Antipsychotic Medications May Be Ineffective for Delirium Treatment

The Journal of the American Geriatrics Society recently published a research article that examined whether or not antipsychotic drugs are effective for the prevention and treatment of delirium (2016;64[4]:705-714).

Researchers Karin J Neufeld, MD, MOH (Johns Hopkins University, Baltimore, MD), and colleagues examined data from 19 different studies that included 10,877 adult surgical and medical inpatients between January 1988 and November 2013. Two authors independently reviewed all citations, extracted relevant data, and assessed studies for potential bias. Sensitivity analyses included evaluation of postoperative prevention studies only, exclusion of studies with high risk of bias, and stratification of typical versus atypical antipsychotics.

In seven studies comparing antipsychotics with placebo or no treatment for delirium prevention after surgery, there was no significant effect on delirium incidence (odds ratio, 0.56, 95% confidence interval, 0.23–1.34, I2, 93%). Based on data from all 19 studies, antipsychotic use was not associated with change in delirium duration, severity, or hospital or intensive care unit length of stay, with high heterogeneity among studies.

When looking at all the causes of delirium, the authors concluded, antipsychotic medications did not lessen the number of new cases of delirium and, also, using antipsychotic medication may not make much difference in the duration, severity, hospital length of stay, or mortality associated with delirium. Thus, the current evidence does not support the use of antipsychotics for prevention or treatment of delirium.

Researchers did caution that their findings may not cover every situation in which antipsychotics might prove useful for delirium treatment. They also suggest that additional methodologically rigorous studies using standardized outcome measures are needed.—Amanda Del Signore