Atypical antipsychotic medications in the treatment of delirium: a systematic review

Abhishek Shastri 1, Santosh Bangar 2, Andrea E. Cavanna 3,4,5

1 Central & North West London NHS Foundation Trust, London, United Kingdom; 2 Sussex Partnership NHS Foundation Trust, Brighton, United Kingdom; 3 Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom; 4 School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, United Kingdom; 5 Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and University College London, London, United Kingdom

Objective

Delirium is an acute neuropsychiatric condition with high mortality rate if untreated. Haloperidol has long been the drug of choice when treating patients with delirium, however more recently atypical antipsychotics have increasingly been used in the management of this condition. We conducted a systematic literature review to assess the effectiveness of atypical antipsychotics in the treatment of delirium.

Methods

We devised a search strategy according to the methodology outlined in the Prisma guidelines on systematic literature reviews to identify randomised controlled trials comparing atypical antipsychotic medications with placebo, haloperidol, or other atypical antipsychotics in adult patients with delirium. We excluded studies where validated rating instruments were not employed and where antipsychotic medications were used to prevent delirium. Multiple risks of bias were estimated and taken into account.

Results

Our initial search yielded 238 articles. Following screening and application of inclusion and exclusion criteria, a total of 8 studies were included in the qualitative synthesis. The results of the reviewed studies showed that atypical antipsychotics can be useful interventions for the treatment of delirium: in addition to superiority to placebo, these medications demonstrated similar levels of effectiveness to conventional antipsychotics, with a better tolerability profile. 

Conclusions

The available evidence from randomised controlled trials suggests that atypical antipsychotics are both safe and effective in the treatment of adult patients diagnosed with delirium. The findings of comparative studies indicate that these medications could be a valuable alternative to conventional antipsychotics. The limitations of the reviewed literature include the recruitment of clinical samples that are limited in size and heterogeneous in clinical presentation. Further clinical research should be conducted in patients with different aetiologies and clinical presentations of delirium, including hypoactive forms.

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