W., Gibson, C., & Tremblay, A. (2002a). The delirium experience: Delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses. Psychosomatics, 43, 183194.CrossRefGoogle ScholarPubMed
Breitbart, W., Marotta, R., Platt, M.M., et al. (1996). A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. American Journal of Psychiatry, 153, 231237.Google Scholar
Breitbart, W., Tremblay, A., & Gibson, C. (2002b). An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients. Psychosomatics, 43, 175182.CrossRefGoogle ScholarPubMed
Casarett, D.J. & Inouye, S.K. (2001). Diagnosis and management of delirium near the end of life. Annals of Internal Medicine, 135, 3240.Google Scholar
Glassman, A.H. & Bigger, J.T. Jr. (2001). Antipsychotic drugs: Prolonged QTc interval, torsade de pointes, and sudden death. American Journal of Psychiatry, 158, 17741782.CrossRefGoogle Scholar
Han, C.S. & Kim, Y.K. (2004). A double-blind trial of risperidone and haloperidol for the treatment of delirium. Psychosomatics, 45, 297301.Google Scholar
Horikawa, N., Yamazaki, T., & Miyamoto, K. (2003). Treatment for delirium with risperidone: Results of a prospective open trial with 10 patients. General Hospital Psychiatry, 25, 289292.Google Scholar
Inouye, S.K. (2006). Delirium in older persons. New England Journal of Medicine, 354, 11571165.CrossRefGoogle ScholarPubMed
Kalisvaart, K.J., de Jonghe, J.F., Bogaards, M.J., et al. (2005). Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: A randomized placebo-controlled study. Journal of the American Geriatric Society, 53, 16581666.CrossRefGoogle ScholarPubMed
Kim, J.Y., Jung, I.K., Han, C., et al. (2005). Antipsychotics and dopamine transporter gene polymorphisms in delirium patients. Psychiatry and Clinical Neurosciences, 59, 183188.CrossRefGoogle Scholar
Leso, L. & Schwartz, T.L. (2002). Ziprasidone treatment of delirium. Psychosomatics, 43, 61–2.Google Scholar
Michaud, L., Bula, C., Berney, A., et al. (2007). Delirium: Guidelines for general hospitals. Journal of Psychosomatic Research, 62, 371383.Google Scholar
Mittal, D., Jimerson, N.A., & Neely, E. (2004). Risperidone in the treatment of delirium: Results from a prospective open-label trial. Journal of Clinical Psychiatry, 65, 662667.CrossRefGoogle ScholarPubMed
Nasrallah, H.A. & Newcomer, J.W. (2004). Atypical antipsychotics and metabolic dysregulation: Evaluating the risk/benefit equation and improving the standard of care. Journal of Clinical Psychopharmacology, 24(Suppl. 1), S714.Google Scholar
Pae, C.U., Lee, S.J., & Lee, C. (2004). A pilot trial of quetiapine for the treatment of patients with delirium. Human Psychopharmacology, 19, 125127.CrossRefGoogle ScholarPubMed
Parellada, E., Baeza, I., de Pablo, J., et al. (2004). Risperidone in the treatment of patients with delirium. Journal of Clinical Psychiatry, 65, 348353.CrossRefGoogle ScholarPubMed
Schneider, L.S., Dagerman, K.S., & Insel, P. (2005). Risk of death with atypical antipsychotic drug treatment for dementia: Meta-analysis of randomized placebo-controlled trials. JAMA, 294, 19341943.Google Scholar
Seitz, D.P., Gill, S.S., & van Zyl, L.T. (2007). Antipsychotics in the treatment of delirium: A systematic review. Journal of Clinical Psychiatry, 68, 1121.Google Scholar
Skrobik, Y.K., Bergeron, N., & Dumont, M. (2004). Olanzapine vs haloperidol: Treating delirium in a critical care setting. Intensive Care Medicine, 30, 444449.Google Scholar
Straker, D.A., Shapiro, P.A., & Muskin, P.R. (2006). Aripiprazole in the treatment of delirium. Psychosomatics 47, 385391.Google Scholar
Trzepacz, P.T. (1999). Update on the neuropathogenesis of delirium. Dementia and Geriatric Cognitive Disorders, 10, 330334.CrossRefGoogle Scholar
Trzepacz, P.T. (2000). Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Seminars in Clinical Neuropsychiatry, 5, 132148.Google Scholar
Trzepacz, P.T., Breitbart, W., Franklin, J., et al. (1999). Practice guideline for the treatment of patients with delirium. American Psychiatric Association. American Journal of Psychiatry, 156(Suppl), 120.Google Scholar
Wang, P.S., Schneeweiss, S., Avorn, J., et al. (2005). Risk of death in elderly users of conventional vs. atypical antipsychotic medications. New England Journal of Medicine 353, 23352341.Google Scholar
Zareba, W. & Lin, D.A. (2003). Antipsychotic drugs and QT interval prolongation. Psychiatric Quarterly, 74, 291306.Google Scholar