Delirium Bibliography

Reference Information

Title

Antipsychotics for treating delirium in hospitalized adults a systematic review

Authors

Nikooie, R. Neufeld, K. J. Oh, E. S. Wilson, L. M. Zhang, A. Robinson, K. A. Needham, D. M.

Year

2019

Journal

Annals of Internal Medicine

Abstract

Background: Delirium is common in hospitalized patients and is associated with worse outcomes. Antipsychotics are commonly used; however, the associated benefits and harms are unclear. Purpose: To conduct a systematic review evaluating the benefits and harms of antipsychotics to treat delirium in adults. Data Sources: PubMed, Embase, CENTRAL, CINAHL, and Psyc- INFO from inception to July 2019 without language restrictions. Study Selection: Randomized controlled trials (RCTs) of antipsychotic versus placebo or another antipsychotic, and prospective observational studies reporting harms. Data Extraction: One reviewer extracted data and assessed strength of evidence (SOE) for critical outcomes, with confirmation by another reviewer. Risk of bias was assessed independently by 2 reviewers. Data Synthesis: Across 16 RCTs and 10 observational studies of hospitalized adults, there was no difference in sedation status (low and moderate SOE), delirium duration, hospital length of stay (moderate SOE), or mortality between haloperidol and second-generation antipsychotics versus placebo. There was no difference in delirium severity (moderate SOE) and cognitive functioning (low SOE) for haloperidol versus second-generation antipsychotics, with insufficient or no evidence for antipsychotics versus placebo. For direct comparisons of different secondgeneration antipsychotics, there was no difference in mortality and insufficient or no evidence for multiple other outcomes. There was little evidence demonstrating neurologic harms associated with short-term use of antipsychotics for treating delirium in adult inpatients, but potentially harmful cardiac effects tended to occur more frequently. Limitations: Heterogeneity was present in terms of dose and administration route of antipsychotics, outcomes, and measurement instruments. There was insufficient or no evidence regarding multiple clinically important outcomes. Conclusion: Current evidence does not support routine use of haloperidol or second-generation antipsychotics to treat delirium in adult inpatients.

PMID

31476770 

Keywords

amisulpride
aripiprazole
haloperidol
neuroleptic agent
olanzapine
placebo
quetiapine
risperidone
ziprasidone
adult
Clinical Global Impression scale
critical illness
critically ill patient
delirium
drug withdrawal
extrapyramidal symptom
heart disease
hospital mortality
hospital patient
human
length of stay
meta analysis
neurologic disease
palliative therapy
priority journal
psychopharmacotherapy
QTc interval
randomized controlled trial (topic)
review
sedation
systematic review

Page(s)

485-494

Volume

171

Issue

7