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Pharmacological Management of Delirium in Hospitalized Adults - A Systematic Evidence Review
Journal of General Internal Medicine, 05/12/09

Campbell N et al. - The existing limited data indicates no superiority for second-generation antipsychotics over haloperidol in managing delirium. Although preliminary results suggest delirium prevention may be accomplished through various mechanisms, further studies are necessary to prove effectiveness.

• Three reviewers independently extracted the data for participants, interventions and outcome measures, and critically appraised each study using the JADAD scale.
• Searched Medline, PubMed, the Cochrane Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) information systems from January 1966 to October 2008.
• We included randomized, controlled trials comparing pharmacologic compounds either to each other or placebo.
• This study excluded non-comparison trials, studies with patients aged < 18 years, a history of an Axis I psychiatric disorder, and patients with alcohol-related delirium.

• This study identified 13 studies that met our inclusion criteria and evaluated 15 compounds:
• second-generation antipsychotics,
• first-generation antipsychotics,
• cholinergic enhancers,
• an antiepileptic agent,
• an inhaled anesthetic,
• injectable sedatives,
• and a benzodiazepine.
• Four trials evaluated delirium treatment and suggested no differences in efficacy or safety among the evaluated treatment methods (first and second generation antipsychotics).
• Neither cholinesterase inhibitors nor procholinergic drugs were effective in preventing delirium.
• Multiple studies, however, suggest either shorter severity and duration, or prevention of delirium with the use of haloperidol, risperidone, gabapentin, or a mixture of sedatives in patients undergoing elective or emergent surgical procedures.

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