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No place for antipsychotics in the treatment of delirium in hospitalised patients?


For decades now, antipsychotics have been used to treat delirium, including the only agent authorised for this indication in the Netherlands, haloperidol. Once more, however, research has found no, or hardly any, scientific evidence for this treatment. This is particularly true for patients who develop delirium in hospital. A recent randomised study has shown, among other things, that haloperidol has no effect on the duration of delirium in patients admitted to the intensive care unit (ICU). The authors of a thorough systematic review also found no clear evidence for the value of antipsychotics in treating delirious patients admitted to other hospital departments than the ICU. The many guidelines that recommend haloperidol or other antipsychotics for the treatment of delirium should stop doing so as long as there is no proof of for their effectiveness from well-designed scientific research. Adjustment of current guidelines on the basis of the most recent scientific publications would then be a logical consequence.

  • There is no scientific basis for the apparently obvious view that delirious patients in hospital should be treated with haloperidol.
  • Placebo-controlled studies have found that haloperidol does not reduce the duration of delirium in patients admitted to an intensive care unit (ICU).
  • The literature provides no evidence for an effect of antipsychotics on the duration of delirium in patients admitted to other hospital departments either.
  • There is evidence for a lack of effectiveness of antipsychotics for patients admitted to other hospital departments than the ICU as regards the following outcomes: severity of the delirium, chances of remission of the delirium and death rate.
  • The lack of any favourable effect of antipsychotics on delirium might be caused by the fact that these agents insufficiently target the multifactorial mechanism by which delirium arises, especially at the ICU.
  • Guidelines for the treatment of delirium should be very reticent about recommending the use of antipsychotics, as long as there is no evidence for their effectiveness from well-designed scientific research.

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The literature refers to the Dutch text

Authors

  • dr H.J.E.M. Janssens