There is no “compelling signal” to support the routine use of antipsychotics for the prevention or treatment of delirium in hospitalized patients, according to Dr. Karin Neufeld, co-author of a review published in the Journal of the American Geriatrics Society. 

To study the efficacy of antipsychotics in preventing and treating delirium, researchers conducted a systematic review and meta-analysis on studies in adult surgical and medical inpatients through various databases from January 1, 1988 to November 26, 2013. A total of 19 randomized controlled trials or cohort studies evaluating antipsychotic administration for delirium were included.

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A random-effects or a fixed-effects model was used to calculate odds ratios (OR) for dichotomous outcomes (delirium incidence and mortality), and mean or standardized mean difference for continuous outcomes (delirium duration, severity, hospital and intensive care unit [ICU] length of stay).

Seven of the 19 studies compared antipsychotics vs. placebo or no treatment for the prevention of delirium after surgery. Data showed no significant effect on delirium incidence (OR 0.56, 95% CI: 0.23–1.34). Findings from all 19 studies showed that antipsychotic use was not associated with changes in delirium duration, severity, or hospital or ICU length of stay. There was also no association identified with mortality (OR 0.90, 95% CI: 0.62–1.29).

Dr. Neufeld concluded that more “methodologically rigorous studies using standardized outcome measures are needed.”

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