CPCP: Drugs for Delirium by Rock Star Residents and A Medical Student

Thomas Salter, MD

Thomas Salter, MD

Paul Thisayakorn, MD

Paul Thisayakorn, MD

We heard a great Clinical Problems in Consultation Psychiatry (CPCP) presentation from rock star residents Thomas Salter, Paul Thisayakorn as well as medical student Rick Siel.  Tom and Paul took the lead in making the slides. The topic was psychopharmacology for agitation of delirium. I wish I could have found pictures for all of them.

It’s a common question for psychiatric consultants from our colleagues in medicine and surgery: What drugs can be used to manage the agitation of delirium so that we can keep working on finding the real treatment for delirium–uncovering and reversing the medical etiologies?

Not to spill the beans too early, but recall that poll about banning Haldol I posted recently, Reflections on the “Ban Haldol?” Poll So Far – The Practical Psychosomaticist? It turns out that we’d better not ban Haldol, which is what the majority of those polled believe.

The article we examined was a pretty good review:

Bledowski, J. and A. Trutia (2012). “A review of pharmacologic management and prevention strategies for delirium in the intensive care unit.” Psychosomatics 53(3): 203-211.

BACKGROUND: The prevalence of delirium has been estimated at anywhere between 10% and 30% in general medical patients and in upwards of 80% in patients who are admitted to an intensive care unit (ICU). Given the high prevalence of delirium in the ICU population, it should not be surprising that a large percentage of psychiatric consults arise from this setting. While the mainstay of pharmacologic management of delirium centers on neuroleptic medications, such as haloperidol, recent studies using alternate agents have shown varying levels of promise. OBJECTIVE: Our purpose is to outline the major prospective studies looking at the efficacy of pharmacologic management and prevention strategies for delirium exclusively in adult ICU patients. Both conventional and novel pharmacotherapeutic interventions are discussed. METHOD: Articles were obtained using the MEDLINE/PUBMED database looking specifically at pharmacologic interventions for delirium in the intensive care unit. A search was performed using the key words”delirium,” “intensive care unit,” “treatment,” and “prophylaxis.” The authors limited their search to prospective studies, specifically randomized trials (both placebo-controlled and non-controlled) in the adult ICU population, and eliminated retrospective and observational studies. Relevant citations from the previously mentioned articles were also included in the review. CONCLUSION: There is a plethora of studies on pharmacologic management strategies in general medical patients with delirium. Findings from these studies are often extrapolated to the ICU population; however, when looking at studies limited to ICU patients with delirium, there are far fewer credible prospective studies.

As usual, the trainees made some excellent slides to get the point across. In order to see the picture galleries of photos or powerpoint slides, click on one of the slides, which will open up the presentation to fill the screen. Use the arrow buttons to scroll left and right through the slides or up and down to view any annotations.

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Comments

  1. Jim, Great stuff as usual. I posted it to my FB page for the consult docs and residency director to see.

    Like

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