0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

INFLUENTIAL PUBLICATIONS   |    
Prophylaxis with Antipsychotic Medication Reduces the Risk of Post-Operative Delirium in Elderly Patients: A Meta-Analysis
Polina Teslyar, M.D.; Veronika M. Stock, M.D.; Christopher M. Wilk, M.D.; Ulas Camsari, M.D.; Mark J. Ehrenreich, M.D.; Seth Himelhoch, M.D., M.P.H.
FOCUS 2013;11:544-551. doi:10.1176/appi.focus.11.4.544
Abstract

Background  Delirium commonly occurs in hospitalized elderly patients, resulting in increased morbidity and mortality. Although evidence for treatment of delirium exists, evidence supporting pharmacologic prevention of delirium in high risk patients is limited.

Objective  This review examined whether delirium in at-risk patients can be prevented with antipsychotic prophylaxis in the inpatient setting.

Data sources  A systematic literature review of articles from January 1950 to April 2012 was conducted in PubMed, Psychlnfo, and Cochrane Controlled Trials and databases.

Study selection  Five studies (1491 participants) met our inclusion criteria for analysis. Medication administered included haloperidol (three studies), risperidone (one study), and olanzapine (1 study). All five studies examined older post-surgical patients, spanning five different countries.

Data extraction  Only RCTs of antipsychotic medication used to prevent delirium were included. Key words used in the search were: “delirium,” “encephalopathy,” “ICU psychosis,” “prevention,” and “prophylaxis.” Studies had to include a validated method of diagnosing delirium. Data analysis was performed using the Metan command in Stata (Stata Corp LP, College Station, TX).

Results  The pooled relative risk of the five studies resulted in a 50% reduction in the relative risk of delirium among those receiving antipsychotic medication compared with placebo (RR(95% CI): 0.51 (0.33–0.79; heterogeneity, p < 0.01, random effects model). Examination of the funnel plot did not indicate publication bias.

Conclusions  Although few studies have examined prophylactic use of antipsychotics, this analysis suggests that perioperative use of prophylactic antipsychotics may effectively reduce the overall risk of postoperative delirium in elderly patients.
(Reprinted with permission from Psychosomatics, 2013; 54:124–131) 

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Figure 1. PRISMA Flow Diagram of Study Inclusion and Exclusion.

Figure 2. Forest Plot.
Anchor for Jump
Table 1.Description of Studies Included for Analysis
Table Footer Note

* OHE = oral haloperidol equivalents.27,28

Anchor for Jump
Table 2.Cochrane Quality Analysis of Studies Included in the Analysis
+

References

Diagnostic and Statistical Manual of Mental Disorders, 4th ed.;  Text Revision ed.   Washington, DC:  American Psychiatric Association; 2000
 
Fricchione  GL;  Nejad  SH;  Esses  JA;  Cummings  TJ  Jr;  Querques  J;  Cassem  NH  et al:  Postoperative delirium.  Am J Psychiatry 2008; 165:803–812
[CrossRef] | [PubMed]
 
Inouye  SK:  Delirium in older persons.  N Engl J Med 2006; 354:1157–1165
[CrossRef] | [PubMed]
 
Robinson  TN;  Raeburn  CD;  Tran  ZV;  Angles  EM;  Brenner  LA;  Moss  M:  Postoperative delirium in the elderly: risk factors and outcomes.  Ann Surg 2009; 249:173–178
[CrossRef] | [PubMed]
 
Siddiqi  N;  House  AO;  Holmes  JD:  Occurrence and outcome of delirium in medical in-patients: a systematic literature review.  Age Ageing 2006; 35:350–364
[CrossRef] | [PubMed]
 
Skrobik  YK;  Bergeron  N;  Dumont  M;  Gottfried  SB:  Olanzapine vs. haloperidol: treating delirium in a critical care setting.  Intensive Care Med 2004; 30:444–449
[CrossRef] | [PubMed]
 
Leslie  DL;  Zhang  Y;  Holford  TR;  Bogardus  ST;  Leo-Summers  LS;  Inouye  SK:  Premature death associated with delirium at 1-year follow-up.  Arch Intern Med 2005; 165:1657–1662
[CrossRef] | [PubMed]
 
Witlox  J;  Eurelings  LS;  de Jonghe  JF;  Kalisvaart  KJ;  Eikelen-boom  P,  van gool WA: Delirium in elderly patients and the risk of post-discharge mortality, institutionalization, and dementia: a meta-analysis.  JAMA 2010; 304:443–451
[CrossRef] | [PubMed]
 
Leslie  DL;  Marcantonio  ER;  Zhang  Y;  Leo-Summers  L;  Inouye  SK:  One-year health care costs associated with delirium in the elderly population.  Arch Intern Med 2008; 168:27–32
[CrossRef] | [PubMed]
 
Cole  MG;  Primeau  F;  McCusker  J:  Effectiveness of interventions to prevent delirium in hospitalized patients: a systematic review.  CMAJ 1996; 155:1263–1268
[PubMed]
 
Marcantonio  ER;  flacker  JM;  Wright  RJ;  Resnick  NM:  Reducing delirium after hip fracture: A randomized trial.  J Am Geriatr Soc 2001; 49:516–522
[CrossRef] | [PubMed]
 
Inouye  SK;  Bogardus  ST;  Carpentier  PA;  Leo-Summers  L;  Acampora  D;  Holford  TR  et al:  A multicomponent intervention to prevent delirium in hospitalized older patients.  N Engl J Med 1999; 340:669–676
[CrossRef] | [PubMed]
 
Bourne  RS;  Tahir  TA;  Borthwick  M;  Sampson  EL:  Drug treatment of delirium: past, present and future.  J Psychosom Res 2008; 65:273–282
[CrossRef] | [PubMed]
 
Campbell  N;  Boustani  MA;  Ayub  A;  Fox  GC;  Munger  SL;  Ott  C  et al:  Pharmacological management of delirium in hospitalized adults—a systematic evidence review.  J Gen Intern Med 2009; 24:848–853
[CrossRef] | [PubMed]
 
Devlin  JW;  Skrobik  Y:  Antipsychotics for the prevention and treatment of delirium in the intensive care unit: what is their role? Harv Rev Psychiatry 2011; 19:59–67
[CrossRef] | [PubMed]
 
Hshieh  TT;  Fong  TG;  Marcantonio  ER;  Inouye  SK:  Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence.  J Gerontol A Biol Sci Med Sci 2008; 63:764–772
[CrossRef] | [PubMed]
 
Trzepacz  PT:  Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine.  Semin Clin Neuro-psychiatry 2000; 5:132–148
 
Levenson  J;  Schneider  R:  APA Delirium Practice Guidelines .  American Psychiatric Association,  Arlington VA. Available at: http://psychiatryonline.org/content. aspx?bookid=28&sectionid=1663978.  Accessed onApril 1, 2012
 
Folstein  MF;  Robins  LN;  Helze  JE:  The mini-mental state examination.  Arch Gen Psychiatry 1983; 40:812
[CrossRef] | [PubMed]
 
Inouye  SK;  van Dyck  CH;  Alessi  CA;  Balkin  S;  Siegal  AP;  Horwitz  RI:  Clarifying confusion: the confusion assessment method. A new method for detection of delirium.  Ann Intern Med 1990; 113:941–948
[CrossRef] | [PubMed]
 
Trzepacz  PT;  Mittal  D;  Torres  R;  Kanary  K;  Norton  J;  Jimerson  N:  Validation of the Delirium Rating Scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium.  J Neuropsychiatry Clin Neurosci 2001; 13:229–242
[CrossRef] | [PubMed]
 
Larsen  KA;  Kelly  SE;  Stern  TA;  Bode  RH  Jr.;  Price  LL;  Hunter  DJ  et al:  Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial.  Psychosomatics 2010; 51:409–418
[PubMed]
 
Prakanrattana  U;  Prapaitrakool  S:  Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery.  Anaesth Intensive Care 2007; 35:714–719
[PubMed]
 
Kaneko  T;  Cai  J;  Ishikura  T;  Kobayashi  M;  Naka  T;  Kaibara  N:  Prophylactic consecutive administration of haloperidol can reduce the occurrence of postoperative delirium in gastrointestinal surgery.  Yonago Acta Med 1999; 42:179–184
 
Kalisvaart  KJ;  de Jonghe  JF;  Bogaards  MJ;  Vreeswijk  R;  Egberts  TC;  Burger  BJ  et al:  Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study.  J Am Geriatr Soc 2005; 53:1658–1666
[CrossRef] | [PubMed]
 
Wang  W;  Li  HL;  Wang  DX;  Zhu  X;  Li  SL;  Yao  GQ  et al:  Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial.  Crit Care Med 2012; 40:731–739
[CrossRef] | [PubMed]
 
Andreasen  NC;  Pressler  M;  Nopoulos  P;  Miller  D;  Ho  BC:  Antipsychotic dose equivalents and dose-years: a standardized method for comparing exposure to different drugs.  Biol Psychiatry 2010; 67:255–262
[CrossRef] | [PubMed]
 
Stern  TA;  Fricchione  GL;  Cassem  NH;  Jellinek  MS;  Rosenbaum  JF, Eds:  Massachusetts General Hospital Handbook of General Hospital Psychiatry , 6th ed.  Philadelphia:  Saunders Elsevier 2010:100
 
Cochrane Handbook for Systematic Reviews of Intervention.  The Cochrane Collaboration version 5.1.0. Available at: www.cochrane-handbook.org. Accessed April 1, 2012
 
Girard  TD;  Pandharipande  PP;  Carson  SS;  Schmidt  GA;  Wright  PE;  Canonico  AE  et al:  Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial.  Crit Care Med 2010; 38:428–437
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 10.  >
APA Practice Guidelines > Chapter 0.  >
APA Practice Guidelines > Chapter 0.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 10.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 25.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles