Old Habits Die Hard: Antipsychotics for Treatment of Delirium
Authors: Edward R. Marcantonio
Journal: Annals of Internal Medicine (2019)

Editorials1 October 2019Old Habits Die Hard: Antipsychotics for Treatment of DeliriumEdward R. Marcantonio, MD, SMEdward R. Marcantonio, MD, SMBeth Israel Deaconess Medical Center, Boston, Massachusetts (E.R.M.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-2624 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Thirty years ago, during my internal medicine residency, I was taught that it was "normal" for hospitalized patients, particularly older adults, to get confused. This confusion had little significance and no impact on outcomes but could be a nuisance. If so, 10 mg of haloperidol ("vitamin H") would take care of the problem.Where have we come in the past 30 years? We now know acute confusion is delirium and that it is never "normal" (1). We have standardized methods to identify delirium (1, 2), though over one half of cases still go unrecognized. We also know that delirium is ...References1. Marcantonio ER. Delirium in hospitalized older adults. N Engl J Med. 2017;377:1456-1466. [PMID: 29020579] doi:10.1056/NEJMcp1605501 CrossrefMedlineGoogle Scholar2. Oh ES, Fong TG, Hshieh TT, et al. Delirium in older persons: advances in diagnosis and treatment. JAMA. 2017;318:1161-1174. [PMID: 28973626] doi:10.1001/jama.2017.12067 CrossrefMedlineGoogle Scholar3. Leslie DL, Marcantonio ER, Zhang Y, et al. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008;168:27-32. [PMID: 18195192] doi:10.1001/archinternmed.2007.4 CrossrefMedlineGoogle Scholar4. Hshieh TT, Yue J, Oh E, et al. Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis. JAMA Intern Med. 2015;175:512-20. [PMID: 25643002] doi:10.1001/jamainternmed.2014.7779 CrossrefMedlineGoogle Scholar5. Oh ES, Needham DM, Nikooie R, et al. Antipsychotics for preventing delirium in hospitalized adults. A systematic review. Ann Intern Med. 2019;171:474-84. doi:10.7326/M19-1859 LinkGoogle Scholar6. Agar MR, Lawlor PG, Quinn S, et al. Efficacy of oral risperidone, haloperidol, or placebo for symptoms of delirium among patients in palliative care: a randomized clinical trial. JAMA Intern Med. 2017;177:34-42. [PMID: 27918778] doi:10.1001/jamainternmed.2016.7491 CrossrefMedlineGoogle Scholar7. Girard TD, Exline MC, Carson SS, et al; MIND-USA Investigators. Haloperidol and ziprasidone for treatment of delirium in critical illness. N Engl J Med. 2018;379:2506-2516. [PMID: 30346242] doi:10.1056/NEJMoa1808217 CrossrefMedlineGoogle Scholar8. Nikooie R, Neufeld KJ, Oh ES, et al. Antipsychotics for treating delirium in hospitalized adults. A systematic review. Ann Intern Med. 2019;171:485-95. doi:10.7326/M19-1860 LinkGoogle Scholar9. U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. Methods Guide for Effectiveness and Comparative Effectiveness Reviews. AHRQ publication no. 534 10(14)-EHC063-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2014. Google Scholar10. Herzig SJ, LaSalvia MT, Naidus E, et al. Antipsychotics and the risk of aspiration pneumonia in individuals hospitalized for nonpsychiatric conditions: A cohort study. J Am Geriatr Soc. 2017;65:2580-2586. [PMID: 29095482] doi:10.1111/jgs.15066 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Beth Israel Deaconess Medical Center, Boston, Massachusetts (E.R.M.)Disclosures: The author has disclosed no conflicts of interest. His form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2624.Corresponding Author: Edward R. Marcantonio, MD, SM, Division of General Medicine, Beth Israel Deaconess Medical Center, CO-216, 330 Brookline Avenue, Boston, MA 02215.This article was published at Annals.org on 3 September 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAntipsychotics for Preventing Delirium in Hospitalized Adults Esther S. Oh , Dale M. Needham , Roozbeh Nikooie , Lisa M. Wilson , Allen Zhang , Karen A. Robinson , and Karin J. Neufeld Antipsychotics for Treating Delirium in Hospitalized Adults Roozbeh Nikooie , Karin J. Neufeld , Esther S. Oh , Lisa M. Wilson , Allen Zhang , Karen A. Robinson , and Dale M. Needham Metrics Cited byDelirium and Behavioral Symptoms in Persons With Dementia at Hospital AdmissionPersonalized sedation goal for agitated delirium in patients with cancer: Balancing comfort and communicationUshering in the New Year With New Research, New Grants, and Age-Friendly Stories to Tell 1 October 2019Volume 171, Issue 7Page: 516-517KeywordsAntipsychoticsDeliriumDrugsForecastingIntensive care unitsLength of stayObservational studiesPalliative careSedationSystematic reviews ePublished: 3 September 2019 Issue Published: 1 October 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...