Delirium is an altered mental status that is transient by nature, acute in onset, and can be caused by etiologies in 12 different categories.
drug intoxication , drug withdrawal, metabolic/endocrine disturbance, TBI, seizures, intracranial infection, systemic infection, intracranial neoplasm, systemic neoplasm, cerebrovascular disease, organ insufficiency, other CNS disorders, other systemic diseases.
Because I had a patient with delirium, I read two articles about the pharmacological treatment of it.
"Efficacy and safety of haloperidol versus atypical antipsychotic medications in the treatment of delirium"
Yoon et all
Found that haldol, risperidone, olanzapine, and quetiapine were equally effictive in improving the symptoms of delirium.
Patients over 75 did not respond as well to olanzapine.
Weaknesses of the study include that there was no placebo, no randomization, high dropout rate.
"Pharmacovigilance in Hospice/Palliative Care: Net Effect of Haloperidol for Delirium"
Crawford et all
119 participants, all on hospice with significant age or poor physical functional status.
Mean dose of 2.1mg/day
1 in 3 patients experienced benefit at 48hrs after starting haldol.
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