Efficacy and Safety of Antipsychotics in the Treatment of Delirium: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 LIAOYu-lin ¹ ,  YUEJi-rong ¹ , XIEDong-mei ¹ , YANGLu ¹ , DENGChuan-yao ¹ , GAOLang-li ¹ , GENGTing ²

1. Department of Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China;
2. Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding?author：

YUEJi-rong, Email: yuejirong11@hotmail.com

Keywords：

Delirium; Antipsychotic drug; Systemic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20150229

Video：

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Objectives To systematically review the clinical efficacy and safety of antipsychotics for delirium. Methods Databases including The Cochrane Library (Issue 5, 2015), PubMed, MEDLINE, EMbase, CNKI, VIP and WanFang Data were electronically searched for randomized controlled trials (RCTs) about antipsychotics compared with placebo/blank for delirium from inception to May 2015. We also hand-searched related conference proceedings and references of included studies for additional studies. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was conducted by using RevMen 5.3 software. Results A total of 7 RCTs involving 712 patients were included. The results of meta-analysis showed that there were no significant differences between the antipsychotics group and the placebo/blank group in mortality (RR=1.00, 95%CI 0.90 to 1.10, P=0.99), duration of delirium (MD=-1.53, 95%CI -4.95 to 1.89, P=0.38), length of stay (MD=-0.89, 95%CI -7.69 to 5.90, P=0.80), and ICU stay time (MD=-3.70, 95%CI -15.83 to 8.43, P=0.55). Compared with the placebo/ blank group, the antipsychotics could reduce the severity of delirium (SMD=-1.62, 95%CI -2.32 to -0.93, P<0.000 01). Conclusion Current evidence shows that the efficacy of antipsychotics in the treatment of delirium is not clear. Due to the limited quantity and quality of the included studies, the above conclusion needs to be further verified by more high quality studies.

Citation： LIAOYu-lin, YUEJi-rong, XIEDong-mei, YANGLu, DENGChuan-yao, GAOLang-li, GENGTing. Efficacy and Safety of Antipsychotics in the Treatment of Delirium: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2015, 15(12): 1401-1406. doi: 10.7507/1672-2531.20150229 Copy

1.	Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet, 2014, 383(9920):911-922.
2.	Wang HR, Woo YS, Bahk WM. Atypical antipsychotics in the treatment of delirium. Psychiatry Clin Neurosci, 2013, 67(5):323-331.
3.	Chaput AJ, Bryson GL. Postoperative delirium:risk factors and management:continuing professional development. Can J Anaesth, 2012, 59(3):304-320.
4.	Witlox J, Eurelings LS, de Jonghe JF, et al. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia:a meta-analysis. JAMA, 2010, 304(4):443-451.
5.	周立峰. 奧氮平治療急性中風后譫妄的臨床觀察. 海峽藥學, 2010, 22(5):121-122.
6.	胡華, 鄧偉, 楊輝, 等. 奧氮平與氟哌啶醇治療老年性譫妄的前瞻性隨機對照研究. 重慶醫學, 2004, 33(8):1234-1237.
7.	劉小兵, 譚慶榮, 王志忠, 等. 奧氮平與氟哌啶醇治療譫妄的對照研究. 華南國防醫學雜志, 2008, 22(6):1-3.
8.	鄒文淑, 王劍峰, 唐文, 等. 奧氮平與氟哌啶醇治療老年譫妄的隨機對照研究. 中華老年心腦血管病雜志, 2010, 12(3):245-247.
9.	Devlin JW, Roberts RJ, Fong JJ, et al. Efficacy and safety of quetiapine in critically ill patients with delirium:a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med, 2010, 38(2):419-427.
10.	Girard TD, Pandharipande PP, Carson SS, et al. Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium:The MIND randomized, placebo-controlled trial. Crit Care Med, 2010, 38(2):428-437.
11.	Tahir TA, Eeles E, Karapareddy V, et al. A randomized controlled trial of quetiapine versus placebo in the treatment of delirium. J Psychosom Res, 2010, 69(5):485-490.
12.	Tamara GF, Samir RT, Sharon KI. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol, 2009, 5(4): 210-220.
13.	Flaherty JH1, Gonzales JP, Dong B. Antipsychotics in the treatment of delirium in older hospitalized adults:a systematic review. J Am GeriatrSoc, 2011, 59(2):269-276.
14.	Seitz DP, Gill SS, van Zyl LT. Antipsychotics in the treatment of delirium:a systematic review. J Clin Psychiatry, 2007, 68(1):11-21.
15.	Lacasse H, Perreault MM, Williamson DR. Systematic review of antipsychotics for the treatment of hospital-associated delirium in medically or surgically ill patients. Ann Pharmacother, 2006, 40(11): 1966-1973.
16.	Lonergan E, Britton AM, Luxenberg J, et al. Antipsychotics for delirium. Cochrane Database Syst Rev, 2007, 18(2):CD005594.
17.	Campbell N, Boustani MA, Ayub A, et al. Pharmacological management of delirium in hospitalized adults——a systematic evidence review. J Gen Intern Med, 2009, 24(7):848-853.
18.	Inouye SK, Marcantonio ER, Metzger ED. Doing Damage in Delirium:The Hazards of Antipsychotic Treatment in Elderly Persons. Lancet Psychiatry, 2014, 1(4):312-315.
19.	Marcantonio ER. In the clinic. Delirium. Ann Intern Med, 2011, 154(11):ITC6-1, ITC6-2, ITC6-3, ITC6-4, ITC6-5, ITC6-6, ITC6-7, ITC6-8, ITC6-9, ITC6-10, ITC16-11, ITC16-12, ITC16-13, ITC16-14, ITC16-15; quiz ITC16-16.
20.	Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med, 2013, 41(1):263-306.
21.	Delirium:Diagnosis, Prevention and Management. National Institute for Health and Clinical Excellence:Guidance. London 2010.

1. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet, 2014, 383(9920):911-922.
2. Wang HR, Woo YS, Bahk WM. Atypical antipsychotics in the treatment of delirium. Psychiatry Clin Neurosci, 2013, 67(5):323-331.
3. Chaput AJ, Bryson GL. Postoperative delirium:risk factors and management:continuing professional development. Can J Anaesth, 2012, 59(3):304-320.
4. Witlox J, Eurelings LS, de Jonghe JF, et al. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia:a meta-analysis. JAMA, 2010, 304(4):443-451.
5. 周立峰. 奧氮平治療急性中風后譫妄的臨床觀察. 海峽藥學, 2010, 22(5):121-122.
6. 胡華, 鄧偉, 楊輝, 等. 奧氮平與氟哌啶醇治療老年性譫妄的前瞻性隨機對照研究. 重慶醫學, 2004, 33(8):1234-1237.
7. 劉小兵, 譚慶榮, 王志忠, 等. 奧氮平與氟哌啶醇治療譫妄的對照研究. 華南國防醫學雜志, 2008, 22(6):1-3.
8. 鄒文淑, 王劍峰, 唐文, 等. 奧氮平與氟哌啶醇治療老年譫妄的隨機對照研究. 中華老年心腦血管病雜志, 2010, 12(3):245-247.
9. Devlin JW, Roberts RJ, Fong JJ, et al. Efficacy and safety of quetiapine in critically ill patients with delirium:a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med, 2010, 38(2):419-427.
10. Girard TD, Pandharipande PP, Carson SS, et al. Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium:The MIND randomized, placebo-controlled trial. Crit Care Med, 2010, 38(2):428-437.
11. Tahir TA, Eeles E, Karapareddy V, et al. A randomized controlled trial of quetiapine versus placebo in the treatment of delirium. J Psychosom Res, 2010, 69(5):485-490.
12. Tamara GF, Samir RT, Sharon KI. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol, 2009, 5(4): 210-220.
13. Flaherty JH1, Gonzales JP, Dong B. Antipsychotics in the treatment of delirium in older hospitalized adults:a systematic review. J Am GeriatrSoc, 2011, 59(2):269-276.
14. Seitz DP, Gill SS, van Zyl LT. Antipsychotics in the treatment of delirium:a systematic review. J Clin Psychiatry, 2007, 68(1):11-21.
15. Lacasse H, Perreault MM, Williamson DR. Systematic review of antipsychotics for the treatment of hospital-associated delirium in medically or surgically ill patients. Ann Pharmacother, 2006, 40(11): 1966-1973.
16. Lonergan E, Britton AM, Luxenberg J, et al. Antipsychotics for delirium. Cochrane Database Syst Rev, 2007, 18(2):CD005594.
17. Campbell N, Boustani MA, Ayub A, et al. Pharmacological management of delirium in hospitalized adults——a systematic evidence review. J Gen Intern Med, 2009, 24(7):848-853.
18. Inouye SK, Marcantonio ER, Metzger ED. Doing Damage in Delirium:The Hazards of Antipsychotic Treatment in Elderly Persons. Lancet Psychiatry, 2014, 1(4):312-315.
19. Marcantonio ER. In the clinic. Delirium. Ann Intern Med, 2011, 154(11):ITC6-1, ITC6-2, ITC6-3, ITC6-4, ITC6-5, ITC6-6, ITC6-7, ITC6-8, ITC6-9, ITC6-10, ITC16-11, ITC16-12, ITC16-13, ITC16-14, ITC16-15; quiz ITC16-16.
20. Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med, 2013, 41(1):263-306.
21. Delirium:Diagnosis, Prevention and Management. National Institute for Health and Clinical Excellence:Guidance. London 2010.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Antipsychotics in the Treatment of Delirium: A Systematic Review

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