Internal Med Medical News about Delirium; Hospitalized Adults

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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.

Methods

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.

Results

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.