antipsychotics for treating delirium in hospitalized adults

DRSR98 score, 2. To evaluate antipsychotic medications for preventing and treating delirium. No trials reported healthrelated quality of life and attempts to obtain data from corresponding study authors proved unsuccessful. Adverse effects: 1) Extrapyramidal symptoms, assessed by the Extrapyramidal Symptom Rating Scale, 2) National Cancer Institute Common Terminology Criteria for Adverse Events. Pae CU, 165 vabicaserin/ or (vabicaserin or "sca 136" or sca136).mp. Study sponsor: Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran. Oneyear health care costs associated with delirium in the elderly population. 180 "disorders of higher cerebral function"/ or disorientation/ or organic brain syndrome/ or organic psychosyndrome/. 83 mazapertine/ or (mazapertine or "rwj 37796" or rwj37796).mp. Seven studies (Agar 2016; Grover 2011; Grover 2016; Han 2004; Hu 2004; Lin 2008; Maneeton 2013) reported this outcome. CGII = Clinical Global Impression Improvement Scale Maneeton B, Maneeton N, Srisurapanont M, et al. 105 oxyprothepine/ or oxyprothepine decanoate/ or (oxyprothepine or oxyprothepin).mp. Baeza I, Authorship for this update has been changed to include new members and remove those no longer involved in the review. Avorn J, 24 (carfenazine or carfenazinum or carphenazine or "nsc 71755" or nsc71755 or procethazine or proketazine or "wy 2445" or wy2445).mp. Smith MJ, Stated that if participant needed an antipsychotic, they were 'separated randomly to an olanzapine group or a haldol group'. For both groups, etiological causes of delirium were addressed and nonessential medications or medications associated with delirium were discontinued. DIEPSSK = Korean Version of Drug Induced Extrapyramidal Symptom Scale Adverse event reporting was limited and measured with inconsistent methods; in those reporting events, the number of events were low. Fraser GL, Dissemination of the hospital elder life program: implementation, adaptation, and successes. Primeau F. Delirium in older medical inpatients and subsequent cognitive and functional status: a prospective study. Singleblind, randomised trial comparing haloperidol, risperidone, and olanzapine in the treatment of delirium. 84 (mepiprazole or "emd 16923" or emd16923 or psigodal or prozine or meprobamate).mp. Puntillo K, The .gov means its official. 31 chlorothiazide plus reserpine/ or (chlorothiazide or "diupres250" or "diupres500").mp. Maneeton N, Pharmacological prevention of postoperative delirium in patients undergoing cardiac surgery: a bayesian network meta-analysis. We limited our search to randomised controlled trials, systematic reviews, and metaanalyses. 7 (alimemazin or alimemasine or alimemazin* or alimezine or "bayer 1219" or electrotrimeprazine or methylpromazine or palpex or "rp 6549" or rp6549 or trimeprazine or trimeprezine or varialgil or nedeltran or panectyl or repeltin or temaril or temaryl or teralen or teralene or theralen or theralene or valergan or vallergan).mp. Total number of participants enrolled and/or lost to followup not reported. As no details were provided, we assumed the drug formulation was unblinded. MDAS = Memorial Delirium Assessment Scale No trials reported healthrelated quality of life, and attempts to obtain data from corresponding study authors proved unsuccessful. A systematic review of adult hospitalized patients with and without serious diseases showed that antipsychotics were not beneficial for treating delirium, improving its severity or shortening its duration and were not associated with ICU and hospital length of stay or mortality. Comparison 2 Resolution, Outcome 3 Resolution (atypical versus typical antipsychotic). Aripiprazole or haloperidol. 89 methyclothiazide plus reserpine/ or (methiothepin* or metitepine or "diutensenr").mp. et al. PubMed, Embase, CENTRAL, CINAHL, and PsycINFO from inception through July 2019, without restrictions based on study setting, language of publication, or length of follow-up. Two authors (LB, BH) entered data in Revman 5 (RevMan 2014). Campbell N, We present below our analyses for our primary outcome, duration of delirium, and our secondary outcomes of severity of delirium, delirium resolution, mortality, hospital length of stay and discharge disposition, healthrelated quality of life, and adverse events. Rosenfeld B, 136 quinethazone plus reserpine/ or hydromax.mp. They found antipsychotics were superior to placebo or nonantipsychotic drugs in this analysis of ICU and nonICU studies in terms of response rate (RR 0.22, 95% CI 0.15 to 0.34, P < 0.00001, I = 0%, three studies). Smith GD, N = 62 hospitalised patients admitted to single hospital in South Korea. Levkoff SE, 163 triflupromazine/ or (triflupromazine or adazine or fluopromazin or fluopromazine or fluorofen or "mc 4703" or mc4703 or nivoman or psyquil or siquil or "skf 4648 a" or "skf 4648a" or skf4648a or trifluopromazine or vespral or vesprin or vetame).mp. A complete listing is available at: http://geriatricscareonline.org/toc/american-geriatrics-society-clinical-practice-guideline-for-postoperative-delirium-in-older-adults/CL018, National Library of Medicine or fluperlapine/ or (fluperlapine or "nb 106689" or nb106689).mp. Inouye SK, 97 ((nicotinic adj4 pentetrazole adj4 reserpine) or (nicozol adj2 reserpine)).mp. 62 Flupenthixol/ or (flupentixol or flupenthixol* or emergil or fluanxol or fluxanxol or "lc 44" or lc44 or "n 7009" or n7009 or siplaril or siplarol or depixol or depot or "lu 5 110" or "lu 5110" or viscoleo).mp. Both are effective for managing the positive symptoms in schizophrenia (e.g. Guidelines suggest limited and cautious use of antipsychotics for treatment of delirium where nonpharmacological interventions have failed and symptoms remain distressing or dangerous, or both. Neufeld KJ, Needham DM, Oh ES, Wilson LM, Nikooie R, Zhang A, Koneru M, Balagani A, Singu S, Aldabain L, Robinson KA. Foreman M, 44 cp 903397/ or ("cp 903397" or cp903397).mp. 109 perazine/ or (perazine or "p 725" or pernazine or taxilan).mp. Basaran C. Morphine is a reasonable alternative to haloperidol in the treatment of postoperative hyperactivetype delirium after cardiac surgery, Journal of Cardiothoracic and Vascular Anesthesia, Comparison of dexmedetomidine or ondansetron with haloperidol for treatment of postoperative delirium in trauma patients admitted to intensive care unit: randomized controlled trial. Open label randomised trial of haloperidol and mianserin in the treatment of delirium. 100 Ondansetron/ or Imidazoles/ or (ondansetron or gr38032f or "gr 38032f" or "sn 307" or sn307 or "gr38032f" or "sn307" or zofran).mp. Risk of cerebrovascular adverse events and death in elderly patients with dementia when treated with antipsychotic medications: a literature review of evidence, American Journal of Alzheimer's Disease and Other Dementias. 1 Antipsychotic drugs/ or (antipsychotic* or neuroleptic* or (major adj2 (tranquilizer* or tranquiliser*))).mp. Chapple S, Kunz R, Change in delirium severity, as measured by the DRS at baseline and study day 7, 2. Purpose: To conduct a systematic review evaluating the benefits and harms of antipsychotics to treat delirium in adults. Hyun Kook L, 177 confusion/ or acute confusion/ or restlessness/ or (Psychomotor* adj2 Agitat*).mp. 118 picobenzide/ or (picobenzide or dosetil or "m 14012 4" or "ma 14012" or picobenzamide).mp. Additional methodologically rigorous studies using standardized outcome measures are needed. Mittal V, Brief Psychiatric Rating Scale, 4. or quetiapine/ or (quetiapine or "ici 204636" or "ici 204646" or ici204636 or ici204646 or seroquel or socalm or tienapine).mp. 176 lorazepam/ or (lorazepam or idalprem or sinestron or ativan or sedicepan or duralozam or orfidal or somagerol or apolorazepam or novolorazem or laubeel or donix or wy4036 or "wy 4036" or "wy4036" or temesta or nuloraz or tolid).mp. Meagher D, 50 dexamphetamine plus reserpine/ or ((dexamphetamine or dexserpine or dextroamphetamine) adj2 reserpine).mp. FormalPara Take-Home Points This systematic review and meta-analysis of 19 studies indicates that antipsychotics do not decrease delirium severity, duration, or hospital length of stay when compared to placebo. 104 (pecazine or lacumin or mepasin or mepazine or nothiazine or "p 391" or pacatal or pacatol or pactal or papital or paxital or pecazine or "w 1224").mp. This review included studies of any design (prospective or historical cohort, casecontrol, and other observational designs) and they included both ICU and nonICU participant populations. The Relationship between Delirium and Statin Use According to Disease Severity in Patients in the Intensive Care Unit. Sponsors Role: The development of this paper was supported in part by the American Geriatrics Society Geriatrics-for-Specialists Initiative (AGS-GSI) through an unrestricted grant from the John A. Hartford Foundation (Grant 2009-0079). or hallucination/ or auditory hallucination/ or hallucinosis/ or visual hallucination/ or illusion/ or visual illusion/ or delusion/ or paranoia/ or paranoid psychosis/ or (inattention or inattentive*).ti,ab. CGISI (Severity) score, change from baseline to study completion, 3. Trzepacz PT, Mittal D, Torres R, et al. Only half of the identified trials reported that nondrug strategies were used during the study period and details of the interventions applied were not provided. We excluded nonrandomised and crossover interventional studies as well as observational studies. New horizons in the pathogenesis, assessment and management of delirium. government site. Federal government websites often end in .gov or .mil. Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (HopeICU): a randomised, doubleblind, placebocontrolled trial. Jackson T, et al. Delirium is an acute confusional state characterized by an alteration of consciousness with reduced ability to focus, sustain, or shift attention. There was a low degree of heterogeneity (I = 0%). Delirium screening occurred daily. Adverse effects: None included as an outcome or reported. Epub 2023 Feb 14. 61 fluanisone/ or (fluanisone or "anti pica" or antipica or fluanison* or fluanizone or fluoanisone or haloanison or haloanisone or "md 2028" or md2028 or "r 2028" or "r 2167" or r2028 or r2167 or sedalande or sedalanide or solusediv).mp. or "n (2,6 dimethylergolin 8alpha yl)pivalamide"/ or ("sdz 208 911" or "sdz 208911" or "sdz 208911" or "sdz 911" or "sdz hac 911" or "sdz hac911" or "sdz208 911" or "sdz208911" or sdz208911 or sdz911).mp. National Library of Medicine Or "disorders of higher cerebral function"/ or disorientation/ or organic brain syndrome/ or organic psychosyndrome/. For each outcome, we present first the results for the comparison of an antipsychotic versus nonantipsychotic or placebo and then the class comparison of typical versus atypical antipsychotic. Sample sizes of trials ranged from 24 (Han 2004) to 247 (Agar 2016) participants. 2016 Apr; 64(4): 705714. Neufeld KJ, sharing sensitive information, make sure youre on a federal Do antipsychotics prevent postoperative delirium? Sakong JK, Needham DM. Neelon VJ, sudden cardiac death, QT prolongation, seizures, use of physical restraints). Rescue drugs: If adjunctive therapy required for acute symptoms, midazolam IM was used. The symptoms of delirium are unpredictable and irregular, contributing to its underdetection (Inouye 2001). We found little or no evidence to determine the effect of antipsychotics on cognitive function, delirium severity, or caregiver burden. Topup searches were performed for this review in May 2011, July 2013, October 2015, November 2016 and July 20 2017. risperidone) received lorazepam or haloperidol as injectable risperidone was not available. Randomised trial comparing olanzapine, haloperidol, and placebo in the treatment of delirium. Disclaimer. Our primary objective was to assess the efficacy of antipsychotics versus nonantipsychotics or placebo on the duration of delirium in hospitalised adults. Devlin JW, Olanzapine vs haloperidol: treating delirium in a critical care setting. or pridopidine/ or (pridopidine or "acr 16" or acr16 or "asp 2314" or asp2314 or "fr 310826" or fr310826 or huntexil).mp. Ely EW, Comparison of haloperidol, non-haloperidol antipsychotics, and no pharmacotherapy for the management of delirium in an inpatient geriatric palliative care population. 10 "alpha [1 [2 (1,4 benzodioxan 5 yloxy)ethyl] 3 pyrrolidinyl] 4 fluoroacetophenone"/ or ("s 16924" or s16924).mp. Salluh JI, Stated as a doubleblind study. 63 Fluphenazine/ or (fluphenazin* or anatensil or anatensol or antasol or cenilene or dapotum or elinol or flufenan or flufenazine or flumezin or fluorfenazine or fluphenacin or "fluzinep" or ftorphenazine or "luogen depot" or lyogen or lyorodin or moditen or moditin or omca or pacinol or permitil or phthorphenazine or potensone or prolixan or prolixene or prolixin* or "s 94" or sevinal or sevinol or siqualine or siqualon* or siquoline or "sq 4918" or sq4918 or tensofin or trancin or valamina or vespazin* or "dapatum d25" or dapotum or decafen or flucan or fludecasine or fludecate or lyogen or mirenil or modecate or phlufdek or sydepres or flunanthate).mp. Leonard M. Features of subsyndromal and persistent delirium. Site randomisation schedules generated using random number tables at an independent and blinded central registry. Lipsitz LA, Antipsychotics for prevention or treatment of delirium is not supported by current evidence. 10 amitriptyline plus perphenazine/ or amitriptyline perphenazine/ or (amitrypline or ((amitriptyline adj2 perphenazine) or "anxipressd" or "duovil 210" or "duovil 225" or "duovil 410" or etrafon or etraphon or longopax or mutabon or mutanxion or mutaspline or "neuragona" or "neuragonb" or pertriptyl or polybon or triavil or triptafen)).mp. Sharma PT, Sieber FE, Zakriya KJ, et al. 11 Only 1 trial had low risk of bias across all domains. We intended to conduct subgroup analyses exploring the effects of controlling for age and history of dementia. DRS or DRS98R) (, Delirium resolution (defined as reduction of DRS or DRS98R below a target set by the authors or complete resolution of symptoms), Hospital discharge disposition (e.g. Leslie DL, Zhang Y, Bogardus ST, et al. Cole M, or rilapine/ or rilapine.mp. et al. There were no reported data to determine whether antipsychotics altered the duration of delirium, length of hospital stay, discharge disposition, or healthrelated quality of life as studies did not report on these outcomes. While antipsychotics in this review do not appear to decrease the incidence of delirium in the postoperative period, or improve other outcomes when used to treat delirious adult inpatients, none of the studies evaluated symptomatic relief attributable to these medications. CGIS = Clinical Global Impression Severity Scale 65 (flutroline or "cp 36,584" or "cp 36584" or "cp36,584" or cp36584).mp. Antipsychotics for delirium in the general hospital setting in consecutive 2453 inpatients: a prospective observational study, International Journal of Geriatric Psychiatry. or sulpiride/ or (sulpiride or abilit or aiglonyl or arminol or dobren or dogmatil or dogmatyl or dolmatil or eglonyl or equilid or "fk 880 " or fk880 or isnamide or levobren or levopraid or levosulpiride or meresa or miradol or neogama or sulfiride or sulpivert or sulpyride or synedil or vipral).mp. 62 farampator/ or (farampator or "cx 691" or cx691 or "org 24448" or org24448).mp. Rizzo JA, Agency for Healthcare Research and Quality. Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland. Delirium was evaluated daily using the DRS and the CGI. Focus on acetylcholine and dopamine. Other outcomes examined in this review, including delirium severity and duration, length of ICU and hospital stay, and mortality were consistent with other analyses that did not demonstrate a significant effect of antipsychotics on these outcomes.32, 36, 37. Set of individual treatment codes kept for emergency outofhours use only. Dodsworth BT, Reeve K, Falco L, Hueting T, Sadeghirad B, Mbuagbaw L, Goettel N, Schmutz Gelsomino N. Age Ageing. Pharmacological treatments of non-substance-withdrawal delirium: A systematic review of prospective trials. 57 duoperone/ or (duoperone or "ahr 6646" or ahr6646).mp. Inclusion: All patients presenting with altered mental status who were referred to the consulting psychiatry division were evaluated. Inouye SK, Bellomo R. Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised openlabel trial. 36 clocapramine/ or (clocapramine or "y 4153" or y4153).mp. or ("acute brain dysfunction" or (acute adj2 brain adj2 dysfunction*) or "septic encephalopath*").ti,ab. : 19-EHC019-EF. 25 cariprazine/ or (cariprazine or "mp 214" or mp214 or "rgh 188" or rgh188).mp. 155 thioridazine/ or (thioridazine or aldazine or apothioridazine or calmaril or mallorol or malloryl or meleril or mellaril or mellerets or mellerette* or melleril or mellerzin or melleryl or melzine or mepiozin or orsanil or ridazin or ridazine or rideril or sonapax or thiomed or thioradizine or thioridacine or thioridazide or thioridazin or thioridizine or thioril or thiosia or thoridazine or thiozine or thioridazineneurazpharm or tioridazin or tioridazine or "tp 21" or tpzl).mp. We judged all studies but one (Hu 2004) to have low risk of blinding bias. 21 bromperidol/ or bromperidol decanoate/ or (bromperidol or impromen or "r 11,333" or "r 11333" or "r11,333" or r11333 or tesoprel or "impromen decanoate" or "r 46,541" or "r 46541" or "r46,541" or r46541).mp. Gill SS, 8600 Rockville Pike Each data extractor independently assessed the risk of bias of each study, which was then verified by another author (NS). 73 hydralazine plus reserpine/ or hydrochlorothiazide plus potassium chloride plus reserpine/ or hydrochlorothiazide plus reserpine/ or (dralserp or (hydralazine adj2 reserpine) or "serpasilapresoline" or hydropres or "dichlotride s" or "h.r.50" or "hydroreserp" or hydrochlorothiazide or hydroserpine or "medeserpine co" or "serpasilesidrix").mp. Bookshelf 157 Trifluoperazine/ or (trifluoperazine or apotrifluoperazine or calmazine or eskazine or eskazinyl or espazine or fluoperazine or flupazine or fluperin or flurazin or "iremopierol" or jatroneural or leptazine or modalina or modiur or nerolet or nylipton or operzine or oxyperazine or psyrazine or "sk and f 5019" or "skf 5019" or sporalon or stelazine or terfluzin* or triflumed or trifluoperazide or trifluoperzine or trifluperazine or trifluoroperazine or trifluorperacine or trifluorperazine or trifluperazine or triflurin or triftazin or triftazine or triftazinum or trinicalm or triozine or triphtazine or triphthasine or triphthazine).mp. Serum anticholinergic activity and cerebral cholinergic dysfunction: an EEG study in frail elderly with and without delirium. 173 diazepam/ or (diazemuls or apaurin or seduxen or faustan or sibazon or valium or stesolid or relanium).mp. Adverse effects were poorly or rarely reported in the trials. prolongation of the QTc interval (QT interval measures the time between the start of the Q wave and the end of the T wave in the hearts electrical cycle), sudden cardiac death, cerebral vascular events, seizures, extrapyramidal effects, use of physical restraints, longterm cognitive impairment (e.g. Risk of bias was assessed independently by 2 reviewers. Extrapyramidal symptoms were not more frequent with antipsychotics compared to nonantipsychotic drug regimens, and no different for typical compared to atypical antipsychotics. Mianserin: flexible dose of 10 to 60 mg/day per os at bed time. 76 isomolpan/ or (isomolpan or "cgs 15855" or "cgs 15855 a" or "cgs 15855a" or cgs15855 or cgs15855a).mp. Exclusion: Participants with delirium secondary to alcohol or benzodiazepine withdrawal, those with dementia, those unresponsive to verbal or physical stimulus, those suffering terminal illness, and those with a comorbid psychotic/mood disorder, profound hearing or visual loss, aphasia, Parkinson's disease, history of neuroleptic malignant syndrome, prolonged QTc interval, past history of hypersensitivity to any of the study drugs. The initial electronic database query yielded 21,599 citations. Eurelings LS, Search strategies utilised a combination of controlled vocabulary and keywords, and vocabulary and syntax were adjusted for each database. Zhang Y, HHS Vulnerability Disclosure, Help AlQadheeb NS, The dose was increased only if DRSR98 and clinical condition showed no improvement and the drug was well tolerated, up to a maximum of 10 days. Antipsychotic drug exposure is associated with notable risk that should be considering when prescribing. LeoSummers L, No study was identified that compared a pharmacologic intervention with placebo in the treatment of delirium in hospitalized adults. Singleblinded study, however the investigator responsible for randomisation and drug titration was different from the one who conducted the outcome assessments (blinded clinical assessment). JBI Database System Rev Implement Rep. 2019 Oct;17(10):2020-2074. doi: 10.11124/JBISRIR-D-18-00010. et al. There is little evidence that short-term use of antipsychotics was associated with neurologic harms. 46 (cyamemazine or cianatil or cyamepromazine or "fi 6229" or fi6229 or kyamepromazin or "rp 7204" or rp7204 or tercian).mp. 49 dexamphetamine plus prochlorperazine/ or ((dextroamphetamine adj2 sulfate adj2 prochlorperazine) or "eskatrol spansule").mp. 162 zetidoline/ or (zetidoline or "dl 308" or "dl 308 it" or "dl 308it" or dl308 or dl308it).mp. Cole MG, Witlox J, or lurasidone/ or (lurasidone or latuda or "mk 3756" or mk3756 or "sm 13496" or sm13496 or "smp 13496" or smp13496).mp. Forest plot of comparison: 2 resolution, outcome: 2.3 atypical antipsychotic versus typical antipsychotic. Delirium is a dangerous and common syndrome among hospitalised patients (Inouye 2006a). Study medication, either 25 mg quetiapine or 0.5 mg haloperidol, was fully filled and concealed in identical capsules. 53 (dolasetron or anemet or anzemet or "mdl 73147" or "mdl 73147ef" or mdl73147 or mdl73147ef or zamanon).mp. Lagaay AM, Unable to load your collection due to an error, Unable to load your delegates due to an error. Hshieh TT, Similarly for the analysis of delirium severity, antipsychotics were significantly superior to no antipsychotic (SMD 1.27, 95% CI 2.44 to 0.11, P = 0.03, I2 = 93%, two studies). 6. (7). 49 diethylstilbestrol plus methyltestosterone plus reserpine/ or ((diethylstilbestrol adj2 methyltestosterone) or tylandril).mp. Treatment should be targeted to specific behaviors and. treatment dose, use of rescue medications or chemical restraint when primary treatment fails, nondrug treatment strategies such as noise reduction or improving the daynight cycle, medications avoided, physical restraint) as well as country of study origin, year of study publication, and single centre versus multicentre study. 161 (vabicaserin or "sca 136" or sca136).mp. 143 (seridopidine or "acr 343" or acr343).mp. dim light, low levels of noise), F. Adequate schedules for medication administration and to take vital signs or medical procedures, G. Sleep hygiene (light in the room and movement during the day), H. Avoidance of dehydration, and I. Avoidance of medications use which are associated with delirium (e.g. Mogun H, 2 Only 1 of the 4 trials was considered low risk of bias across all domains. See: Characteristics of excluded studies table. Kim SW, Yoo JA, Lee SY, et al. Selected trials were screened for relevance against defined inclusion and exclusion criteria (Appendix 9). Conflict of Interest: Dr. Neufeld has received grant funding in the past from Ornim Medical Device manufacturers and currently from Hitachi Medical Incorporated. To answer our primary objective, we included studies comparing an antipsychotic to a nonantipsychotic drug (e.g. Bae KY, No mention of blinding process. 148 spiperone/ or (spiperone or "r 5147" or r5147 or spiroperidol or spiropitan).mp. Wetle TT,
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