Pharmacological management of delirium in hospitalized adults - A systematic review

Campbell, Noll, Boustani, Malaz A., Ayub, Amir, Fox, Chris, Munger, Stephanie L., Ott, Carol, Guzman, Oscar, Farber, Mark, Ademuyiwa, Adetayo and Singh, Ranjeet (2009) Pharmacological management of delirium in hospitalized adults - A systematic review. Journal of General Internal Medicine, 24 (7). pp. 848-853. ISSN 0884-8734

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Abstract

BACKGROUND AND OBJECTIVES: Despite the significant burden of delirium among hospitalized adults, there is no approved pharmacologic intervention for delirium. This systematic review evaluates the efficacy and safety of pharmacologic interventions targeting either prevention or management of delirium. DATA SOURCES: We 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. We excluded non-comparison trials, studies with patients aged < 18 years, a history of an Axis I psychiatric disorder, and patients with alcohol-related delirium. REVIEW METHODS: Three reviewers independently extracted the data for participants, interventions and outcome measures, and critically appraised each study using the JADAD scale. RESULTS: We 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. CONCLUSION: 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.

Item Type:	Article
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Psychological Sciences (former - to 2018) Faculty of Medicine and Health Sciences > Research Groups > Mental Health Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Centres > Institute for Volunteering Research
Depositing User:	EPrints Services
Date Deposited:	25 Nov 2010 11:08
Last Modified:	28 Mar 2025 03:17
URI:	https://ueaeprints.uea.ac.uk/id/eprint/12089
DOI:	10.1007/s11606-009-0996-7

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