David J Meagher1. 1. Department of Adult Psychiatry, Midwestern Regional Hospital, Limerick, Ireland. david.meagher@ul.ie
Abstract
BACKGROUND: There is uncertainty regarding the optimal use of pharmacological strategies in delirium particularly regarding preferred agents, duration of treatment and effectiveness in different populations. METHODS: Attitudes towards delirium pharmacotherapy were investigated before and after an educational workshop using the format of a television game show. RESULTS: Most respondents (65/66) reported psychotropic use with variable frequency (median 60%). Antipsychotic use was inversely related to perception of supporting evidence (p = 0.02). Respondents rated sedative (38%) and antipsychotic (33%) effects as the principal mechanism of action rather than a specific neurochemical anti-delirium effect (21%). Haloperidol was the preferred first-line agent (65%). Suggested continuation treatment after symptom resolution was three days. Eleven respondents had used psychotropics prophylactically. Antipsychotic use was influenced by concerns regarding potential for extrapyramidal (52%), sedative (32%), cerebrovascular (30%) and metabolic (8%) effects. Post-workshop concerns regarding extrapyramidal effects were reduced with a more positive general attitude towards pharmacological interventions, especially in hypoactive presentations (61%) and prophylactically in high-risk patients (56%). CONCLUSIONS: Attitudes towards key aspects of delirium pharmacotherapy vary considerably and relate to concerns regarding side effect potential more than perceived mechanism of action. Educational interventions can impact positively upon attitudes.
BACKGROUND: There is uncertainty regarding the optimal use of pharmacological strategies in delirium particularly regarding preferred agents, duration of treatment and effectiveness in different populations. METHODS: Attitudes towards delirium pharmacotherapy were investigated before and after an educational workshop using the format of a television game show. RESULTS: Most respondents (65/66) reported psychotropic use with variable frequency (median 60%). Antipsychotic use was inversely related to perception of supporting evidence (p = 0.02). Respondents rated sedative (38%) and antipsychotic (33%) effects as the principal mechanism of action rather than a specific neurochemical anti-delirium effect (21%). Haloperidol was the preferred first-line agent (65%). Suggested continuation treatment after symptom resolution was three days. Eleven respondents had used psychotropics prophylactically. Antipsychotic use was influenced by concerns regarding potential for extrapyramidal (52%), sedative (32%), cerebrovascular (30%) and metabolic (8%) effects. Post-workshop concerns regarding extrapyramidal effects were reduced with a more positive general attitude towards pharmacological interventions, especially in hypoactive presentations (61%) and prophylactically in high-risk patients (56%). CONCLUSIONS: Attitudes towards key aspects of delirium pharmacotherapy vary considerably and relate to concerns regarding side effect potential more than perceived mechanism of action. Educational interventions can impact positively upon attitudes.
Authors: Carolina J P W Keijsers; Larissa van Hensbergen; Lotte Jacobs; Jacobus R B J Brouwers; Dick J de Wildt; Olle Th J ten Cate; Paul A F Jansen Journal: Br J Clin Pharmacol Date: 2012-11 Impact factor: 4.335
Authors: Lisa Burry; Sangeeta Mehta; Marc M Perreault; Jay S Luxenberg; Najma Siddiqi; Brian Hutton; Dean A Fergusson; Chaim Bell; Louise Rose Journal: Cochrane Database Syst Rev Date: 2018-06-18
Authors: A Morandi; D Davis; J K Taylor; G Bellelli; B Olofsson; S Kreisel; A Teodorczuk; B Kamholz; W Hasemann; J Young; M Agar; S E de Rooij; D Meagher; M Trabucchi; A M MacLullich Journal: Int Psychogeriatr Date: 2013-08-20 Impact factor: 3.878