Encouraging data for the effectiveness of medications for delirium—especially for prevention of the disorder—were found in a systematic review of literature on the subject. “Pharmacological Treatments of Non-Substance-Withdrawal Delirium: A Systematic Review of Prospective Trials” was published online in AJP in Advance.
Delirium can accompany a number of medical conditions and hospital-based treatments. Researchers at Icahn School of Medicine at Mount Sinai and the Clinical Neuroscience Center at Pilgrim Psychiatric Center in New York reviewed published prospective trials of potential pharmacological interventions for preventing and treating delirium. The pharmacological strategies reviewed showed greater success in preventing delirium than in treating it. Significant delirium prevention effects were associated with haloperidol, second-generation antipsychotics, iliac fascia block, gabapentin, melatonin, lower levels of intraoperative propofol sedation, and a single dose of ketamine during anesthetic induction and with dexmedetomidine, compared with other sedation strategies for mechanically ventilated patients.
“Given the association between delirium and increased hospital-based complications, including mortality, and long-term complications such as cognitive decline and need for custodial care, there is an imperative to prevent the appearance of delirium and, once present, to treat it with the intention of both improving the immediate clinical picture and potentially improving long-term outcome,” the researchers said. “The preponderance of evidence suggests greater success at preventing delirium with the pharmacological strategies reviewed here than treating delirium once it develops.”
“These promising results warrant further study with consideration of the methodological weaknesses and inconsistencies of studies to date,” they acknowledged.