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: 3, Funny) by Anonymous Coward on Monday October 22 2018, @11:53PM (3 children)
Let's keep in mind that the study is biased.
There was no consultation with the big pharma and, indeed, the industry lob..., err, professional bodies. As such, the study is based only on their opinion and it's terrible, terrible biased.
Since this is not the first such biased study, let us reiterate one negative impact: in the absence of such consultation, the industry's point of view is eschewed and the participation of the industry in MAGA seriously hampered.
If the executive branch does not want to see these negative aspects, it should act towards the creation of a legislative framework in which such rogue science studies need to be validated by the industry's professional bodies before publishing.
(Score: 0) by Anonymous Coward on Tuesday October 23 2018, @12:10AM
So true. Those opinionated bastards doing studies that validate their opinions. What bullshit, only 600 patients, with multiple drugs and a placebo control group. All with indistinguishable results because they probably did it blind. Now I tell you how it's supposed to be done: write your study conclusion first, publish, then shred all the results that didn't validate the conclusion. Double blind experimentation is flawed to the core, why have blind people do something that could clearly be done so much better by someone with 20/20 vision? A blind person is likely to trip over and drop the bottle of pills, or accidentally give the pills to the wrong patient because they couldn't read the name on the chart.
If these kinds of dodgy blind studies continue, I'll have to start looking at other unscrupulous corporate industries to invest.
(Score: 0) by Anonymous Coward on Tuesday October 23 2018, @01:32PM
Meta-analyses have shown that psychiatric studies sponsored by pharmaceutical companies are several times more likely to report positive results, and if a drug company employee is involved the effect is even larger.
-- Controversy about drug marketing and lobbying [wikipedia.org]
This is a big problem, apparently especially in psychiatry.
(Score: 2) by driverless on Wednesday October 24 2018, @05:50AM
It's biased, but in a different way than you think. Haloperidol is used to treat schizophrenia and Tourette’s Disorder. Use of intravenous haloperidol to treat acutely agitated patients is an unapproved, off-label use. So what the study is saying is that using this particular medication to treat something it's not intended for treating doesn't work, which isn't terribly surprising.
It's not the shock, horror story people want it to be. Someone, somewhere, decided to use haloperidol in an unapproved, off-label manner. Somehow, this became adopted as common practice (it's not done here, a non-US country, so I don't know what the story behind it was). What the study is saying is that this off-label use doesn't work, so stop doing it.
(Score: 1, Funny) by Anonymous Coward on Tuesday October 23 2018, @12:20AM (10 children)
Just a thought, but shouldn't this be from the Michael David Crawford department?
(Score: 2) by PartTimeZombie on Tuesday October 23 2018, @12:53AM (9 children)
If you're looking for +5 insightful comments on mental health problems, MDC is absolutely the man to go to.
(Score: 0) by Anonymous Coward on Tuesday October 23 2018, @12:57AM (8 children)
I'm hoping he's well enough (and awake!) to drop by and offer his take.
(Score: 3, Insightful) by aristarchus on Tuesday October 23 2018, @01:46AM (6 children)
Of course, if you do not know the difference between mania, psychosis, delerium, and/or dementia, then no amount of pharmaceuticals are going to do the trick for you. Interesting trivia point: in Greek φάρμακον means "poison". It's all about the dosage.
(Score: -1, Troll) by Anonymous Coward on Tuesday October 23 2018, @02:16AM (5 children)
It's good that in Greek, poison means poison. Maybe someday, we can have a full translation from civilized languages into Greek, and back again. Of course, our keyboards will probably be a lot larger, to accommodate all those extra keys. And, forget mobile devices, right?
(Score: 3, Informative) by c0lo on Tuesday October 23 2018, @04:57AM (4 children)
three words (or a composed and a normal one): space-cadet keyboard [wikipedia.org]
Right.
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 3, Informative) by aristarchus on Tuesday October 23 2018, @06:13AM (3 children)
24 glyphs in Greek, 26 in English. And most of the Greek ones are stolen from Phonecian. And all of the English ones are stolen from Latin. So what is your point? Mobile illiterate devices? Buffy!
c0lo says: "right". c0lo is most often just right. He is smarter than you are.
(Score: 2) by c0lo on Tuesday October 23 2018, @10:38AM (2 children)
Including upper and lowercase, the number of glyphs in the two pale in significance in the face of emojis [unicode.org].
Which is sorta telling: for a couple of millennia, the civilisation made do with 100 glyphs.
And the cultural vacuum nowadays needs over 1500 more to express nothing.
So, the question majestically raises: when did you say you plan to use the 52 glyphs borrowed from Phoenicians via Latin to have another instalment of Ethics for Soylentils? Or are we witnessing a permanent "in stall"ness state?
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 2) by aristarchus on Tuesday October 23 2018, @10:51AM (1 child)
Tiny font point taken, though it will all be in Romanish glyphs, since Kant did not Write Using the Futhark. Makes me wonder. Does Google translate handle runic script? Old Norse? I haven't used it for quite some time (since it was new-ish).
(Score: 2) by c0lo on Wednesday October 24 2018, @11:52AM
Irrespective of the alphabet he'd use, I wonder how would he be answering the question today?
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(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]
(Score: 0) by Anonymous Coward on Tuesday October 23 2018, @01:53AM (1 child)
https://en.wikipedia.org/wiki/Haloperidol [wikipedia.org]
Doesn't look like anyone is getting rich off this older drug.
https://en.wikipedia.org/wiki/Ziprasidone [wikipedia.org]
Nothing on the price or cost of this one in the Wikipedia article...but Pfizer is one of the usual suspects when high drug prices are discussed.
(Score: 3, Informative) by sjames on Tuesday October 23 2018, @02:15AM
Taking dosing info from medline and cost from drugs.com, it looks like Ziprasidone runs about $4000/year in spite of being less effective that it's now generic predecessor. Not the big gouge some drugs are, but not cheap either.
(Score: 3, Interesting) by Barenflimski on Tuesday October 23 2018, @02:38AM (1 child)
I guess in this case, the placebo effect was good enough to make people feel like the Dr was doing something useful? If it wasn't doing anything at all, how did it take trained professionals 60+ years to figure this out? Whats next, removing appendixes will be a thing of the past?
(Score: 0) by Anonymous Coward on Tuesday October 23 2018, @06:20PM
Funny you should mention that. [cbsnews.com]
(Score: 2) by MichaelDavidCrawford on Tuesday October 23 2018, @07:16AM
However I need quite a lot of it as I can drink the liquid variety like it was Coca-Cola.
Zyprexa (olanzipine) is more commonly employed for acute mania, but I object to it quite strongly as it commonly causes hyperglycemia - increased blood sugar - and can cause diabetes even without weight gain. I have diabetes in my family.
Yes I Have No Bananas. [gofundme.com]