A Choosing Wisely: Things we do for no reason article addresses the use for antipsychotics and when they are appropriate. Highlights below:
- Approximately 25% of hospitalized patients experience delirium during their stay.
- 10-30% of hospitalized patients are prescribed antipsychotics.
- A systemic review from the Journal of the American Geriatric Society (2016) by Neufeld et al. included 19 studies and found that antipsychotics did not change the severity of delirium, length of delirium, or length of hospital stay.
- The American Geriatrics Society recommends against antipsychotics in older adults with postoperative delirium unless they are agitated or a threat to themselves or others.
- Recommendations from Choosing Wisely to limit the use of antipsychotics:
- Assess for modifiable factors: meds, pain electrolytes, infection, alcohol withdrawal. Assess if invasive lines can be discontinued.
- Try behavioral interventions and delirium precautions.
- If a patient poses a risk of harm to themselves or others, use the lowest effective dose for the shortest possible duration of time.
Citation: Pahwa AK, Qureshi I, Cumbler E. Things We Do For No Reason: Use of Antipsychotic Medications in Patients with Delirium. J Hosp Med. 2019 Mar 20;14:E1-E3. doi: 10.12788/jhm.3166. Epub ahead of print. PMID: 30897059.