A new study has found that antipsychotic drugs have no effect on delirium, according to a study released today in the New England Journal of Medicine.
Until now, research on the effectiveness of treating delirium with antipsychotics was mixed, despite the fact the medication has been widely prescribed for the condition for over 40 years, both in hospitals and in aged care.
With no convincing evidence to support use of the medication, a team of US researchers set out to get to the bottom of the issue.
The study was conducted across 16 US hospital intensive care units (ICU). Almost 600 patients – 566 – with delirium were divided into three groups.
One group was given the powerful antipsychotic haloperidol. Another was given ziprasidone, a drug considered an ‘atypical antipsychotic’. And the third group was given a placebo.
What is delirium?
Delirium is the term used to people who are confused, incoherent, hyperactive or experiencing hallucinations.
The condition may come on quickly, within only a few hours or days.
Delirium can lead to long-term cognitive problems, including dementia.
“Not a shred of evidence” that “aggressive” approach does anything
The study found there was no significant difference in the outcomes of each of the groups.
Dr E Wesley Ely, an intensive care specialist at Vanderbilt University Medical Center, told National Public Radio, “The three groups did exactly the same.”
The study found there was no change in the duration of delirium or the number of coma-free days. Patients didn’t get out of the hospital any sooner.
“There’s not a shred of evidence in this entire investigation that this aggressive approach to treating delirium with antipsychotics, which is commonplace and usual care, did anything for the patients,” Dr Ely said.
Intravenous antipsychotic medications have been used to treat delirium in hospitalized patients for more than 40 years, according to the authors of the study.
Use of antipsychotic medications in aged care
Antipsychotic medications are also used widely to treat delirium in aged care.
The recent expose of the aged care industry on Four Corners, ‘Who Cares?’, touched on the issue of antipsychotic over-prescribing in aged care.
Rather than using these medications as a last resort, the program said they are being readily prescribed and are often given without family’s approval, despite consent being required.
The Four Corners report revealed that one resident ended up in a mental health ward after being prescribed the antipsychotic Risperidone, and other medications, for delirium.
This person’s family were only made aware the medication had been given to her after it appeared on her bill.
Study could change the way we treat delirium
Dr Juliana Barr, an anesthesiologist and intensive care specialist at Stanford University, told NPR that healthcare professionals need to “think differently” about managing delirium in their patients.
“A pill or an injection is really not a magic bullet for this devastating illness,” she said.
Dr Barr said she expects the new study will change medical practice for managing delirium, at least in intensive care.
Both Dr Barr and Dr Ely recommend a more “holistic” approach to treating delirium that involves getting patients off medication, and “up and about” as soon as possible.
Will the findings of this study mean we see fewer antipsychotics prescribed in aged care?
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