Differences

Last edited on February 1, 2024

This shows you the differences between two versions of the page.

--- cl:1-delirium [on February 1, 2024]
psychdb [Pharmacological]
+++ cl:1-delirium [on February 1, 2024]
psychdb [Pharmacological]
@@ Line 272: / Line 272: @@
 Don't forget to order a baseline ECG for a [[meds:qtc|QTc]], especially if you are starting out with [[meds:antipsychotics:first-gen-typical:1-haloperidol|haloperidol]].
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-  * Antipsychotic medications should not be used as standard treatment for delirium, and should only be considered for patients with delirium experiencing severe agitation or distress.
+  * Antipsychotic medications should not be used as standard treatment for delirium, and should only be considered for patients with delirium experiencing severe agitation or distress.[([[https://www.cmaj.ca/content/195/31/E1038|Reppas-Rindlisbacher, C., Wiesenfeld, L., & Stall, N. M. (2023). Antipsychotic medications for older adults with delirium admitted to hospital. CMAJ, 195(31), E1038-E1039.]])]
-[([[https://www.cmaj.ca/content/195/31/E1038|Reppas-Rindlisbacher, C., Wiesenfeld, L., & Stall, N. M. (2023). Antipsychotic medications for older adults with delirium admitted to hospital. CMAJ, 195(31), E1038-E1039.]])]
   * Most studies have shown that haloperidol (at doses < 3.5 mg daily), risperidone, and olanzapine are all equally effective in managing delirium.
   * There is no evidence that prophylactic or preventative pharmacologic treatment works.[([[https://jamanetwork.com/journals/jama/article-abstract/2673149?redirect=true|van den Boogaard, M., Slooter, A. J., Brüggemann, R. J., Schoonhoven, L., Beishuizen, A., Vermeijden, J. W., ... & Van der Voort, P. H. (2018). Effect of Haloperidol on Survival Among Critically Ill Adults With a High Risk of Delirium: The REDUCE Randomized Clinical Trial. JAMA, 319(7), 680-690.]])][([[https://www.ncbi.nlm.nih.gov/pubmed/31476766|Oh, E. S., Needham, D. M., Nikooie, R., Wilson, L. M., Zhang, A., Robinson, K. A., & Neufeld, K. J. (2019). Antipsychotics for Preventing Delirium in Hospitalized Adults. Annals of internal medicine, 171(7), 474-484.]])]
     * The adverse effects of antipsychotic medications include sedation, hypotension, falls, [[geri:parkinsons|parkinsonism]], [[meds:qtc|QT interval prolongation]] and aspiration pneumonia.[([[https://www.cmaj.ca/content/195/31/E1038|Reppas-Rindlisbacher, C., Wiesenfeld, L., & Stall, N. M. (2023). Antipsychotic medications for older adults with delirium admitted to hospital. CMAJ, 195(31), E1038-E1039.]])]
     * If there are [[meds:qtc|QTc prolongation]] concerns, then lower-risk antipsychotics such as aripiprazole can also be used.[([[https://pubmed.ncbi.nlm.nih.gov/25514894/|Kirino, E. (2015). Use of aripiprazole for delirium in the elderly: a short review. Psychogeriatrics, 15(1), 75-84.]])]
+  * Antipsychotics if prescribed, should be at the lowest effective dose for the shortest possible duration and be reevaluated at or shortly after discharge.[([[https://www.cmaj.ca/content/195/31/E1038|Reppas-Rindlisbacher, C., Wiesenfeld, L., & Stall, N. M. (2023). Antipsychotic medications for older adults with delirium admitted to hospital. CMAJ, 195(31), E1038-E1039.]])]
   * There is some emerging evidence that [[meds:melatonin-agonist:melatonin|melatonin]] and melatonin agonists may be effective in the prevention and management of delirium.[([[https://www.ncbi.nlm.nih.gov/pubmed/20845391|Al‐Aama, T., Brymer, C., Gutmanis, I., Woolmore‐Goodwin, S. M., Esbaugh, J., & Dasgupta, M. (2011). Melatonin decreases delirium in elderly patients: a randomized, placebo‐controlled trial. International journal of geriatric psychiatry, 26(7), 687-694.]])][([[https://www.ncbi.nlm.nih.gov/pubmed/24554232|Hatta, K., Kishi, Y., Wada, K., Takeuchi, T., Odawara, T., Usui, C., & Nakamura, H. (2014). Preventive effects of ramelteon on delirium: a randomized placebo-controlled trial. JAMA psychiatry, 71(4), 397-403.]])]