Pharmacological Treatment Of Delirium Research Articles

Orexin receptor antagonists versus antipsychotics for the management of delirium in intensive care unit patients with cardiovascular disease: A retrospective observational study

ObjectiveAlthough antipsychotics are often used in the pharmacological treatment of delirium, recent reports suggest the efficacy of orexin receptor antagonists. This study investigated whether orexin receptor antagonists could be a possible treatment option for delirium. MethodA nonblinded nonrandomized routine clinical treatment was performed. Patients treated in intensive care units (ICU) for cardiovascular disease and receiving psychiatric intervention were studied retrospectively. The scores from the Intensive Care Delirium Screening Checklist (ICDSC) were compared between patients treated with orexin receptor antagonists and those treated with antipsychotics. ResultsThe mean (standard deviation) ICDSC scores were 4.5 (1.8) at day −1 and 2.6 (2.6) at day 7 for orexin receptor antagonist group (n = 25) and 4.6 (2.4) at day −1 and 4.1 (2.2) at day 7 for antipsychotic group (n = 28). The orexin receptor antagonist group showed significantly lower ICDSC scores than the antipsychotic group (p = 0.021). ConclusionWhile precise efficacy cannot be determined from our retrospective, observational, and uncontrolled pilot study, this analysis encourages a future double-blind randomized placebo-controlled trial of orexin-antagonists for delirium treatment.

Delirium in the context of intensive care medicine-Part 2: diagnosis, prevention and treatment

Despite the high prevalence and the enormous medical and health economic impact, delirium syndromes are often underdiagnosed, which is mainly attributable to the high frequency of hypoactive delirium and to the frequently subtle and fluctuating psychopathology in the initial phase of delirium. These aspects also justify the need for aconsequent and continuous application of standardized screening tools to detect delirium as early as possible. Amultidimensional, nonpharmacological prevention of delirium is effective and still underutilized in the clinical practice. So far, there are no consensus recommendations regarding the pharmacological prevention of delirium. From a therapeutic perspective acausal approach is prioritized. Pharmacological treatment of delirium can only be considered under strict observance of specific indicators. When treating non-withdrawal-related delirium benzodiazepines should be avoided.

SOP: treatment of delirium

IntroductionDelirium is a frequent complication in hospitalised patients, often leading to difficulties in patient management and is associated with increased morbidity and mortality. Most patients in intensive care units develop delirium, however, it is also frequently observed in non-intensive care unit settings. Risk factors are, among others, older age, brain pathology, severe trauma, orthopaedic or heart surgery, metabolic or electrolyte dysregulations, infections and polypharmacy. The most important measures to prevent and treat delirium are recognition and removal of risk factors and causes. Although delirium is a very common and serious complication, evidence for pharmacological treatment is poor, and guidelines remain controversial. Accordingly, non-pharmacological treatments have gained increasing attention and should be applied. Based on current literature, guidelines and personal recommendations, we developed a standard operating procedure (SOP) encompassing non-pharmacological and pharmacological treatment of delirium.CommentsIn order to prevent delirium, risk factors should be identified and taken into account when planning the hospital stay and treatment. Prevention should include multimodal non-pharmacological interventions. The treatment of delirium should encompass the elimination of potential causes and non-pharmacological interventions. Pharmacological treatment should be used in a time-limited manner and in the lowest possible dose for the management of highly stressful symptoms or high-risk behaviour.ConclusionThe SOP provides a pragmatic algorithm for the non-pharmacological and pharmacological treatment of delirium.

Delirium in Geriatric Trauma Patients

This review focuses on exploring the most recent literature on delirium among older adult trauma and acute care surgery patients. There are numerous scientific advances in the understanding and management of delirium among geriatric trauma patients (GTP). In terms of prevention, most of these advances are focused on non-pharmacological interventions. There are several studies exploring biomarkers for the objective assessment of delirium. Current recommendations for the pharmacologic treatment of delirium suggest reserving the use of antipsychotics and other sedating medications for the treatment of severe agitation that poses a risk to the patient. Despite extensive strides in the prevention and treatment of delirium, there is still a paucity of data in GTPs. Our review shows that GTPs benefit from multi-faceted interventions that serve primarily as preventive measures, and there is evidence that some novel pharmacological interventions may help in the treatment of GTPs.

Delirium.

Delirium, a syndrome characterized by an acute change in attention, awareness and cognition, is caused by a medical condition that cannot be better explained by a pre-existing neurocognitive disorder. Multiple predisposing factors (for example, pre-existing cognitive impairment) and precipitating factors (for example, urinary tract infection) for delirium have been described, with most patients having both types. Because multiple factors are implicated in the aetiology of delirium, there are likely several neurobiological processes that contribute to delirium pathogenesis, including neuroinflammation, brain vascular dysfunction, altered brain metabolism, neurotransmitter imbalance and impaired neuronal network connectivity. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) is the most commonly used diagnostic system upon which a reference standard diagnosis is made, although many other delirium screening tools have been developed given the impracticality of using the DSM-5 in many settings. Pharmacological treatments for delirium (such as antipsychotic drugs) are not effective, reflecting substantial gaps in our understanding of its pathophysiology. Currently, the best management strategies are multidomain interventions that focus on treating precipitating conditions, medication review, managing distress, mitigating complications and maintaining engagement to environmental issues. The effective implementation of delirium detection, treatment and prevention strategies remains a major challenge for health-care organizations globally.

Are common delirium assessment tools appropriate for evaluating delirium at the end of life in cancer patients?

The objectives of this study are to investigate how many advanced cancer patients became unconscious or non-communicative after pharmacological treatment for delirium, and to explore whether existing delirium assessment tools can successfully evaluate its severity at the end of life. This was a secondary analysis of a registry study that examined the efficacy and safety of antipsychotics for advanced cancer patients with delirium. A total of 818 patients were recruited from 39 specialized palliative care services in Japan. The severity of delirium was measured using the Richmond Agitation-Sedation Scale-Palliative care version, the Delirium Rating Scale-Revised-98 (DRS-R-98), and the Nursing Delirium Screening Scale (Nu-DESC) on Day 3. Data from 302 patients with motor anxiety with an Agitation Distress Scale score ≥2 on Day 0 were analyzed for this study. The patients were categorized into four treatment response groups: complete response (CR: no agitation and fully communicative), partial response (PR: no/mild agitation and partially communicative), unconscious/non-communicative (UC), and no change (NC). On Day 3, 29 (10%; 95% confidence intervals [CI], 7-13) and 2 (1%; 95% CI, 0-2) patients became unconscious and non-communicative, respectively. Forty-four patients were categorized as CR, 97 as PR, 31 as UC, and 96 as NC. The scores of the DRS-R-98 and Nu-DESC in the UC group were rated higher than patients in the NC group were. A considerable number of cancer patients with delirium became unconscious or non-communicative. Existing delirium assessment tools may be inappropriate for measuring the severity of delirium in end-of-life.

Antipsychotic Drugs in Prevention of Postoperative Delirium-What Is Known in 2020?

Delirium is one of the most frequently reported neuropsychiatric complications in the perioperative period, especially in the population of elderly patients who often suffer from numerous comorbidities undergoing extensive or urgent surgery. It can affect up to 80% of patients who require hospitalization in an intensive care setting postoperatively. Delirium increases mortality, morbidity, length of hospital stay, and cost of treatment. An episode of delirium in the acute phase may lower the general quality of life and increases the risk of cognitive decline long-term. Since pharmacological treatment of delirium is not highly effective, focus of research has shifted towards developing preventive strategies. We aimed to perform a review of the topic based on the most recent literature. We conclude that, based on the available data, it seems impossible to make strong recommendations for using antipsychotic drugs in prophylaxis. Further research should answer the question what, if any, benefit patients receive from the pharmacological prevention of delirium, and which agents should be used.

Pharmacological Treatments for Delirium in Critically Ill Adults

What effects do pharmacological treatments for delirium have on the duration of delirium in critically ill adults?Delirium is one of the most common behavioral manifestations of acute brain dysfunction in patients in intensive care units (ICUs), affecting up to 80% of those who are critically ill.1 Delirium is characterized by inattention, altered consciousness, and disorganized thinking, and it is associated with various serious adverse outcomes including hospital and ICU mortality, longer duration of mechanical ventilator support, prolonged ICU and hospital stays, and long-term cognitive impairment.2 For this reason, nurses must appropriately manage delirium to minimize adverse outcomes.Treatment options include both pharmacological and nonpharmacological interventions, although serious illness often requires a pharmacological treatment. The effectiveness of such regimens vary and are not standardized internationally.2 The most common pharmacological interventions are antipsychotic medications, yet published evidence provides mixed support for their use. A Cochrane systematic review by Burry et al3 compared the 6 main types of medications and assessed their impact on delirium in critically ill patients.This summary describes the review by Burry et al,3 which included data from 14 randomized controlled trials with a combined total of 1844 participants. The review explored 1 primary outcome: Duration of delirium (ie, the time from when delirium was identified until it resolved) measured in days.The randomized controlled trials evaluated by Burry et al3 compared various medications with placebo:The review also evaluated various secondary outcomes:Burry et al3 independently assessed the risk of bias in each study, including selection, performance, detection, attrition, reporting, and publication biases. They resolved any disagreements by reviewing and discussing the data together.The authors used medians and means with 95% CIs as measures of treatment effects among various comparisons and outcomes. They used the internationally approved Grades of Recommendation, Assessment, Development and Evaluation approach to determine the quality of evidence for each outcome. This approach assigns a level of high, moderate, low, or very low regarding the confidence of an outcome or conclusion: (1) high, which indicates that further research is very unlikely to change the confidence in the conclusion; (2) moderate, which means that further research is likely to have an important impact on the confidence in the conclusion and may change it; (3) low, which indicates that further research is very likely to have an important impact on the confidence in the conclusion and is likely to change it; and (4) very low, which means the conclusion is uncertain.4When each drug class was directly compared with a placebo, only the α2-adrenergic agonist dexmedetomidine reduced the duration of delirium; the cholinesterase inhibitor rivastigmine prolonged the duration. Both of these results are based on findings from a single small study. The other drugs, when compared with placebo, did not change delirium duration. In addition, the results did not indicate that any drug reduced the duration of coma, the length of stay, or mortality, nor did the drugs improve long-term cognitive outcomes. Some results did show that dexmedetomidine shortened the duration of mechanical ventilation.The following points provide additional detail about the main results of this systematic review.Delirium continues to be a challenge in the critical care setting, and health care teams continue to use pharmacological interventions to treat it. The main outcomes explored in the systematic review by Burry et al3 suggest that the α2-adrenergic agonist dexmedetomidine may help shorten the duration of both delirium and mechanical ventilation, but those results are based on the findings of only a single small study. No other pharmacological intervention—including antipsychotics, the medication most commonly prescribed for treating delirium—had any effect on delirium duration or on any of the secondary outcomes.One key result was that the cholinesterase inhibitor rivastigmine was associated with harm and a longer stay in the ICU; as such, clinicians should advocate against and carefully consider its use for treating delirium in patients in the ICU. One study showed advantages to using dexmedetomidine to treat delirium in such patients, but additional evidence is needed to fully support this. Health care teams should evaluate the options and make the most appropriate clinical decision on the basis of the best available evidence. The results of ongoing studies such as the international work from the group Del-COrS (Development of core outcome sets for effectiveness trials of interventions to prevent and/or treat delirium) may provide further insight into and guidance regarding delirium management.5Advocating for the best evidence-based treatment is an important part of our role as nurses caring for critically ill patients. We must always consider the best available evidence and understand the feasibility, appropriateness, meaningfulness, and effectiveness of any intervention to determine whether it is appropriate for our particular patient.

Pharmacological treatment of hyperactive delirium in people with COVID-19: rethinking conventional approaches.

People with coronavirus disease (COVID-19) might have several risk factors for delirium, which could in turn notably worsen the prognosis. Although pharmacological approaches for delirium are debated, haloperidol and other first-generation antipsychotics are frequently employed, particularly for hyperactive presentations. However, the use of these conventional treatments could be limited in people with COVID-19, due to the underlying medical condition and the risk of drug–drug interactions with anti-COVID treatments. On these premises, we carried out a rapid review in order to identify possible alternative medications for this particular population. By searching PubMed and the Cochrane Library, we selected the most updated systematic reviews of randomised trials on the pharmacological treatment of delirium in both intensive and non-intensive care settings, and on the treatment of agitation related to acute psychosis or dementia. We identified medications performing significantly better than placebo or haloperidol as the reference treatment in each population considered, and assessed the strength of association according to validated criteria. In addition, we collected data on other relevant clinical elements (i.e. common adverse events, drug-drug interactions with COVID-19 medications, daily doses) and regulatory elements (i.e. therapeutic indications, contra-indications, available formulations). A total of 10 systematic reviews were included. Overall, relatively few medications showed benefits over placebo in the four selected populations. As compared with placebo, significant benefits emerged for quetiapine and dexmedetomidine in intensive care unit (ICU) settings, and for none of the medications in non-ICU settings. Considering also data from indirect populations (agitation related to acute psychosis or dementia), aripiprazole, quetiapine and risperidone showed a potential benefit in two or three different populations. Despite limitations related to the rapid review methodology and the use of data from indirect populations, the evidence retrieved can pragmatically support treatment choices of frontline practitioners involved in the COVID-19 outbreak, and indicate future research directions for the treatment of delirium in particularly vulnerable populations.

Effectiveness and Harms of Pharmacological Treatments for Delirium in Adult Intensive Care Patients After Cardiac Surgery: A Systematic Review

Effectiveness and Harms of Pharmacological Treatments for Delirium in Adult Intensive Care Patients After Cardiac Surgery: A Systematic Review

Delirium In The Emergency Department: Diagnosis, Evaluation, And Management

Delirium, an acute confusional state characterized by disturbances in attention, cognition, and arousal, is present in 7 to 10% of older emergency department (ED) patients, underdiagnosed in the ED setting, and associated with increased short-term mortality. Delirium is typically precipitated by a physiologic stressor, such as an acute medical illness, a new medication, or a change in environment. The keys to the care and management of delirious patients are timely diagnosis of delirium and identification and treatment of the precipitating cause. The medical evaluation should include a formal delirium assessment that includes tests of attention and targeted diagnostic tests to identify the underlying etiology, such as infection, metabolic derangement, neurologic emergencies, new medications, and/or toxidromes. Pharmacologic treatment of delirium should be limited to patients who are severely agitated and at risk for substantial harm to self and/or others and patients with delirium secondary to alcohol withdrawal. Typical and atypical psychotics at low doses are first line for use in severely agitated patients. Benzodiazepines may worsen delirium and should be reserved for treatment of patients with delirium secondary to alcohol withdrawal or if sedation is required for critical imaging and/or procedures. ED physicians should also be conscious of and strive to minimize iatrogenic precipitants of delirium. This review contains 2 figures, 10 tables and 53 references Key words: aged, agitation, arousal attention, confusion, delirium, delirium/diagnosis, delirium/etiology, delirium/therapy, dementia complications, geriatrics, risk factors

Delirium In The Emergency Department: Diagnosis, Evaluation, And Management

Delirium, an acute confusional state characterized by disturbances in attention, cognition, and arousal, is present in 7 to 10% of older emergency department (ED) patients, underdiagnosed in the ED setting, and associated with increased short-term mortality. Delirium is typically precipitated by a physiologic stressor, such as an acute medical illness, a new medication, or a change in environment. The keys to the care and management of delirious patients are timely diagnosis of delirium and identification and treatment of the precipitating cause. The medical evaluation should include a formal delirium assessment that includes tests of attention and targeted diagnostic tests to identify the underlying etiology, such as infection, metabolic derangement, neurologic emergencies, new medications, and/or toxidromes. Pharmacologic treatment of delirium should be limited to patients who are severely agitated and at risk for substantial harm to self and/or others and patients with delirium secondary to alcohol withdrawal. Typical and atypical psychotics at low doses are first line for use in severely agitated patients. Benzodiazepines may worsen delirium and should be reserved for treatment of patients with delirium secondary to alcohol withdrawal or if sedation is required for critical imaging and/or procedures. ED physicians should also be conscious of and strive to minimize iatrogenic precipitants of delirium. This review contains 2 figures, 10 tables and 53 references Key words: aged, agitation, arousal attention, confusion, delirium, delirium/diagnosis, delirium/etiology, delirium/therapy, dementia complications, geriatrics, risk factors

Delirium In The Emergency Department: Diagnosis, Evaluation, And Management

Delirium, an acute confusional state characterized by disturbances in attention, cognition, and arousal, is present in 7 to 10% of older emergency department (ED) patients, underdiagnosed in the ED setting, and associated with increased short-term mortality. Delirium is typically precipitated by a physiologic stressor, such as an acute medical illness, a new medication, or a change in environment. The keys to the care and management of delirious patients are timely diagnosis of delirium and identification and treatment of the precipitating cause. The medical evaluation should include a formal delirium assessment that includes tests of attention and targeted diagnostic tests to identify the underlying etiology, such as infection, metabolic derangement, neurologic emergencies, new medications, and/or toxidromes. Pharmacologic treatment of delirium should be limited to patients who are severely agitated and at risk for substantial harm to self and/or others and patients with delirium secondary to alcohol withdrawal. Typical and atypical psychotics at low doses are first line for use in severely agitated patients. Benzodiazepines may worsen delirium and should be reserved for treatment of patients with delirium secondary to alcohol withdrawal or if sedation is required for critical imaging and/or procedures. ED physicians should also be conscious of and strive to minimize iatrogenic precipitants of delirium. This review contains 2 figures, 10 tables and 53 references Key words: aged, agitation, arousal attention, confusion, delirium, delirium/diagnosis, delirium/etiology, delirium/therapy, dementia complications, geriatrics, risk factors

Delirium In The Emergency Department: Diagnosis, Evaluation, And Management

Delirium, an acute confusional state characterized by disturbances in attention, cognition, and arousal, is present in 7 to 10% of older emergency department (ED) patients, underdiagnosed in the ED setting, and associated with increased short-term mortality. Delirium is typically precipitated by a physiologic stressor, such as an acute medical illness, a new medication, or a change in environment. The keys to the care and management of delirious patients are timely diagnosis of delirium and identification and treatment of the precipitating cause. The medical evaluation should include a formal delirium assessment that includes tests of attention and targeted diagnostic tests to identify the underlying etiology, such as infection, metabolic derangement, neurologic emergencies, new medications, and/or toxidromes. Pharmacologic treatment of delirium should be limited to patients who are severely agitated and at risk for substantial harm to self and/or others and patients with delirium secondary to alcohol withdrawal. Typical and atypical psychotics at low doses are first line for use in severely agitated patients. Benzodiazepines may worsen delirium and should be reserved for treatment of patients with delirium secondary to alcohol withdrawal or if sedation is required for critical imaging and/or procedures. ED physicians should also be conscious of and strive to minimize iatrogenic precipitants of delirium. This review contains 2 figures, 10 tables and 53 references Key words: aged, agitation, arousal attention, confusion, delirium, delirium/diagnosis, delirium/etiology, delirium/therapy, dementia complications, geriatrics, risk factors

Delirium In The Emergency Department: Diagnosis, Evaluation, And Management

Delirium, an acute confusional state characterized by disturbances in attention, cognition, and arousal, is present in 7 to 10% of older emergency department (ED) patients, underdiagnosed in the ED setting, and associated with increased short-term mortality. Delirium is typically precipitated by a physiologic stressor, such as an acute medical illness, a new medication, or a change in environment. The keys to the care and management of delirious patients are timely diagnosis of delirium and identification and treatment of the precipitating cause. The medical evaluation should include a formal delirium assessment that includes tests of attention and targeted diagnostic tests to identify the underlying etiology, such as infection, metabolic derangement, neurologic emergencies, new medications, and/or toxidromes. Pharmacologic treatment of delirium should be limited to patients who are severely agitated and at risk for substantial harm to self and/or others and patients with delirium secondary to alcohol withdrawal. Typical and atypical psychotics at low doses are first line for use in severely agitated patients. Benzodiazepines may worsen delirium and should be reserved for treatment of patients with delirium secondary to alcohol withdrawal or if sedation is required for critical imaging and/or procedures. ED physicians should also be conscious of and strive to minimize iatrogenic precipitants of delirium. This review contains 2 figures, 10 tables and 53 references Key words: aged, agitation, arousal attention, confusion, delirium, delirium/diagnosis, delirium/etiology, delirium/therapy, dementia complications, geriatrics, risk factors

Delirium In The Emergency Department: Diagnosis, Evaluation, And Management

Delirium, an acute confusional state characterized by disturbances in attention, cognition, and arousal, is present in 7 to 10% of older emergency department (ED) patients, underdiagnosed in the ED setting, and associated with increased short-term mortality. Delirium is typically precipitated by a physiologic stressor, such as an acute medical illness, a new medication, or a change in environment. The keys to the care and management of delirious patients are timely diagnosis of delirium and identification and treatment of the precipitating cause. The medical evaluation should include a formal delirium assessment that includes tests of attention and targeted diagnostic tests to identify the underlying etiology, such as infection, metabolic derangement, neurologic emergencies, new medications, and/or toxidromes. Pharmacologic treatment of delirium should be limited to patients who are severely agitated and at risk for substantial harm to self and/or others and patients with delirium secondary to alcohol withdrawal. Typical and atypical psychotics at low doses are first line for use in severely agitated patients. Benzodiazepines may worsen delirium and should be reserved for treatment of patients with delirium secondary to alcohol withdrawal or if sedation is required for critical imaging and/or procedures. ED physicians should also be conscious of and strive to minimize iatrogenic precipitants of delirium. This review contains 2 figures, 10 tables and 53 references Key words: aged, agitation, arousal attention, confusion, delirium, delirium/diagnosis, delirium/etiology, delirium/therapy, dementia complications, geriatrics, risk factors

10 What is the best way to manage delirium? a systematic review of the evidence

Objective Delirium is a transient acute confusional state which can have long-term neurological sequelae. The purpose of this systematic review is to investigate the best ways to manage delirium from a pharmacological and non-pharmacological perspective. Method I followed the PRISMA guidelines to conduct a systematic review, using Medline, Embase and PsycInfo to search for literature. I searched for “delirium” and then “manag*” OR “treat*” OR “pharm*” OR “non-pharm*” OR “interven*” OR “care” or “psych*”, combining these searches with AND. This gave 5215 search results, which was refined to 4359 search results by including on English articles with abstracts. By reading the titles I was left with 43 results to be looked at more closely by reading the abstract. This was reduced to 21 on reading those abstracts. Results 13 studies looked at the efficacy of atypical antipsychotics in treating delirium, usually comparing them with haloperidol, other atypical antipsychotics or with a placebo. Most of these studies found atypical antipsychotics as effective as haloperidol. All atypical antipsychotics appeared equally efficacious. Most articles found that atypical antipsychotics were safe for use in delirium, with few associated adverse events. Some studies looked at the effect of place of treatment on delirium resolution. Here, patients responded better when treated on wards offering holistic, specialist geriatric care. Pitkala et al. (2006) found that such patients were more likely to receive acetylcholinesterase inhibitors and atypical antipsychotics than other pharmacological options and overall had fewer psychotropic drugs. Conclusion The articles reviewed in this study predominantly had small sample sizes. Just one study looked purely at non-pharmacological care for delirium, finding it was effective. Very few studies compared the efficacy and safety of psychoactive drugs to that of placebo, preferring to compare them with each other. The findings of this systematic review indicate that patients with delirium are best managed on geriatric wards where they will be given individually tailored treatment. The one article reviewed investigating non-pharmacological management of delirium suggests that this may also be a useful method of treating of delirium. Our findings suggest that atypical antipsychotics are equally effective as typical antipsychotics, such as haloperidol. These may also be safer than previously thought but there is insufficient evidence to determine whether pharmacological treatment of delirium is actually safe.

Effectiveness of Antipsychotics on Delirium in Elderly Patients

Study background: Delirium is common in older adults, but the pharmacological treatment of delirium in the elderly has not been established. This study aimed to compare the efficacy of three atypical antipsychotics (amisulpride, quetiapine, and risperidone) for the treatment of delirium in patients aged >65 years. Methods: Psychiatrists examined subjects aged >65 years referred to the consultation–liaison psychiatry service for at baseline, day 3, and day 7. Totally, 129 subjects were enrolled and assigned to receive either amisulpride (n=44), quetiapine (n=44), risperidone (n=21), or not to receive any antipsychotic medications (n=20). We examined the efficacy of each medication using the Korean version of the Delirium Rating Scale-Revised-98, which investigates the severity of delirium episodes. We then evaluated the cognitive function of subjects using the Mini-Mental Status Examination. Results: At baseline, no significant differences were found among the four groups with regard to mean Korean version of the Delirium Rating Scale-Revised-98 or Mini-Mental Status Examination scores. In all groups, including the non-antipsychotic group, the Korean version of the Delirium Rating Scale-Revised-98 score decreased and Mini-Mental Status Examination score increased a week after the delirium diagnosis. There were no significant differences in improved Korean version of the Delirium Rating Scale-Revised-98 or Mini-Mental Status Examination scores among these four groups. Conclusion: Compared to subjects taking atypical antipsychotics, subjects not taking any antipsychotic medications equally improved their delirium symptoms and cognition. For hospitalized older adults with acute delirium, the data suggests that atypical antipsychotic treatment is ineffective for improving delirium outcomes.

P.5.d.003 First- and second-line pharmacological treatment for delirium – retrospective analysis in a general hospital setting

P.5.d.003 First- and second-line pharmacological treatment for delirium – retrospective analysis in a general hospital setting

Pharmacological Treatment of Delirium in the Intensive Care Unit—Reply

Pharmacological Treatment of Delirium in the Intensive Care Unit—Reply