Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-02T20:03:26.576Z Has data issue: false hasContentIssue false
  • English
  • Français

Expert opinions on the first-line pharmacological treatment for delirium in Japan: a conjoint analysis

Published online by Cambridge University Press:  18 January 2016

Yasuyuki Okumura ,
Kotaro Hatta ,
Ken Wada ,
Takashi Takeuchi ,
Yasuhiro Kishi  and
DELIRIA-J Group
Yasuyuki Okumura*
Affiliation:
Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, 105-0003, Tokyo, Japan
Kotaro Hatta
Affiliation:
Department of Psychiatry, Juntendo University Nerima Hospital, 177-0033, Tokyo, Japan
Ken Wada
Affiliation:
Department of Psychiatry, Hiroshima City Hospital Organization, Hiroshima City Hiroshima Citizens Hospital, 730-8518, Hiroshima, Japan
Takashi Takeuchi
Affiliation:
Department of Psychiatry, Tokyo Medical and Dental University, 113-8510, Tokyo, Japan
Yasuhiro Kishi
Affiliation:
Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, 211-0063, Kanagawa, Japan
*
Correspondence should be addressed to: Yasuyuki Okumura, PhD, Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo 105-0003, Japan. Phone: +81-3-3506-8529; Fax: +81-3-3506-8528. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

There is little expert consensus as to which drugs should comprise the first-line pharmacological treatment for delirium. We sought to assess experts’ opinions on the first-line oral and injection drugs for delirium associated with a diverse range of clinical features using a rating-based conjoint analysis.

Methods:

We conducted a cross-sectional study. We mailed a questionnaire to all consultation-liaison psychiatrists/educators certified by the Japanese Society of General Hospital Psychiatry.

Results:

Of 136 experts (response rate: 27.5%), more than 68% recommended the use of risperidone or quetiapine administered orally for hyperactive delirium, except in patients with comorbid diabetes and renal dysfunction. More than 67% recommended the use of haloperidol administered intravenously for hyperactive delirium if an intravenous line has been placed. No oral or injection drugs were recommended by over half of experts for treatment of hypoactive delirium with any clinical features.

Conclusions:

In the absence of a definitive treatment trial, there are both areas of agreement and a lack of consensus regarding the first-line drug. Efforts are needed to routinely collect information that would allow a comparison of the effectiveness and safety of various drugs in real-world clinical practice.

Keywords

expert consensusdeliriumtreatment guidelineacute carepreferenceconsultation-liaison psychiatry
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 6 , June 2016 , pp. 1041 - 1050
Copyright
Copyright © International Psychogeriatric Association 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, G. S., Streim, J., Carpenter, D., Docherty, J. P. and Expert Consensus Panel for Using Antipsychotic Drugs in Older Patients (2004). Using antipsychotic agents in older patients. Journal of Clinical Psychiatry, 65 (Suppl. 2), 5–99; Discussion 100–102; quiz 103–104.Google Scholar
American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults (2015). Postoperative delirium in older adults: best practice statement from the American geriatrics society. Journal of the American College of Surgeons, 220, 136–148 e131.Google Scholar
American Psychiatric Association (1999). Practice guideline for the treatment of patients with delirium. American Psychiatric Association. American Journal of Psychiatry, 156, 1–20.Google Scholar
Boettger, S., Jenewein, J. and Breitbart, W. (2015). Haloperidol, risperidone, olanzapine and aripiprazole in the management of delirium: a comparison of efficacy, safety, and side effects. Palliative and Supportive Care, 13, 1079–1085.Google Scholar
Borthwick, M., Bourne, R., Craig, M., Egan, A. and Oxley, J. (2006). Detection, Prevention and Treatment of Delirium in Critically Ill Patients. Leicester: United Kingdom Clinical Pharmacy Association.Google Scholar
Carvalho, J. et al. (2013). Pharmacological treatment of hypoactive delirium in critically ill patients: a systematic review. Critical Care, 17, P36.Google Scholar
Cook, I. A. and American Psychiatric Association (2004). Guideline Watch: Practice Guideline for the Treatment of Patients with Delirium. Available at: http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/delirium-watch.pdf; last accessed August 1.Google Scholar
Devlin, J. W. et al. (2010). Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Critical Care Medicine, 38, 419–427.Google Scholar
Girard, T. D. et al. (2010). Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial. Critical Care Medicine, 38, 428–437.Google Scholar
Hakim, S. M., Othman, A. I. and Naoum, D. O. (2012). Early treatment with risperidone for subsyndromal delirium after on-pump cardiac surgery in the elderly: a randomized trial. Anesthesiology, 116, 987–997.Google Scholar
Hatta, K. (2005). Clinical Guideline for the Treatment of Delirium: Japanese Society of General Hospital Psychiatry Practice Guidelines 1 [in Japanese]. Tokyo: Seiwa Shoten.Google Scholar
Hatta, K. et al. (2014). Antipsychotics for delirium in the general hospital setting in consecutive 2453 inpatients: a prospective observational study. International Journal of Geriatric Psychiatry, 29, 253–262.Google Scholar
Leslie, D. L., Marcantonio, E. R., Zhang, Y., Leo-Summers, L. and Inouye, S. K. (2008). One-year health care costs associated with delirium in the elderly population. Archives of Internal Medicine, 168, 27–32.Google Scholar
McLaren, K. D. and Marangell, L. B. (2004). Special considerations in the treatment of patients with bipolar disorder and medical co-morbidities. Annals of General Hospital Psychiatry, 3, 7.Google Scholar
Meyer-Massetti, C., Cheng, C. M., Sharpe, B. A., Meier, C. R. and Guglielmo, B. J. (2010). The FDA extended warning for intravenous haloperidol and torsades de pointes: how should institutions respond? Journal of Hospital Medicine, 5, E8–E16.CrossRefGoogle ScholarPubMed
Michaud, L. et al. (2007). Delirium: guidelines for general hospitals. Journal of Psychosomatic Research, 62, 371–383.CrossRefGoogle ScholarPubMed
Miyaji, S., Yamamoto, K., Hoshino, S., Yamamoto, H., Sakai, Y. and Miyaoka, H. (2007). Comparison of the risk of adverse events between risperidone and haloperidol in delirium patients. Psychiatry and Clinical Neurosciences, 61, 275–282.Google Scholar
Morandi, A. et al. (2013). Consensus and variations in opinions on delirium care: a survey of European delirium specialists. International Psychogeriatrics, 25, 2067–2075.Google Scholar
National Institute for Health and Clinical Excellence (2010). Delirium: Diagnosis Prevention and Management. London: National Clinical Guideline Centre.Google Scholar
Noguchi, M. et al. (2014). A report on the current situation of general hospital psychiatry: the results of the Japanese general hospital psychiatry survey 2012 (in Japanese). Japanese Journal of General Hospital Psychiatry, 26, 182–190.Google Scholar
Okumura, Y., Ito, H., Kobayashi, M., Mayahara, K., Matsumoto, Y. and Hirakawa, J. (2010). Prevalence of diabetes and antipsychotic prescription patterns in patients with schizophrenia: a nationwide retrospective cohort study. Schizophrenia Research, 119, 145–152.Google Scholar
Orme, B. K. (2010). Getting Started with Conjoint Analysis: Strategies for Product Design and Pricing Research. Wisconsin: Research Publishers.Google Scholar
Pinheiro, J. C. and Bates, D. M. (2000). Mixed-Effects Models in S and S-PLUS. New York: Springer.CrossRefGoogle Scholar
R Core Team (2015). R: A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing.Google Scholar
Salluh, J. I. et al. (2015). Outcome of delirium in critically ill patients: systematic review and meta-analysis. British Medical Journal, 350, h2538.CrossRefGoogle ScholarPubMed
Someya, T., Endo, T., Hara, T., Yagi, G. and Suzuki, J. (2001). A survey on the drug therapy for delirium. Psychiatry and Clinical Neurosciences, 55, 397–401.Google Scholar
Srinivasan, V., Pandi-Perumal, S. R., Cardinali, D. P., Poeggeler, B. and Hardeland, R. (2006). Melatonin in Alzheimer's disease and other neurodegenerative disorders. Behavioral and Brain Functions, 2, 15.CrossRefGoogle ScholarPubMed
Swan, J. T., Fitousis, K., Hall, J. B., Todd, S. R. and Turner, K. L. (2012). Antipsychotic use and diagnosis of delirium in the intensive care unit. Crit Care, 16, R84.Google Scholar
Tahir, T. A. et al. (2010). A randomized controlled trial of quetiapine versus placebo in the treatment of delirium. Journal of Psychosomatic Research, 69, 485–490.Google Scholar
Thyrum, P. T., Wong, Y. W. and Yeh, C. (2000). Single-dose pharmacokinetics of quetiapine in subjects with renal or hepatic impairment. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 24, 521–533.Google Scholar
Tropea, J., Slee, J. A., Brand, C. A., Gray, L. and Snell, T. (2008). Clinical practice guidelines for the management of delirium in older people in Australia. Australasian Journal on Ageing, 27, 150–156.Google Scholar
Witlox, J., Eurelings, L. S., de Jonghe, J. F., Kalisvaart, K. J., Eikelenboom, P. and van Gool, W. A. (2010). Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. Journal of the American Medical Association, 304, 443–451.Google Scholar
Supplementary material: File

Okumura supplementary material

Appendix A1-A3

Download Okumura supplementary material(File)
File 236.5 KB