Background: Delirium is a common disorder in hospitalized adults and is associated with poor outcomes. Antipsychotics are used clinically to treat delirium, but benefits and harms remain unclear.
Dr. Andrew Berry
Study design: A systematic review evaluating treatment of delirium in 16 randomized, controlled trials (RCTs) of antipsychotics vs. placebo or other antipsychotics, as well as 10 prospective observational studies reporting harm.
Setting: Data obtained from PubMed, Embase, CENTRAL, CINAHL, and PsycINFO from inception to July 2019 without language restrictions.
Synopsis: For 5,607 adult inpatients, treatment of delirium with haloperidol showed no difference in sedation status, duration of delirium, hospital length of stay, or mortality when compared with second-generation antipsychotics or placebo (low and moderate strength of evidence). Regarding second-generation antipsychotics versus haloperidol, no difference was found in delirium severity and cognitive function (low strength of evidence). Direct comparisons between second-generation antipsychotics showed no difference in mortality.
Limitations include heterogeneous use of agents, routes, dose, and measurement tools, which limits generalization of evidence. Multiple RCTs excluded patients with underlying cardiac and neurologic conditions that likely led to underrepresentation of harm in routine use. Insufficient evidence still exists for multiple clinically relevant outcomes including long-term cognitive function.
Bottom line: Evidence from several studies does not support the use of haloperidol or newer antipsychotics to treat delirium.
Citation: Nikooie R et al. Antipsychotics for delirium treatment in adults: A systematic review. Ann Intern Med. 2019 Oct 1;171(7):485-95.
Dr. Berry is assistant professor of medicine, hospital medicine, at the Rocky Mountain Veterans Affairs Regional Medical Center, Aurora, Colo.
