Abstract
The mainstay of the pharmacologic management of delirium remains typical antipsychotics, primarily haloperidol. Typical antipsychotics are associated with significant side effects, particularly in the elderly. This article reviews the literature on the use of both typical and atypical antipsychotics in the management of acute delirium, with a focus on the elderly. In this population, typical antipsychotics are associated with substantially more drug induce side effects—either extrapyramidal side effects or anticholinergic effects from the antipsychotics alone or in combination with benztropine or trihexyphenidyl. Anticholinergic toxicity is especially problematic in delirious, demented patients, because most dementias are associated with pre-existing deficiencies in cholinergic neurotransmission. These issues will be reviewed for typical antipsychotics as well as the emerging literature on the use of atypical antipsychotics—risperidone, olanzapine, and quetiapine—for pharmacologic management of acute delirium. Data from two studies conducted at the Wesley Woods Center at Emory University will be briefly reviewed as they constitute the largest series to date investigating the pharmacologic management of delirious demented patients.
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References and Recommended Reading
Levkoff SE, Evans DA, Lipzin B, et al.: Delirium: the occurrence and persistence of symptoms among elderly hospitalized patients. Arch Intern Med 1992, 152:334–340.
Pollack BG, Mulsant BH: Antipsychotics in older patients: a safety perspective. Drugs Aging 1995, 6:312–323.
Someya T, Endo T, Hara T, et al.: A survey on the drug therapy. Psychiatry Clin Neurosci 2001, 55:397–401.
Sipahimalani A, Masand P: Use of risperidone in delirium: case reports. Ann Clin Psychiatry 1997, 9:105–107.
Sipahimalani A, Masand P: Olanzapine in the treatment of delirium. Psychosomatics 1998, 39:422–430.
Robertsson B, Karlsson I, Eriksson L: An atypical neuroleptic drug in the treatment of behavioral disturbances and psychotic symptoms in elderly people. Dementia 1996, 7:142–146.
Tune LE: Serum anticholinergic activity levels and delirium in the elderly. Semin Clin Neuropsychiatry 2000, 5:149–153.
Tune L, Jewart D, Egeli S, Green Y: Pharmacologic management of acute delirium: a naturalistic, prospective comparison of atypical antipsychotics and haloperidol using average length of stay and EPS ratings as outcome measurements. Presented at the Annual Meeting of the American Medical Directors Association; March 15–18, 2001; Atlanta, Georgia. An important article.
Auerswald KB, Charpentier PA, Inouye SK: The informed consent process in older patients who developed delirium: a clinical epidemiologic study. Am J Med 1997, 103:410–418.
Mulsant BH, Mazumdar S, Pollock BG, et al.: Methodological issues in characterizing treatment response in demented patients with behavioral disturbances. Int J Geriatr Psychiatry 1997, 12:537–547.
Folstein ME, Folstein SE, McHugh PR: Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Psychiatr Res 1975, 12:189–198.
Inouye SK, van Dyck CH, Alessi CA, et al.: Clarifying confusion: the confusion assessment method: a new method for detection of delirium. Ann Intern Med 1990, 13:941–948.
Inouye SK, Bogardus ST, Charpentier PA, et al.: A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999, 340:669–676.
O’Keefe KP, Sanson TG: Elderly patients with altered mental status. Emerg Med Clin North Am 1998, 16:701–715.
Treloar A, MacDonald A: Outcome of delirium: part 2. Clinical features of reversible cognitive dysfunction: are they the same as accepted definitions of delirium? Int J Geriatr Psychiatry 1997, 12:614–618.
McKeith IG, Perry EK, Perry RH: Report of the second dementia with Lewy body international workshop: diagnosis and treatment. Neurology 1999, 53:902–905.
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Tune, L. The role of antipsychotics in treating delirium. Curr Psychiatry Rep 4, 209–212 (2002). https://doi.org/10.1007/s11920-002-0031-8
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DOI: https://doi.org/10.1007/s11920-002-0031-8