[Psychopharmalogical treatment of delirium in the elderly].

Abstract

Delirium is frequent in hospitalized elderly. Treatment of the medical problems causing delirium is paramount. Mostly antipsychotics are used for treatment of psychological and behavioral symptoms in delirium. Increased mortality of elderly and demented patients receiving antipsychotics suggests caution in prescribing antipsychotics for delirium. Standard treatment is low-dose haloperidol. If more sedation is needed, melperone or pipamperone can be used. In delirious Parkinsonian patients or if dementia with Lewy-bodies is suspected quetiapine is better tolerated. Other sedating antipsychotics like prothipendyl, promethazine or levomepromazin are considered inappropriate medication in the elderly due to their anticholinergic and orthostatic side effects. Cholinesterase inhibitors are not effective in delirium, except physostigmine for treatment of anticholinergic intoxication confined to intensive care. Benzodiazepines are effective in alcohol- und benzodiazepine-withdrawal, but may induce delirium (paradox reaction). Clomethiazole is contraindicated in frequent pulmonal conditions in the elderly like COPD. Chloral hydrate is considered inappropriate medication in the elderly due to QTc-prolongation. On intensive care units clonidine and recently dexmedetomidine are useful. At the moment there are no data indicating melatonin being effective for treatment of delirium.

• Authors: Lutz M Drach
• Journal: Medizinische Monatsschrift fur Pharmazeuten (Med Monatsschr Pharm) Vol. 37 Issue 4 Pg. 124-31; quiz 133-4 (Apr 2014) ISSN: 0342-9601 [Print] Germany
• Vernacular Title: Symptomatische Psychopharmakotherapie des Delirs im Alter.
• PMID: 24779187 (Publication Type: English Abstract, Journal Article, Review)

Chemical References

• Antipsychotic Agents
• Cholinesterase Inhibitors

Topics

• Aged
• Antipsychotic Agents (therapeutic use)
• Cholinesterase Inhibitors (therapeutic use)
• Delirium (drug therapy, etiology, therapy)
• Female
• Humans
• Male