Department of Psychiatry, Juntendo University Nerima Hospital, Tokyo, Japan.
Int J Geriatr Psychiatry. 2014 Mar;29(3):253-62. doi: 10.1002/gps.3999. Epub 2013 Jun 25.
Attention to risk of antipsychotics for older patients with delirium has been paid. A clinical question was whether risk of antipsychotics for older patients with delirium would exceed efficacy of those even in the general hospital setting.
A prospective observational study proceeded over a 1-year period at 33 general hospitals, where at least one psychiatrist worked full time. Subjects were patients who developed delirium during their admission due to acute somatic diseases or surgery, and who received antipsychotics for delirium. The primary outcome was rates and kinds of serious adverse events.
Among 2834 patients who developed delirium, 2453 patients received antipsychotics, such as risperidone (34%), quetiapine (32%), and parenteral haloperidol (20%), for delirium. Out of 2453 patients, 22 serious adverse events (0.9%) were reported. Aspiration pneumonia was the most frequent (17 patients, 0.7%), followed by cardiovascular events (4 patients, 0.2%) and venous thromboembolism (1 patient, 0.0%). There was no patient with a fracture or intracranial injury due to a fall. No one died because of antipsychotic side effects. The mean Clinical Global Impressions-Improvement Scale score was 2.02 (SD 1.09). Delirium was resolved within 1 week in more than half of the patients (54%).
In the general hospital setting under management including fine dosage adjustment and early detection of side effects, risk of antipsychotics for older patients with delirium might be low, in contrast to antipsychotics for dementia in the nursing home or outpatient settings. A point may be not how to avoid using antipsychotics but how to monitor their risk.
人们已经关注到抗精神病药物治疗老年谵妄患者的风险。一个临床问题是，在综合医院环境中，抗精神病药物治疗老年谵妄患者的风险是否会超过其疗效。
这项前瞻性观察性研究在 33 家综合医院进行了为期 1 年的研究，这些医院至少有一名全职精神科医生。研究对象为因急性躯体疾病或手术而在住院期间发生谵妄并接受抗精神病药物治疗的患者。主要结局指标为严重不良事件的发生率和类型。
在 2834 例发生谵妄的患者中，有 2453 例患者接受了抗精神病药物治疗，如利培酮（34%）、喹硫平（32%）和氟哌啶醇（20%）。在 2453 例患者中，报告了 22 例严重不良事件（0.9%）。吸入性肺炎最为常见（17 例，0.7%），其次是心血管事件（4 例，0.2%）和静脉血栓栓塞症（1 例，0.05%）。没有因跌倒导致骨折或颅内损伤的患者。没有患者因抗精神病药的副作用而死亡。临床总体印象-改善量表的平均得分为 2.02（标准差 1.09）。超过一半的患者（54%）在 1 周内谵妄得到缓解。
在包括精细剂量调整和早期发现副作用的综合医院环境下，与养老院或门诊环境中的痴呆患者使用抗精神病药物相比，老年谵妄患者使用抗精神病药物的风险可能较低。重要的不是如何避免使用抗精神病药物，而是如何监测其风险。
