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Mei X, Liu YH, Han YQ, Zheng CY. Risk factors, preventive interventions, overlapping symptoms, and clinical measures of delirium in elderly patients. World J Psychiatry 2023; 13:973-984. [PMID: 38186721 PMCID: PMC10768493 DOI: 10.5498/wjp.v13.i12.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/14/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Delirium is an acute reversible neuropsychiatric syndrome caused by multiple factors. It is associated with many adverse clinical outcomes including cognitive impairment, functional decline, prolonged hospitalization, and increased nursing service. The prevalence of delirium was high in department of cardiology, geriatric, and intensive care unit of hospital. With the increase in the aged population, further increases in delirium seem likely. However, it remains poorly recognized in the clinical practice. This article comprehensively discusses the latest research perspectives on the epidemiological data, risk factors, preventive interventions, overlapping symptoms, and clinical measures of delirium, including specific measures to manage delirium in clinical real-world situations. This article helps readers improve their knowledge and understanding of delirium and helps clinicians quickly identify and implement timely therapeutic measures to address various delirium subtypes that occur in the clinical settings to ensure patients are treated as aggressively as possible.
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Affiliation(s)
- Xi Mei
- Department of Psychiatry, Ningo Kangning Hospital, Ningbo 315201, Zhejiang Province, China
| | - Yue-Hong Liu
- Department of Psychiatry, Ningo Kangning Hospital, Ningbo 315201, Zhejiang Province, China
| | - Ya-Qing Han
- Department of Psychiatry, Ningo Kangning Hospital, Ningbo 315201, Zhejiang Province, China
| | - Cheng-Ying Zheng
- Department of Psychiatry, Ningo Kangning Hospital, Ningbo 315201, Zhejiang Province, China
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Yang CJ, Chiu CT, Yeh YC, Chao A. Successful management of delirium with dexmedetomidine in a patient with haloperidol-induced neuroleptic malignant syndrome: A case report. World J Clin Cases 2022; 10:625-630. [PMID: 35097088 PMCID: PMC8771406 DOI: 10.12998/wjcc.v10.i2.625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 11/04/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We report a case of lorazepam-induced agitated delirium treated with haloperidol, which in turn triggered the onset of neuroleptic malignant syndrome (NMS). The latter condition, a medical emergency, was effectively treated with medical treatment and dexmedetomidine, a versatile and highly selective short-acting alpha-2 adrenergic agonist with sedative-hypnotic and anxiolytic effects.
CASE SUMMARY A 65-year-old man with a history of bipolar disorder presented to the emergency department with severe abdominal discomfort after binge eating. During his hospital stay, he received intravenous lorazepam for insomnia. On the next day, he became delirious and was thus treated with seven doses (5 mg each) of haloperidol over a 48 h period. Signs of NMS (hyperthermia, rigidity, myoclonus of upper limbs, impaired consciousness, tachypnea, and dark urine) became apparent and haloperidol was immediately suspended and brisk diuresis was initiated. On intensive care unit admission, he was confused, disoriented, and markedly agitated. Dexmedetomidine infusion was started with the goal of achieving a Richmond Agitation-Sedation Scale score of -1 or 0. NMS was resolved gradually and the patient stabilized, permitting discontinuation of dexmedetomidine after 3 d.
CONCLUSION Dexmedetomidine may be clinically helpful for the management of NMS, most likely because of its sympatholytic activity.
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Affiliation(s)
- Chi-Ju Yang
- Department of Pharmacy, National Taiwan University Hospital, Taipei 100220, Taiwan
| | - Ching-Tang Chiu
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 100220, Taiwan
| | - Yu-Chang Yeh
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 100220, Taiwan
| | - Anne Chao
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 100220, Taiwan
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Bellman V, Russell N, Depala K, Dellenbaugh A, Desai S, Vadukapuram R, Patel S, Srinivas S. Challenges in Treating Cancer Patients With Unstable Psychiatric Disorder. World J Oncol 2021; 12:137-148. [PMID: 34804276 PMCID: PMC8577605 DOI: 10.14740/wjon1402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 11/14/2022] Open
Abstract
In this review, we first present a case of chronic myeloid leukemia with acute psychosis, and then we will discuss the incidence of cancer in patients with psychotic disorders, the manifestations of new-onset psychosis, and the prevalence of preexisting psychosis in cancer patients, coupled with their impact on the treatment, diagnosis, and prognosis of cancer. This was a case that presented with acute psychosis and was found to have an elevated white blood cell count upon admission to an inpatient psychiatric unit. He was diagnosed with chronic myeloid leukemia and successfully managed with imatinib/dasatinib therapy. Psychiatrically, he was stabilized on two long-acting injectable medications to help maintain adherence. We were able to eliminate his active psychotic symptoms and return him to normal functioning in affect and thinking, achieving sustained compliance with treatment. We identified multiple inconsistencies in screening for cancer of all types in these patients, masking of signs and symptoms that would typically clue physicians to the presence of cancers, underreporting of symptoms, and disparate access to healthcare resources in patients with mental disorders when compared to the general population. Treatment of cancer in these patients as compared to the general population has also been shown to be incongruent, which will be elaborated upon. Psychiatric interventions, as well as supportive measures, for treating patients who are facing challenges during active cancer treatment will be discussed.
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Affiliation(s)
- Val Bellman
- Department of Psychiatry, University of Missouri Kansas City School of Medicine, 1000 E. 24th Street, Kansas City, MO 64108, USA
| | - Nina Russell
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Kartik Depala
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Saral Desai
- Department of Psychiatry, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Ramu Vadukapuram
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Sushma Srinivas
- A.J. Institute of Medical Sciences and Research Centre, NH66, Kuntikan, Mangalore, Karnataka, India
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Beach SR, Gross AF, Hartney KE, Taylor JB, Rundell JR. Intravenous haloperidol: A systematic review of side effects and recommendations for clinical use. Gen Hosp Psychiatry 2020; 67:42-50. [PMID: 32979582 DOI: 10.1016/j.genhosppsych.2020.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Though not approved by the United States Food and Drug Administration, intravenous haloperidol (IVH) is widely used off-label to manage agitation and psychosis in patients with delirium in the hospital setting. Over the years, concerns have emerged regarding side effects of IVH, particularly its potential to cause QT prolongation, torsades de pointes (TdP), extrapyramidal symptoms and catatonia. METHODS We conducted a systematic review of literature of published literature related to side effects of IVH in PubMed in accordance with PRISMA guidelines. RESULTS 77 of 196 identified manuscripts met inclusion criteria, including 34 clinical trials and 34 case reports or series. DISCUSSION Extrapyramidal symptoms, catatonia and neuroleptic malignant syndrome appears to be relatively rare with IVH. In most prospective studies, IVH did not cause greater QT prolongation than placebo, and rates of TdP with IVH appear to be low. There is not clear evidence to suggest that IVH carries greater risk for QT prolongation or TdP than other antipsychotics. CONCLUSIONS Based on the available literature, we provide modified evidence-based monitoring recommendations for clinicians prescribing IVH in hospital settings. Specifically, we recommend electrocardiogram monitoring only when using doses >5 mg of IVH and telemetry only for high-risk patients receiving cumulative doses of at least 100 mg or with accurately corrected QTc >500 ms.
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Affiliation(s)
- Scott R Beach
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.
| | - Anne F Gross
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States of America
| | - Kimberly E Hartney
- Department of Psychiatry, University of South Florida, Tampa, FL, United States of America
| | - John B Taylor
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - James R Rundell
- Department of Psychiatry, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, United States of America
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Triple Therapeutic Effects of Ketamine in Prehospital Settings: Systematic Review. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2020. [DOI: 10.1007/s40138-020-00215-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Affiliation(s)
- Robyn P Thom
- The Department of Psychiatry, Brigham and Women's Hospital, Boston
| | | | - Melissa Bui
- The Department of Psychiatry, Brigham and Women's Hospital, Boston
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Ungarian J, Rankin JA, Then KL. Delirium in the Intensive Care Unit: Is Dexmedetomidine Effective? Crit Care Nurse 2019; 39:e8-e21. [DOI: 10.4037/ccn2019591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Delirium in the intensive care unit affects approximately 30% of patients despite vigorous efforts to encourage the use of effective screening tools and preventive strategies. The success of pharmacological treatment of delirium remains equivocal; moreover, a paucity of research supports the use of atypical antipsychotic medications. However, dexmedetomidine appears to have a promising role in delirium management. This review includes an overview of the pathophysiology and types of delirium and describes 2 established tools used to screen for delirium. Published research related to the use of dexmedetomidine in the management of delirium is also discussed. The authors make recommendations for critical care nurses on dexmedetomidine use in the context of providing evidence-based nursing care to intensive care unit patients with delirium.
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Affiliation(s)
- Joelle Ungarian
- Joelle Ungarian is an orthopedic nurse practitioner with Alberta Health Services, Calgary, Alberta, Canada. James A. Rankin is a professor at the University of Calgary Faculty of Nursing, Calgary, Alberta, Canada, and a nurse practitioner in rheumatology with Alberta Health Services. Karen L. Then is a professor at the University of Calgary Faculty of Nursing and a nurse practitioner in cardiovascular surgery with Alberta Health Services
| | - James A. Rankin
- Joelle Ungarian is an orthopedic nurse practitioner with Alberta Health Services, Calgary, Alberta, Canada. James A. Rankin is a professor at the University of Calgary Faculty of Nursing, Calgary, Alberta, Canada, and a nurse practitioner in rheumatology with Alberta Health Services. Karen L. Then is a professor at the University of Calgary Faculty of Nursing and a nurse practitioner in cardiovascular surgery with Alberta Health Services
| | - Karen L. Then
- Joelle Ungarian is an orthopedic nurse practitioner with Alberta Health Services, Calgary, Alberta, Canada. James A. Rankin is a professor at the University of Calgary Faculty of Nursing, Calgary, Alberta, Canada, and a nurse practitioner in rheumatology with Alberta Health Services. Karen L. Then is a professor at the University of Calgary Faculty of Nursing and a nurse practitioner in cardiovascular surgery with Alberta Health Services
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Ketamine for Rapid Sedation of Agitated Patients in the Prehospital and Emergency Department Settings: A Systematic Review and Proportional Meta-Analysis. J Emerg Med 2018; 55:670-681. [PMID: 30197153 DOI: 10.1016/j.jemermed.2018.07.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/06/2018] [Accepted: 07/11/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rapid tranquilization of agitated patients can prevent injuries and expedite care. Whereas antipsychotics and benzodiazepines are commonly used for this purpose, ketamine has been suggested as an alternative. OBJECTIVE The aim of this systematic review is to determine the safety and effectiveness of ketamine to sedate prehospital and emergency department (ED) patients with undifferentiated agitation. METHODS Studies and case series of patients receiving ketamine for agitation were included. Studies were excluded if ketamine was used for analgesia, procedural sedation, asthma, or induction. Information sources included traditional and gray literature. RESULTS The initial search yielded 1176 results from 14 databases. After review of titles and abstracts, 32 studies were reviewed and 18 were included in the analysis, representing 650 patient encounters. The mean dose of ketamine was 315 mg (SD 52) given intramuscularly, with adequate sedation achieved in 7.2 min (SD 6.2, range 2-500). Intubation occurred in 30.5% of patients (95% confidence interval [CI] 27.0-34.1%). In the majority of those patients, ketamine was administered by paramedics during ground transport and the patient was intubated on ED arrival. When ketamine was administered in the ED, the intubation rate was 1.8% (95% CI 0.0-4.4%); in air medical transport, the rate was 4.9% (95% CI 0.0-10.3%). Other reported side effects included: vomiting, 5.2% (2.3-8.1%); hypertension, 12.1% (5.7-18.6%); emergence reactions, 3.5% (1.4-5.6%); transient hypoxia, 1.8% (0.1-3.6%) and laryngospasm, 1.3% (0.3-2.3%). CONCLUSIONS Ketamine provides rapid sedation for undifferentiated agitated patients and is associated with higher intubation rates when used by ground Emergency Medical Services paramedics, compared with ED or air medical transport patients. Other side effects are common but usually self-limiting.
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Barbateskovic M, Kraus SR, Collet MO, Mathiesen O, Jakobsen JC, Perner A, Wetterslev J. Haloperidol for delirium in critically ill patients - protocol for a systematic review. Acta Anaesthesiol Scand 2018; 62:712-723. [PMID: 29441518 DOI: 10.1111/aas.13088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/09/2018] [Accepted: 01/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the intensive care unit, the prevalence of delirium is high. Delirium has been associated with morbidity and mortality including more ventilator days, longer intensive care unit stay, increased long-term mortality, and cognitive impairment. Thus, the burden of delirium for patients, relatives, and societies is considerable. The objective of this systematic review was to critically access the evidence of randomised clinical trials on the effects of haloperidol vs. placebo or any other agents for delirium in critically ill patients. METHODS We will search for randomised clinical trials in the following databases: Cochrane Library, MEDLINE, EMBASE, Science Citation Index, BIOSIS, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, and Allied and Complementary Medicine Database. Two authors will independently screen and select references for inclusion using Covidence, extract data and assess the methodological quality of the included randomised clinical trials using the Cochrane risk of bias tool. Any disagreement will be resolved by consensus. We will analyse the extracted data using Review Manager, STATA 15, and Trial Sequential. ANALYSIS The aim of this study was to assess the quality of the evidence, we will create a 'Summary of Findings' table containing our primary and secondary outcomes using the GRADE assessment. DISCUSSION Our ambition with this systematic review is to provide reliable and powered evidence to better inform decision makers on the use of or future trials with haloperidol for the management of delirium in critically ill patients.
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Affiliation(s)
- M. Barbateskovic
- Copenhagen Trial Unit; Centre for Clinical Intervention Research; Copenhagen Denmark
- Centre for Research in Intensive Care; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - S. R. Kraus
- Copenhagen Trial Unit; Centre for Clinical Intervention Research; Copenhagen Denmark
| | - M. O. Collet
- Centre for Research in Intensive Care; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
- Department of Intensive Care; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - O. Mathiesen
- Centre for Research in Intensive Care; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
- Department of Anaesthesiology and Intensive Care; Zealand University Hospital; Køge Denmark
| | - J. C. Jakobsen
- Copenhagen Trial Unit; Centre for Clinical Intervention Research; Copenhagen Denmark
- Centre for Research in Intensive Care; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
- Department of Cardiology; Holbaek Hospital; Holbaek Denmark
| | - A. Perner
- Centre for Research in Intensive Care; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
- Department of Intensive Care; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - J. Wetterslev
- Copenhagen Trial Unit; Centre for Clinical Intervention Research; Copenhagen Denmark
- Centre for Research in Intensive Care; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
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Maldonado JR. Acute Brain Failure: Pathophysiology, Diagnosis, Management, and Sequelae of Delirium. Crit Care Clin 2017; 33:461-519. [PMID: 28601132 DOI: 10.1016/j.ccc.2017.03.013] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Delirium is the most common psychiatric syndrome found in the general hospital setting, with an incidence as high as 87% in the acute care setting. Delirium is a neurobehavioral syndrome caused by the transient disruption of normal neuronal activity secondary to systemic disturbances. The development of delirium is associated with increased morbidity, mortality, cost of care, hospital-acquired complications, placement in specialized intermediate and long-term care facilities, slower rate of recovery, poor functional and cognitive recovery, decreased quality of life, and prolonged hospital stays. This article discusses the epidemiology, known etiological factors, presentation and characteristics, prevention, management, and impact of delirium.
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Affiliation(s)
- José R Maldonado
- Psychosomatic Medicine Service, Emergency Psychiatry Service, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Suite 2317, Stanford, CA 94305-5718, USA.
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Page VJ, Casarin A. Use of antipsychotics for the treatment of intensive care unit delirium. Rev Bras Ter Intensiva 2015; 26:86-8. [PMID: 25028943 PMCID: PMC4103935 DOI: 10.5935/0103-507x.20140016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/06/2014] [Indexed: 01/16/2023] Open
Affiliation(s)
- Valerie J Page
- Intensive Care Unit, Watford General Hospital, West Hertfordshire Hospitals NHS Trust, Watford, Reino Unido
| | - Annalisa Casarin
- Intensive Care Unit, Watford General Hospital, West Hertfordshire Hospitals NHS Trust, Watford, Reino Unido
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Shin SH, Hui D, Chisholm G, Kang JH, Allo J, Williams J, Bruera E. Frequency and Outcome of Neuroleptic Rotation in the Management of Delirium in Patients with Advanced Cancer. Cancer Res Treat 2014; 47:399-405. [PMID: 25648094 PMCID: PMC4506099 DOI: 10.4143/crt.2013.229] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 05/22/2014] [Indexed: 01/09/2023] Open
Abstract
Purpose The response to haloperidol as a first-line neuroleptic and the pattern of neuroleptic rotation after haloperidol failure have not been well defined in palliative care. The purpose of this study was to determine the efficacy of haloperidol as a first-line neuroleptic and the predictors associated with the need to rotate to a second neuroleptic. Materials and Methods We conducted a retrospective review of the charts of advanced cancer patients admitted to our acute palliative care unit between January 2012 and March 2013. Inclusion criteria were a diagnosis of delirium and first-line treatment with haloperidol. Results Among 167 patients with delirium, 128 (77%) received only haloperidol and 39 (23%) received a second neuroleptic. Ninety-one patients (71%) who received haloperidol alone improved and were discharged alive. The median initial haloperidol dose was 5 mg (interquartile ranges [IQR], 3 to 7 mg) and the median duration was 5 days (IQR, 3 to 7 days). The median final haloperidol dose was 6 mg (IQR, 5 to 7 mg). A lack of treatment efficacy was the most common reason for neuroleptic rotation (87%). Significant factors associated with neuroleptic rotation were inpatient mortality (59% vs. 29%, p=0.001), and being Caucasian (87% vs. 62%, p=0.014). Chlorpromazine was administered to 37 patients (95%) who were not treated successfully by haloperidol. The median initial chlorpromazine dose was 150 mg (IQR, 100 to 150 mg) and the median duration was 3 days (IQR, 2 to 6 days). Thirteen patients (33%) showed reduced symptoms after the second neuroleptic. Conclusion Neuroleptic rotation from haloperidol was only required in 23% of patients with delirium and was associated with inpatient mortality and white race.
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Affiliation(s)
- Seong Hoon Shin
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA ; Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gary Chisholm
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jung Hun Kang
- Department of Internal Medicine, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Julio Allo
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janet Williams
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Page VJ. Prophylactic haloperidol: too early to lose hope - author's reply. THE LANCET. RESPIRATORY MEDICINE 2013; 1:e28. [PMID: 24461671 DOI: 10.1016/s2213-2600(13)70194-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Valerie J Page
- Intensive Care Unit, Watford General Hospital, Watford WD18 0HB, UK.
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Antipsychotic prophylaxis in surgical patients modestly decreases delirium incidence--but not duration--in high-incidence samples: a meta-analysis. Gen Hosp Psychiatry 2013; 35:370-5. [PMID: 23351526 DOI: 10.1016/j.genhosppsych.2012.12.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 12/18/2012] [Accepted: 12/19/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective was to examine whether prophylactic treatment with antipsychotics can decrease the incidence and severity of postsurgical delirium. METHOD A meta-analysis of existing trials comparing delirium incidence between patients given prophylactic antipsychotic and placebo was performed. Secondary outcomes were total hospital days, total days of delirium and severity. Pooled odds ratios (ORs) and mean differences were calculated using a random-effects model. RESULTS Five randomized placebo-controlled trials comprising a total of 1491 patients were included. In the pooled analysis, prophylactic antipsychotic administration showed a reduction in delirium incidence (OR: 0.42; 95% confidence interval (CI): 0.24, 0.74). Among the studies reporting other outcomes, patients receiving antipsychotics prophylactically showed no differences in total hospital days (0.1; 95% CI: -0.73, 0.94), days of delirium (-1.17; 95% CI: -5.22, 2.88) or delirium severity (-1.02; 95% CI: -6.81, 4.76). CONCLUSIONS Prophylactic antipsychotic treatment in surgical patients modestly decreases the incidence of delirium, but not the length of hospital stay, duration of delirium or its severity. Given the modest protective effect of antipsychotics and their potential adverse reactions, there is insufficient evidence to support its universal use as a preventive agent, though potential benefit may be seen in populations at high risk of developing delirium.
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