Okumura Yasuyuki, Hatta Kotaro, Wada Ken, Takeuchi Takashi, Kishi Yasuhiro
Research Department,Institute for Health Economics and Policy,Association for Health Economics Research and Social Insurance and Welfare,105-0003,Tokyo,Japan.
Department of Psychiatry,Juntendo University Nerima Hospital,177-0033,Tokyo,Japan.
Int Psychogeriatr. 2016 Jun;28(6):1041-50. doi: 10.1017/S1041610215002446. Epub 2016 Jan 18.
There is little expert consensus as to which drugs should comprise the first-line pharmacological treatment for delirium. We sought to assess experts' opinions on the first-line oral and injection drugs for delirium associated with a diverse range of clinical features using a rating-based conjoint analysis.
We conducted a cross-sectional study. We mailed a questionnaire to all consultation-liaison psychiatrists/educators certified by the Japanese Society of General Hospital Psychiatry.
Of 136 experts (response rate: 27.5%), more than 68% recommended the use of risperidone or quetiapine administered orally for hyperactive delirium, except in patients with comorbid diabetes and renal dysfunction. More than 67% recommended the use of haloperidol administered intravenously for hyperactive delirium if an intravenous line has been placed. No oral or injection drugs were recommended by over half of experts for treatment of hypoactive delirium with any clinical features.
In the absence of a definitive treatment trial, there are both areas of agreement and a lack of consensus regarding the first-line drug. Efforts are needed to routinely collect information that would allow a comparison of the effectiveness and safety of various drugs in real-world clinical practice.
对于哪些药物应构成谵妄的一线药物治疗，专家们几乎没有达成共识。我们试图通过基于评分的联合分析来评估专家们对与多种临床特征相关的谵妄的一线口服和注射药物的意见。
我们进行了一项横断面研究。我们向所有获得日本综合医院精神科协会认证的会诊联络精神科医生/教育工作者邮寄了一份问卷。
在136名专家中（回复率：27.5%），超过68%的专家建议，对于躁动性谵妄患者，除合并糖尿病和肾功能不全的患者外，口服使用利培酮或喹硫平。如果已建立静脉通路，超过67%的专家建议对躁动性谵妄患者静脉注射使用氟哌啶醇。超过半数的专家未推荐任何口服或注射药物用于治疗具有任何临床特征的安静型谵妄。
在缺乏确定性治疗试验的情况下，关于一线药物既有一致意见的领域，也存在缺乏共识的情况。需要努力常规收集信息，以便在实际临床实践中比较各种药物的有效性和安全性。
