annals of delirium vol 3 november 2010

8/8/2019 Annals of Delirium Vol 3 November 2010

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Table 1. Workshops 1-3: true / false questions

Consensus opinion atworkshop

Question Referencematerial used in

discussion

1 2 3

1. Drug treatment of

delirium is supported byquality prospectiveresearch studies

Meagher andLeonard(2008)

False False False

2. Placebo controlledstudies of deliriumtreatment are lacking

Breitbart et al(1996),

Hu et al (2006)

True True True

3. Placebo controlledstudies of antipsychoticsin delirium prevention arelacking

Kalisvaart et al(2005),PrakanrattanaandPrapaitrakool(2007), Larsenet al (2007)

False False False

4. Studies support the roleof procholinergic agents indelirium prevention

Liptzin et al(2005),Sampson et al(2006),Gamberini etal (2009)

FalseFalse False

5. The effectiveness ofdrug treatment mostlyreflects sedation and / orpsychosis reduction

Meagher et al(1996), Breitbart

et al (1996)

False True False

6. Benzodiazepines havea useful role in deliriumNOT related to substancewithdrawal or seizures

Gaudreau et al(2005),

Pandharipandeet al (2006),

Lonergan et al(2009)

False

False

True

7. Studies indicate that

drug-treatment responsediffers according to clinicalsubtype (e.g. hypoactivevs hyperactivepresentations)

Platt et al

(1994), Breitbartet al (2002),Boettger et al

(2007a),Boettger et al

(2007b),

True True False

8. Patients with deliriumare especially prone toextrapyramidal symptoms

Meagher andLeonard (2008)

False False False

9. The treatment ofdelirium is similarregardless of whether it

involves comorbiddementia

Breitbart et al(2002), Van derCammen et al

(2006)

False True False

10. Excess sedation iscommonly reported instudies of deliriumtreatment

Meagher andLeonard (2008)

False False False


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Table 2. Suggested first and second line agents with doseranges

N Suggested dose range(mg / day)

First Line 61Haloperidol 40 0.5 - 15

Risperidone 9 0.25 - 5

Quetiapine 6 6.25 100

Lorazepam 4 0.5 4

Olanzapine 2 2.5 15

Second Line 61

Lorazepam 19 0.5 4

Olanzapine 11 1.25 - 20

Haloperidol 10 0.5 20

Risperidone 8 0.25 6

Quetiapine 8 12.5 400

Rivastigmine 2 1.5 3Melatonin 1 3

Clozapine 1 6.25 upwards

Amisulpiride 1 50 - 100

Table 3. Impact of the workshop upon proposed use of

pharmacological strategies in future delirium management

More likely touse in the

future

About thesame

Less likely touse in the

future

Delirium treatment ingeneral

40%55% 5%

Hypoactivepresentations

61%26% 13%

Hyperactivepresentations

30%67% 3%

Comorbid delirium-dementia

14%73% 13%

Older medico-surgicalpatients

37%68% 5%

ICU 47% 50% 3%Palliative Care 47% 51% 2%

Prophylaxis in high-risk patients

56%36% 8%


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ReferencesBettin, K. M., et al. (1998). Measuring delirium severity in oldergeneral hospital inpatients without dementia. The Delirium SeverityScale. The American Journal of Geriatric Psychiatry, 6, 296-307.

Brown, L. J., Fordyce, C., Zaghdani, H., Starr, J. M., & MacLullich,A. M. (2010). Detecting deficits of sustained visual attention indelirium. Journal of Neurology, Neurosurgery, and Psychiatry.

Davis, D., & MacLullich A.M.J. (2009). Understanding barriers todelirium care: a multicentre survey of knowledge and attitudesamongst UK junior doctors. Age Ageing, 38, 559-63.

Kean, J, & Ryan, K. (2008). Delirium detection in clinical practiceand research: critique of current tools and suggestions for futuredevelopment. Journal of Psychosomatic Research, 65, 255-259

OKeeffe, S. T., & Gosney, M. A. (1997). Assessing attentiveness inolder hospital patients: global assessment versus tests of attention.Journal of the American Geriatrics Society, 45, 470-473.

Mathias, J. L., & Wheaton, P. (2007). Changes in attention andinformation-processing speed following severe traumatic braininjury: a meta-analytic review. Neuropsychology, 21, 212-23.

Meagher, D. J., Leonard, M., Donnelly, S., Conroy, M., Saunders,J., & Trzepacz, P. T. (2010). A comparison of neuropsychiatric andcognitive profiles in delirium, dementia, comorbid delirium-dementiaand cognitively intact controls. Journal of Neurology, Neurosurgery,and Psychiatry, 81, 876-881.

Figure 1. Objective, paper and pencil neuropsychological tests

used for measuring attention in delirium.
http://www.ncbi.nlm.nih.gov/journals/4443http://www.ncbi.nlm.nih.gov/journals/4443http://www.ncbi.nlm.nih.gov/journals/4443http://www.ncbi.nlm.nih.gov/journals/4443http://www.ncbi.nlm.nih.gov/journals/4443http://www.ncbi.nlm.nih.gov/journals/4443http://www.ncbi.nlm.nih.gov/journals/4443http://www.ncbi.nlm.nih.gov/journals/4443http://www.ncbi.nlm.nih.gov/journals/4443http://www.ncbi.nlm.nih.gov/journals/4443http://www.ncbi.nlm.nih.gov/journals/4443http://www.ncbi.nlm.nih.gov/journals/4443http://www.ncbi.nlm.nih.gov/journals/4443


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News

American Delirium Society

To further address awareness of and knowledge about delirium inthe United States, the American Delirium Society (ADS) is in theprocess of development and incorporation at this time. This societygrew out of a national group dedicated to the development ofexpertise in delirium from with the United States VeteransAdministration (VA). The National VA Delirium Working Group,which has had monthly phone calls for 5 years, will continue to havea role within VA. The Working Group has been quite successful sofar, having sponsored (with assistance from national VA educationaldevelopment funds), two national delirium conferences in June,2009, and June 2010. In conjunction with the June, 2010 VAconference, the new ADS board convened to launch the Society.

The Society has already received grant support from the HartfordFoundation (Hartford, Connecticut, US) and has received furthersignificant support from Malaz Boustani, MD, MPH, IndianaUniversity and the Regenstrief Institute in Indianapolis. The

Regenstrief Institute is a free standing geriatrics research institute.Dr Boustani has offered resources to develop the ADS website andwill sponsor next years ADS meeting in Indianapolis in June, 2011(details to follow). We are also indebted to the leadership ofKenneth Shay, DDS, MS, Director of Geriatric Programs, CentralOffice, VA Washington, DC. The ADS plans to have yearlymeetings to enhance the awareness of the dire clinical outcomes ofdelirium, to educate both the public as well as healthcare providers,and to advocate for further research. We are authoring asupplement to the Journal of the American Geriatrics Society, whichwill be published in mid-2011. We eagerly anticipate collaborationswith the EDA and are already grateful for the kind extensions of

offers to help from members of the EDA.

Until the website is operative (within the next month), the Societycan be reached by emailing our secretary, Marianne Shaughnessy,RN, PhD, our president, James Rudolph, MD, or our treasurer,Barbara Kamholz MD.


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http://www.nice.org.uk/guidance/index.jsp?action=byID&o=13060http://www.nice.org.uk/guidance/index.jsp?action=byID&o=13060http://www.bbc.co.uk/programmes/b00ts58d

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