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Antipsychotic Drugs Don't Ease ICU Delirium Or Dementia
Powerful drugs that have been used for decades to treat delirium are ineffective for that purpose, according to a study published online Monday in the New England Journal of Medicine.
[...] "In some surveys up to 70 percent of patients [in the ICU] get these antipsychotics," says Dr. E. Wesley "Wes" Ely, an intensive care specialist at Vanderbilt University Medical Center. They're prescribed by "very good doctors at extremely good medical centers," he says. "Millions of people worldwide are getting these drugs to treat their delirium." [...] Patients with delirium are often confused and incoherent and sometimes can suffer hallucinations. This condition can lead to long-term cognitive problems, including a form of dementia.
[...] Ely and colleagues at 16 U.S. medical centers decided to put antipsychotic drugs to a rigorous test. They divided nearly 600 patients who were suffering from delirium into three groups. One group got the powerful antipsychotic haloperidol. A second group got ziprasidone, which is a related medication from a class of drugs called "atypical antipsychotics." A third group got a placebo.
"The three groups did exactly the same," Ely says. There was no change in the duration of delirium, or the number of coma-free days. "They stayed in the ICU the same amount of time. They stayed on the mechanical ventilator the same amount of time. They didn't get out of the hospital any sooner." "There's not a shred of evidence in this entire investigation that this aggressive approach to treating delirium with antipsychotics, which is commonplace and usual care, did anything for the patients," he concludes.
Also at Vanderbilt University Medical Center.
Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness (open, DOI: 10.1056/NEJMoa1808217) (DX)
(Score: 2) by MichaelDavidCrawford on Tuesday October 23 2018, @07:21AM
I am quite dismayed to report that psychiatrists as well as - in many US states - prescribing nurse practitioners use their personal preferences rather than academic studies to determine what to prescribe.
For example, after an inpatient psychiatrist at a certain hospital prescribed Adderal for ADD, an outpatient psychiatrist at that same hospital refused to prescribe it "because it's addictive", and that particular outpatient psychiatrist was quite openly a recovering alcoholic.
While in my experience Adderal's addictiveness is highly overrated, whether or not one should prescribe it should be based only upon comparing the actual experience of the patient with the results of peer reviewed studies, yet that's hardly ever done in practice.
Yes I Have No Bananas. [gofundme.com]