Antipsychotics Don't Ease Delirium in Hospitalized Patients

These drugs won't prevent or effectively treat the condition, review suggests

Tuesday, March 29, 2016

TUESDAY, March 29, 2016 (HealthDay News) -- Antipsychotic medications, such as haloperidol (Haldol) or clozapine (Clozaril), aren't appropriate for preventing or routinely treating delirium in hospitalized patients, a new study suggests.

The researchers reviewed past studies and found that antipsychotic drugs given before surgery didn't prevent delirium. These drugs also didn't make any difference in the course of delirium in medical or surgical patients, the study authors said.

"The American Geriatrics Society guidelines suggest avoiding using these medications as a part of routine care of a patient with delirium," said lead researcher Dr. Karin Neufeld, clinical director of psychiatry at Johns Hopkins Bayview Medical Center in Baltimore.

Delirium causes confused thinking and diminished awareness of the environment, such as time and place. Delirium is often caused by physical or mental illness, such as drug abuse or an electrolyte imbalance. Delirium is usually temporary and reversible.

Antipsychotic drugs are routinely used to treat delirium. But the U.S. Food and Drug Administration hasn't specifically approved their use for treating the condition.

However, antipsychotics can be used for limited periods for treating specific symptoms, such as distressing hallucinations, or "when the patient's life or safety are at risk due to severe agitation," Neufeld said.

Treating delirium without drugs has also been shown to be successful, she added.

"Interventions, such as getting the patient out of bed and engaging in physical activity, can be first-line approaches to treating delirium," Neufeld said. "These non-drug types of treatments have been shown to decrease delirium in hospitalized patients and we should incorporate them into our practices," she suggested.

For the new study, Neufeld and colleagues reviewed data from 19 previously published studies. Seven of the studies looked specifically at preventing delirium after surgery. The studies compared antipsychotics with placebo pills or no treatment. The researchers found antipsychotics didn't reduce the risk of delirium.

Pooling data from all 19 studies that included medical and surgical patients, Neufeld's team found that antipsychotics didn't alter how long patients suffered from delirium. The drugs also didn't reduce the severity of delirium. And giving people antipsychotics didn't change how long a patient stayed in the hospital, or if a patient died, the study authors reported.

"At this point we do not have any clear evidence that using antipsychotic medications can generally prevent or shorten the course of delirium," Neufeld said.

The report findings were published online recently in the Journal of the American Geriatrics Society.

Dr. Eugene Grudnikoff, a psychiatrist at South Oaks Hospital in Amityville, N.Y., pointed out that delirium is not a disease. "It is a group of symptoms that may result from a number of conditions," he explained.

It's not surprising that antipsychotics didn't work for patients who developed delirium after surgery or because of a medical condition that may have caused the delirium in the first place, Grudnikoff said. But that doesn't mean that these drugs might not be effective in patients who have delirium due to drug abuse or mental illness, he said.

Grudnikoff said simple measures can be useful in helping patients regain their mental compass. These can include keeping a clock and calendar on the wall that the patient can see when waking up from surgery. It's also helpful to keep the room dark at night and lit during the day. Having the same staff treat the patient throughout a hospitalization can also help, he suggested.

"These seem trivial and obvious, but they are important," he added.

SOURCES: Karin Neufeld, M.D., M.P.H., clinical director, psychiatry, Johns Hopkins Bayview Medical Center, associate professor, Johns Hopkins University School of Medicine, Baltimore; Eugene Grudnikoff, M.D., psychiatrist, South Oaks Hospital, Amityville, N.Y.; March 23, 2015, Journal of the American Geriatrics Society

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