• David J Meagher.
• Department of Adult Psychiatry, Midwestern Regional Hospital, Limerick, Ireland. david.meagher@ul.ie
• Int Psychogeriatr. 2010 Sep 1; 22 (6): 938-46.

BackgroundThere is uncertainty regarding the optimal use of pharmacological strategies in delirium particularly regarding preferred agents, duration of treatment and effectiveness in different populations.MethodsAttitudes towards delirium pharmacotherapy were investigated before and after an educational workshop using the format of a television game show.ResultsMost 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%).ConclusionsAttitudes 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.

21 keywords...

hide…