Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Ireland.
Department of Psychiatry, University Hospital Limerick, Ireland.
Int J Geriatr Psychiatry. 2018 Nov;33(11):1420-1427. doi: 10.1002/gps.4759. Epub 2017 Jul 30.
Prescribing of antipsychotic medications for patients with delirium remains controversial. Concerns exist that these vulnerable and frail patients may be prescribed antipsychotics inappropriately as a substitute for non-pharmacological approaches when identifiable causes are not found or they challenge ward processes. Moreover, recent evidence suggests that antipsychotics may cause more harm than good in the palliative care patient group with delirium. On the other hand, guidelines in the United Kingdom and the Netherlands support prescribing of antipsychotics in certain circumstances, and a large European survey has revealed that antipsychotics tend to be prescribed first line for hyperactive delirium. Never before, therefore, is there a greater need to examine whether indeed these medications are clinically useful for the treatment of delirium. With this in mind, evidence-based arguments for and against prescribing antipsychotics for the treatment of delirium are presented in this debate article. The paper concludes with a moderation piece to help guide clinical practice.
对于谵妄患者开具抗精神病药物的处方仍然存在争议。人们担心，当无法确定病因或患者对病房流程提出挑战时，这些脆弱和虚弱的患者可能会被不适当地开具抗精神病药物作为非药物治疗的替代方法。此外，最近的证据表明，抗精神病药物在伴有谵妄的姑息治疗患者群体中可能弊大于利。另一方面，英国和荷兰的指南支持在某些情况下开具抗精神病药物，一项大型的欧洲调查显示，抗精神病药物往往被开为治疗活跃性谵妄的一线药物。因此，现在比以往任何时候都更需要研究这些药物是否确实对治疗谵妄具有临床意义。考虑到这一点，本文在这篇辩论文章中提出了支持和反对开具抗精神病药物治疗谵妄的循证论点。本文最后有一篇调解文章，以帮助指导临床实践。
