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Zeitschrift für Gerontologie und Geriatrie

, Volume 49, Issue 5, pp 416–422 | Cite as

DEL-FINE: a new tool for assessing the delirogenic properties of drugs of relevance for European pharmacotherapy

  • Birgit Böhmdorfer
  • Sonja Rohleder
  • Martin Wawruch
  • T.J.M. van der Cammen
  • Thomas Frühwald
  • Christian Jagsch
  • Susanne Melitta Maria Janowitz
  • Marietta Nagano
  • Mirko Petrovic
  • Ulrike Sommeregger
  • Bernhard Iglseder
Originalien

Abstract

This article presents a list of potentially delirogenic properties of drugs that are currently of relevance to drug therapy in Europe, which was created through a Delphi process including experts from professions relevant to diagnosis and treatment of delirium. The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) defines delirium as a disturbance in attention, awareness and cognition that develops over a short period of time and fluctuates. Possible causes of delirium are manifold: usually delirium is considered to develop in a multifactorial way, caused by inalterable parameters, such as advanced age and pre-existing cognitive impairment and precipitated by modifiable parameters, such as the use of certain drugs or substance withdrawal. Delirium is a serious condition with a pronounced impact on morbidity, mortality and costs to the healthcare system. Circumstances and drugs that might precipitate or worsen delirium should therefore be avoided whenever possible. A list of drugs that might have a detrimental influence on the emergence and duration of delirium has been created using the terms “delirogenity” and “delirogenic” to describe the potential of a drug or withdrawal to cause or worsen delirium. The results are novel and noteworthy, as their focus is on substances relevant to European pharmacotherapy. Furthermore, they represent a methodical consensus from a group of experts of a wide variety of professions relevant to the prevention, diagnosis and treatment of delirium, such as nursing, pharmacy, pharmacology, surgical and internal medicine, neurology, psychiatry, intensive care and medicine, with working, teaching and scientific experience in several European countries practicing both in primary and secondary care.

Keywords

Delirium Drugs Anticholinergic properties Pharmacotherapy Substance withdrawal 

DEL-FINE: ein neues Tool zur Beurteilung der delirogenen Eigenschaften relevanter Arzneimittel für die Pharmakotherapie in Europa

Zusammenfassung

In diesem Beitrag wird eine Aufstellung von Arzneimitteln vorgestellt, die für die aktuelle Pharmakotherapie in Europa relevant sind und die potentiell delirogene Eigenschaften aufweisen. Diese Liste wurde durch einen Delphi-Prozess, unter Mitbeteiligung von Berufen, die für die Delirdiagnose und -behandlung von Relevanz sind, erstellt. Das „Diagnostic and Statistical Manual of Mental Disorders 5“ (DSM 5) definiert ein Delir als eine Störung von Aufmerksamkeit, Bewusstsein und Wahrnehmung, die sich innerhalb kurzer Zeit entwickelt und fluktuiert. Die möglichen Ursachen für eine Delirentwicklung sind zahlreich: Generell geht man von einer multifaktoriellen Genese aus, die einerseits von vorgegebenen Parametern, wie vorgerücktem Alter oder bereits vorbestehenden kognitiven Einschränkungen, und andererseits durch modifizierbare Einflüsse, wie den Einsatz bestimmter Arzneimittel oder Substanzentzug, beeinflusst wird. Das Durchleben eines Delirs ist eine für die Betroffenen einschneidend grausame Erfahrung, die von einer deutlich erhöhten Morbidität, Mortalität und finanziellen Belastungen für das Gesundheitssystem begleitet wird. Begleitumstände und der Einsatz von Substanzen, die ein Delir auslösen oder verschlimmern können sollten daher tunlichst vermieden werden. Eine Liste von Arzneimitteln, die ein Delir auslösen und einen ungünstigen Einfluss auf dessen Dauer haben können, wurde erstellt. Dabei wurden die Termini „Delirogenität“ und „delirogen“ verwendet, um das Potenzial eines Wirkstoffs zu charakterisieren, der selbst oder durch seinen Entzug ein Delir auslösen oder verschlechtern kann. Die Ergebnisse besitzen insofern einen beachtenswerten Neuwert, als dass der Fokus auf Arzneimitteln lag, welche für die medikamentöse Therapie in Europa repräsentativ sind. Zusätzlich sind sie der Konsensus einer Expertengruppe, die ein breites Spektrums an Berufen repräsentiert, die für Prävention, Diagnose und Therapie des Delirs relevant sind, wie z.B. Pflege, Pharmazie, Pharmakologie, chirurgische und konservative Medizin, Psychiatrie, Neurologie und Intensivmedizin. Die Delphi-Gruppe wies Erfahrung in mehreren europäischen Ländern im extra- und intramuralen Bereich, sowie in Lehre und Wissenschaft auf.

Schlüsselwörter

Delir Arzneimittel Anticholinerge Eigenschaften Pharmakotherapie Substanzentzug 

Notes

Acknowledgements

The authors would like to thank the following for their work in the expert panel: Mag. DGKP Günter Geyer, Priv. Doz. Mag. Dr. Markus Gosch, Mag. Bernadette Gradwohl, Priv. Doz. Dr. Eva Mann, Dr. Peter Machacek, lic. pharm. Isabel Morales-Olmo, Mag. DGKS Gerda Sailer, Univ. Prof. Dr. Wolfgang Umek, Dr. Karl Wagner, Dr. Neil Andrew McNair for proofreading the English version and Natalia Nagano for the conceptual design of the DEL-FINE logo.

This work is dedicated to the loving memory of Dr. Alexandra Elisabeth Henein-McNair (22 November 1974–8 February 2013).

Compliance with ethical guidelines

Conflicts of interest

Birgit Böhmdorfer, Martin Wawruch, Tischa J.M. van der Cammen, Thomas Frühwald, Christian Jagsch, Susanna Melitta Maria Janowitz, Marietta Nagano, Mirko Petrovic, Ulrike Sommeregger and Bernhard Iglseder declare that there are no conflicts of interest related to the manuscript. Christian Jagsch declares there are interests with respect to honoraria for presentations (CSC, Lundbeck, Merz, Novartis, Pfizer, Genericon) and also support for the annual conference of Psychiatry and Psychotherapy of Old Age in Austria (AOP, Astra Zeneca, Austroplant, CSC, Eli Lilly, Germania, Janssen, KRKA, Lundbeck, Merz, Novartis, Pfizer, Sandoz). Sonja Rohleder declares that she is currently employed by Becton Dickinson Austria GmbH in the area of medical workflow solutions for oncology. There are no conflicts of interest related to the manuscript because all corresponding work on the publication was conducted before the present employment starting in December 2013.

This work did not involve chemicals, procedures or equipment that have any unusual hazards inherent in their use. The work did not involve the use of animal or human subjects. The work did not involve studies on patients or volunteers, which require ethics committee approval and informed consent. The work does not include case details or other personal information or images of patients or any other individuals. The plans for conducting a European Delphi process regarding delirogenic drugs have been presented at the 8th Austrian-German Geriatrics Congress in Vienna 2013 as well as at the 9th European Geriatric Medicine Society Congress in Venice 2013. The finished complete work as presented in this article has not been submitted for publication elsewhere. This work was done in partial fulfilment of the requirements for a doctoral degree in medical sciences.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Birgit Böhmdorfer
    • 1
    • 2
  • Sonja Rohleder
    • 3
  • Martin Wawruch
    • 4
  • T.J.M. van der Cammen
    • 5
    • 6
    • 7
  • Thomas Frühwald
    • 8
  • Christian Jagsch
    • 9
  • Susanne Melitta Maria Janowitz
    • 2
  • Marietta Nagano
    • 10
  • Mirko Petrovic
    • 11
  • Ulrike Sommeregger
    • 8
  • Bernhard Iglseder
    • 1
  1. 1.Department of Geriatric MedicineParacelsus Medical UniversitySalzburgAustria
  2. 2.Pharmacy DepartmentHospital Hietzing with Neurological Centre RosenhügelViennaAustria
  3. 3.ViennaAustria
  4. 4.Department of Pharmacology and Clinical PharmacologyFaculty of Medicine, Comenius UniversityBratislavaSlovakia
  5. 5.Section of Geriatric Medicine, Department of Internal MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
  6. 6.Department of MedicineBrighton and Sussex Medical SchoolBrightonUK
  7. 7.Faculty of Industrial Design EngineeringDelft University of TechnologyDelftThe Netherlands
  8. 8.Department of Geriatric Acute CareHospital Hietzing with Neurological Centre RosenhügelViennaAustria
  9. 9.Department of Psychiatry and Psychotherapy of Old AgeLandeskrankenhaus Graz Süd-WestGrazAustria
  10. 10.Pharmacy DepartmentSMZ-Ost/DonauspitalViennaAustria
  11. 11.Department of GeriatricsGhent University HospitalGhentBelgium

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