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Treating delirium in a general hospital: a descriptive study of prescribing patterns and outcomes

Published online by Cambridge University Press:  29 September 2009

Irena Briskman ,
Ron Dubinski  and
Yoram Barak
Irena Briskman
Affiliation:
Wolfson Medical Center, Holon, Israel
Ron Dubinski
Affiliation:
Wolfson Medical Center, Holon, Israel
Yoram Barak*
Affiliation:
Abarbanel Mental Health Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
*
Correspondence should be addressed to: Yoram Barak, MD, MHA, Director, Psychogeriatric Department, Abarbanel Mental Health Center, 15 KKL Street, Bat-Yam, 59100, Israel. Phone/Fax: +972-3-5552738. Email: mdybarak@gmail.com.
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Abstract

Background: Delirium exemplifies the interface between medicine and psychiatry. The mainstay of treatment of delirium are the antipsychotic drugs. These are efficacious and safe for the treatment of delirium. In the last decade the use of second generation antipsychotics has been advocated at the expense of the classical drugs, particularly haloperidol. We thus aimed to compare the outcome of delirium treatment in a large, university-affiliated general hospital.

Methods: We used retrospective medical charts analysis over a one-year period. Those included were all patients who had been admitted to an acute internal medicine ward for delirium or who had developed delirium during their hospital stay.

Results: 191 patients' records were analysed. Mean age for the group was 78.8 ± 1.1 years. There were 108 males (56.5%) and 83 (43.5%) female patients. The most frequent co-morbid psychiatric diagnosis was that of dementia (106; 56%). The most common physical conditions were: cardiovascular (75 patients) and sepsis (24 patients). Patients suffering from delirium were mostly treated with an antipsychotic: 147 (77%) were treated either with risperidone (73 patients) or classical antipsychotics (74 patients). The most frequently used classical antipsychotic was haloperidol (59/74). Mean risperidone dose was 1.7 ± 0.4 mg/daily. Mean haloperidol dose was 7.8 ± 1.9 mg/daily. Mean duration of antipsychotic treatment was 3.8 days for the classical antipsychotics group and 2.6 for the risperidone group (p = 0.04). In the untreated group, mean delirium episodes lasted 5.6 days – significantly longer than that of either treated groups, p = 0.02.

Mean hospital stay (days) for the group was 12.8 ± 1.4. In the risperidone treated group the mean stay was 10.8 days while in the classical antipsychotics group it was 13.5 and in the untreated group it was 15.5 (p = 0.008). Fourteen patients (7.3%) died during the delirium episode: 10 untreated, 3 treated by classical antipsychotics and 1 risperidone treated (p = 0.04). The majority of patients (65%) were discharged to the community.

Conclusions: The present study adds to the growing body of evidence favoring risperidone as the drug of choice for the treatment of delirium. However, due to the limitations inherent in a retrospective analysis, prospective large-scale trials are needed to support this recommendation.

Keywords

deliriumtreatmentrisperidonehaloperidoloutcomemortality
Type
Research Article
Information
International Psychogeriatrics , Volume 22 , Issue 2 , March 2010 , pp. 328 - 331
Copyright
Copyright © International Psychogeriatric Association 2009

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References

Attard, A., Ranjith, G. and Taylor, D. (2008). Delirium and its treatment. CNS Drugs, 22, 631–644.CrossRefGoogle ScholarPubMed
Boettger, S. and Breitbart, W. (2005). Atypical antipsychotics in the management of delirium: a review of the empirical literature. Palliative and Supportive Care, 3, 227–237.CrossRefGoogle ScholarPubMed
Han, C. S. and Kim, Y. K. (2004). A double-blind trial of risperidone and haloperidol for the treatment of delirium. Psychosomatics, 45, 297–301.Google Scholar
Horikawa, N. et al. (2003). Treatment for delirium with risperidone: results of a prospective open trial with 10 patients. General Hospital Psychiatry, 25, 289–292.Google Scholar
Lacasse, H., Perreault, M. M. and Williamson, D. R. (2006). Systematic review of antipsychotics for the treatment of hospital-associated delirium in medically or surgically ill patients. Annals of Pharmacotherapy, 40, 1966–2019.CrossRefGoogle ScholarPubMed
Liu, C. Y., Juang, Y. Y., Liang, H. Y., Lin, N. C. and Yeh, E. K. (2004). Efficacy of risperidone in treating the hyperactive symptoms of delirium. International Clinical Psychopharmacology, 19, 165–168.Google Scholar
Lonergan, E., Britton, A., Luxenberg, J. and Wyller, T. (2007). Antipsychotics for delirium. Cochrane Database Systemic Reviews, 7, CD005594.Google Scholar
Mittal, D. et al. (2004). Risperidone in the treatment of delirium: results from a prospective open-label trial. Journal of Clinical Psychiatry, 65, 662–667.CrossRefGoogle ScholarPubMed
Miyaji, S., Yamamoto, K., Hoshino, S., Yamamoto, H., Sakai, Y. and Miyaoka, H. (2007). Comparison of the risk of adverse events between risperidone and haloperidol in delirium patients. Psychiatry and Clinical Neuroscience, 61, 275–282.CrossRefGoogle ScholarPubMed
Onur, E. and Cimilli, C. (2005). A new approach to the treatment of delirium: atypical antipsychotics. Turk Psikiyatri Dergisi, 16, 216–224.Google Scholar
Parellada, E., Baeza, I., de Pablo, J. and Martinez, G. (2004). Risperidone in the treatment of patients with delirium. Journal of Clinical Psychiatry, 65, 348–353.CrossRefGoogle ScholarPubMed
Rea, R. S., Battistone, S., Fong, J. J. and Devlin, J. W. (2007). Atypical antipsychotics versus haloperidol for treatment of delirium in acutely ill patients. Pharmacotherapy, 27, 588–594.CrossRefGoogle ScholarPubMed
SAS Institute (1990). SAS/STAT Users’ Guide, Version 6, 4th edn, vols. 1 and 2. Cary, NC: SAS Institute.Google Scholar
Schwartz, T. L. and Masand, P. S. (2002). The role of atypical antipsychotics in the treatment of delirium. Psychosomatics, 43, 171–174.CrossRefGoogle ScholarPubMed
Seitz, D. P., Gill, S. S. and van Zyl, L. T. (2007). Antipsychotics in the treatment of delirium: a systematic review. Journal of Clinical Psychiatry, 68, 11–21.Google Scholar
Sipahimalani, A. and Masand, P. S. (1997). Use of risperidone in delirium: case reports. Annals of Clinical Psychiatry, 9,105–107.CrossRefGoogle ScholarPubMed