Postgraduate School in Geriatrics, University of Brescia, Brescia, Italy.
Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
J Clin Psychiatry. 2019 Mar 12;80(2):18m12430. doi: 10.4088/JCP.18m12430.
This study aimed to evaluate the association between polypharmacy and delirium, the association of specific drug categories with delirium, and the differences in drug-delirium association between medical and surgical units and according to dementia diagnosis.
Data were collected during 2 waves of Delirium Day, a multicenter delirium prevalence study including patients (aged 65 years or older) admitted to acute and long-term care wards in Italy (2015-2016); in this study, only patients enrolled in acute hospital wards were selected (n = 4,133). Delirium was assessed according to score on the 4 "A's" Test. Prescriptions were classified by main drug categories; polypharmacy was defined as a prescription of drugs from 5 or more classes.
Of 4,133 participants, 969 (23.4%) had delirium. The general prevalence of polypharmacy was higher in patients with delirium (67.6% vs 63.0%, P = .009) but varied according to clinical settings. After adjustment for confounders, polypharmacy was associated with delirium only in patients admitted to surgical units (OR = 2.9; 95% CI, 1.4-6.1). Insulin, antibiotics, antiepileptics, antipsychotics, and atypical antidepressants were associated with delirium, whereas statins and angiotensin receptor blockers exhibited an inverse association. A stronger association was seen between typical and atypical antipsychotics and delirium in subjects free from dementia compared to individuals with dementia (typical: OR = 4.31; 95% CI, 2.94-6.31 without dementia vs OR = 1.64; 95% CI, 1.19-2.26 with dementia; atypical: OR = 5.32; 95% CI, 3.44-8.22 without dementia vs OR = 1.74; 95% CI, 1.26-2.40 with dementia). The absence of antipsychotics among the prescribed drugs was inversely associated with delirium in the whole sample and in both of the hospital settings, but only in patients without dementia.
Polypharmacy is significantly associated with delirium only in surgical units, raising the issue of the relevance of medication review in different clinical settings. Specific drug classes are associated with delirium depending on the clinical setting and dementia diagnosis, suggesting the need to further explore this relationship.
本研究旨在评估多种药物治疗与谵妄之间的关联、特定药物类别与谵妄之间的关联，以及根据痴呆诊断，医疗和外科单位之间药物-谵妄关联的差异。
该研究是一项多中心谵妄患病率研究，在意大利的急性和长期护理病房中收集了 2 波谵妄日的数据（纳入年龄≥65 岁的患者）；在此研究中，仅选择了急性医院病房的患者（n=4133）。谵妄根据“4A”测试的评分进行评估。处方按主要药物类别分类；多种药物治疗定义为使用 5 种或更多类别的药物。
在 4133 名参与者中，969 名（23.4%）患有谵妄。患有谵妄的患者中，多种药物治疗的总体患病率较高（67.6%比 63.0%，P=0.009），但因临床环境而异。调整混杂因素后，仅在外科病房收治的患者中，多种药物治疗与谵妄相关（OR=2.9；95%CI，1.4-6.1）。胰岛素、抗生素、抗癫痫药、抗精神病药和非典型抗抑郁药与谵妄相关，而他汀类药物和血管紧张素受体阻滞剂则呈负相关。与无痴呆的患者相比，在无痴呆的个体中，典型和非典型抗精神病药与谵妄之间的关联更强（典型：OR=4.31；95%CI，2.94-6.31 无痴呆 vs OR=1.64；95%CI，1.19-2.26 有痴呆；非典型：OR=5.32；95%CI，3.44-8.22 无痴呆 vs OR=1.74；95%CI，1.26-2.40 有痴呆）。在整个样本和两个医院环境中，处方中没有抗精神病药与谵妄呈负相关，但仅在无痴呆的患者中。
多种药物治疗与谵妄显著相关，仅在外科病房中，这引发了在不同临床环境下药物审查的重要性问题。特定药物类别与谵妄相关，这取决于临床环境和痴呆诊断，提示需要进一步探索这种关系。
