Delirium

A disorder characterized by CONFUSION; inattentiveness; disorientation; ILLUSIONS; HALLUCINATIONS; agitation; and in some instances autonomic nervous system overactivity. It may result from toxic/metabolic conditions or structural brain lesions. (From Adams et al., Principles of Neurology, 6th ed, pp411-2)

Also Known As:

Networked: 8410 relevant articles (524 outcomes, 1467 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Critical Illness (Critically Ill)
2.	Neoplasms (Cancer)
3.	Pain (Aches)
4.	Dementia (Dementias)
5.	Confusion (Bewilderment)

Experts

1.	Ely, E Wesley: 156 articles (01/2022 - 06/2003)
2.	Inouye, Sharon K: 86 articles (03/2022 - 10/2002)
3.	Marcantonio, Edward R: 80 articles (07/2022 - 01/2003)
4.	Devlin, John W: 70 articles (01/2022 - 04/2007)
5.	Pandharipande, Pratik P: 64 articles (10/2021 - 12/2007)
6.	Girard, Timothy D: 50 articles (01/2022 - 01/2007)
7.	Jones, Richard N: 47 articles (01/2022 - 01/2003)
8.	Skrobik, Yoanna: 44 articles (01/2022 - 06/2002)
9.	Bruera, Eduardo: 41 articles (12/2021 - 04/2004)
10.	Slooter, Arjen J C: 41 articles (12/2021 - 08/2008)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Delirium:

1.	Antipsychotic Agents (Antipsychotics)IBA 09/30/2013 - "Most previous studies on the efficacy of antipsychotic medication for the treatment of delirium have reported that there is no significant difference between typical and atypical antipsychotic medications. " 01/01/2020 - "Most reports noted efficacy with antipsychotics, but these reports were limited by sample size and lacked a validated PICU delirium tool. " 01/01/2020 - "Most reports described improvement in delirium symptoms; however, only 5 reports used a validated screening tool for PICU delirium to evaluate antipsychotic response. " 03/03/2014 - "Short-term, low-dose haloperidole is still the best choice of treatment in controlling symptoms in hyperactive delirium, but atypical antipsychotics are probably equally efficacious. " 06/01/2013 - "Although randomized placebo controlled studies are needed to better characterize the indications, risks, and benefits, these atypical antipsychotic medications appeared to be effective and safe for managing delirium symptoms in very young pediatric patients."
2.	Haloperidol (Haldol)FDA LinkGeneric 11/01/2019 - "The AID-ICU trial is based on gold standard methodology applied to a large sample of clinically representative patients and will provide pivotal high-quality data on the benefits and harms of haloperidol for the treatment ICU-acquired delirium." 01/01/2017 - "These studies showed that short-term prophylactic administration of low-dose intravenous haloperidol significantly decreased the incidence of delirium in elderly patients admitted to intensive care units after non-cardiac surgery and in general intensive care unit patients with a high risk of delirium.However" 01/01/2016 - "Results from placebo-controlled prevention studies suggest a haloperidol-induced protective effect for delirium in older patients scheduled for surgery: two studies reported a significant reduction in ICU delirium incidence and one study found a significant reduction in delirium severity and duration. " 12/29/2022 - "Among patients in the ICU with delirium, treatment with haloperidol did not lead to a significantly greater number of days alive and out of the hospital at 90 days than placebo. " 05/01/2015 - "These results emphasize the need for more studies regarding the efficacy of haloperidol for treatment of delirium among older medical ICU patients and demonstrate the value of assessing nonintubated patients."
3.	DexmedetomidineFDA Link 06/04/2018 - "Only few studies have compared the efficacy of dexmedetomidine in non-intubated ICU patients as a first-line curative treatment of delirium. " 01/01/2022 - "A high-dose continuous infusion of IV dexmedetomidine was administered, and his violent behavior and delirium significantly improved. " 01/01/2019 - "Pooled analysis showed a significant reduction in delirium incidence for dexmedetomidine treatment, and bispectral index (BIS)-guided anaesthesia. " 04/12/2016 - "Among the 21 a priori secondary outcomes, none were significantly worse with dexmedetomidine, and several showed statistically significant benefit, including reduced time to extubation (median, 21.9 hours vs 44.3 hours with placebo; median difference between groups, 19.5 hours [95% CI, 5.3 to 31.1 hours]; P < .001) and accelerated resolution of delirium (median, 23.3 hours vs 40.0 hours; median difference between groups, 16.0 hours [95% CI, 3.0 to 28.0 hours]; P = .01). " 02/01/2015 - "In the dexmedetomidine group, delirium rating scale was significantly smaller than that of the control group (P<0.05) while Ramsay sedation score was significantly greater than that of the control group (P<0.05). "
4.	BenzodiazepinesIBA 10/01/2013 - "Benzodiazepines and delirium: the best option for the right patient." 12/01/2018 - "Here we present a case of GHB withdrawal delirium that was treated successfully with fixed and symptom-triggered benzodiazepine dosing regimen based on Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) scale. " 01/01/2020 - "There is no enough evidence to determine whether benzodiazepines are effective when used to treat patients with delirium who are cared for in non-ICU settings. " 04/01/2014 - "Benzodiazepines are effective in alcohol- und benzodiazepine-withdrawal, but may induce delirium (paradox reaction). " 01/01/2019 - "Opportunities for improvement in care include increasing delirium monitoring, performing SATs, and decreasing use of sedation, particularly benzodiazepines."
5.	MelatoninIBA 10/01/2017 - "Future research should focus on daily multiple melatonin measurements to determine whether melatonin supplementation might be beneficial for delirium treatment or prevention." 01/28/2016 - "Emerging evidence suggests that melatonin may be biologically implicated in the development of delirium and that melatonin supplementation may be beneficial in reducing the incidence of delirium in medical and surgical patients. " 01/01/2020 - "Study protocol for a prospective randomised double-blind placebo-controlled clinical trial investigating a Better Outcome with Melatonin compared to Placebo Administered to normalize sleep-wake cycle and treat hypoactive ICU Delirium: the Basel BOMP-AID study." 01/01/2021 - "A power calculation accounting for drop-out (31.0%), suggests 120 participants would be required to demonstrate with 90% power that melatonin 5 mg reduces the severity of delirium by 3 points or more on MDAS. " 11/07/2022 - "Melatonin is also a chronobiotic medication effective in treating delirium and restoring the circadian imbalance seen in COVID patients in the intensive care unit. "
6.	Quetiapine Fumarate (Seroquel)FDA Link 11/01/2020 - "Significant improvement was associated with age of 75 or older (ES = 0.07), better performance status (0.32), longer estimated prognosis (0.25), psycho-oncological consultation settings (0.20), hyperactive (0.14) or mix-motor subtypes (0.24) of delirium, and quetiapine administration (0.19); significant deterioration was observed in patients with "days" prognosis (0.18). " 10/01/2007 - "The efficacy of quetiapine on delirium was evaluated by using the Delirium Rating Scale (DRS) and the Clinical Global Impression-Severity scale (CGI-S). " 04/01/2013 - "Quetiapine appears to be an effective and safe agent for the treatment of delirium in both general medicine and intensive care unit patients. " 03/01/2003 - "In our study, we found that quetiapine was a safe and effective treatment in hospitalized older patients with delirium." 10/01/2014 - "Quetiapine is regarded as an effective and safe treatment for delirium. "
7.	Olanzapine (Zyprexa)FDA Link 09/01/1998 - "Five of the 11 olanzapine patients showed significant improvement (> 50% score reduction) on the Delirium Rating Scale (DRS) and no patients had side effects, whereas 6 of the 11 control subjects showed improvement on the DRS and 5 had extrapyramidal symptoms or excessive sedation. " 06/01/2013 - "The objective of this study was to examine the efficacy of olanzapine for the treatment of delirium in the pediatric intensive care unit (ICU) using methodological procedures to reduce bias and allow greater generalization. " 01/01/2008 - "Studies of olanzapine indicated that it was approximately 70% to 76% effective in treating delirium at doses of 2.5 to 11.6 mg daily. " 11/01/2010 - "Oral olanzapine is effective in controlling agitation in patients with delirium, but often, parenteral administration is necessary. " 01/01/2006 - "Although olanzapine is useful in the treatment of delirium, elderly patients treated with this drug can develop delirium and hence should be closely monitored."
8.	ramelteon (Rozerem)FDA Link 12/01/2012 - "Marked improvement in delirium with ramelteon: five case reports." 03/01/2015 - "In this study, ramelteon was found to be beneficial in preventing delirium in medically ill individuals when compared to placebo. " 07/01/2011 - "These cases suggest that ramelteon may be beneficial in the treatment of delirium. " 04/01/2023 - "Seven major electronic databases were systematically searched to identify randomized controlled trials examining the efficacy of ramelteon in delirium prevention. " 01/01/2014 - "The aim of the present study was to determine the efficacy of ramelteon in elderly patients with delirium caused by different primary diseases/conditions. "
9.	Risperidone (Risperdal Consta)FDA LinkGeneric 05/01/2004 - "The present study showed that risperidone appears to be effective and safe for the treatment of delirium." 08/01/2012 - "In addition to changes in agitation and perceptional disturbances, risperidone was also effective for other specific delirium symptoms. " 08/01/2012 - "Risperidone with routine clinical management was effective for the treatment of delirium: 48% of the patients responded and 38% achieved remission. " 05/01/2004 - "The results showed that risperidone and haloperidone were both effective for treating hyperactive symptoms of delirium. " 03/01/2004 - "Low-dose risperidone proved to be a safe and effective drug in the treatment of symptoms of delirium in medically hospitalized patients. "
10.	Opioid Analgesics (Opioids)IBA 07/01/2008 - "Although our understanding of the pathogenesis of delirium has improved somewhat, there remains a compelling need to further elucidate the underlying pathophysiology, especially in relation to opioids and the other psychoactive medications that are used in supportive care. " 01/01/2023 - "While the risk of long-term dependence following the opioid treatment of musculoskeletal injury is often studied in younger populations, studies in older patients have centered on short-term risks such as oversedation and delirium. " 10/01/2022 - "Opioids are known to induce delirium, but few studies have closely investigated differences in incidence of delirium among different opioids. " 01/01/2021 - "This study suggests that incremental increases in intraoperative opioids combined with CKD increase odds of POD2 delirium after hip fracture repair, compared with patients without CKD." 01/01/2021 - "There are few studies demonstrating how kidney function affects the risk of developing delirium in older adult surgical patients administered opioids. "

Therapies and Procedures

1.	Length of Stay 07/01/2010 - "A structured QI model can be applied to implementation of early PM&R in the ICU resulting in markedly improved delirium status, delivery of PM&R, functional mobility, and length of stay." 04/01/2010 - "Using a quality improvement process, intensive care unit delirium, physical rehabilitation, and functional mobility were markedly improved and associated with decreased length of stay." 03/01/2022 - "The Eat Walk Engage program did not reduce the composite primary outcome of any HAC-OP or length of stay, but there was a significant reduction in the incidence of delirium. " 01/01/2020 - "Patients in the new wards had a significantly reduced incidence of delirium during hospital stay compared with patients in the old wards; hazard ratio 0.66 (95% CI 0.48-0.93, p < 0.02). " 09/15/2013 - "Patients with delirium in both cohorts demonstrated significantly greater comorbidities, length of stay, greater costs, and more frequent discharge to skilled nursing facilities (P < 0.001). "
2.	Therapeutics 01/01/2017 - "Combination therapy consisting of acupuncture and herbal medicine was found to be effective in lowering the incidence of delirium in patients with CV disease in ICUs. " 01/01/2015 - "In the absence of definitive pharmacologic therapy, interventions prioritizing maintenance of normal circadian, sleep, and behavioral patterns have shown promise in delirium risk reduction." 06/15/2010 - "We present a patient with clear manifestations of CSA with frank delirium that improved only after BPAP therapy." 06/01/2021 - "The objective of this study was to determine the local incidence of delirium and to characterize the effectiveness and safety of pharmacological therapy used to treat delirium. " 04/01/2021 - "Recent studies support nonpharmacological therapy, including cognitive stimulation, to address delirium. "
3.	Critical Care (Surgical Intensive Care) 02/01/2022 - "Interactive E-learning is effective in significantly improving critical care nurses' delirium recognition ability and reducing their strain of care. " 12/15/2021 - "Emerging evidence indicates that animal-assisted intervention improves the efficacy of critical care regarding primary symptoms and secondary factors of delirium." 01/01/2018 - "Study results highlight the need for improvement in delirium education for pediatric cardiac intensive care clinicians as well as the need for systematic evaluation of current delirium assessment and management practices." 04/01/2020 - "This information may be helpful in the development of clinical tools and may guide future quality improvement projects aimed at reducing delirium through sleep promotion in critical care patients. " 07/01/2014 - "Delirium prevention program in the surgical intensive care unit improved the outcomes of older adults."
4.	Artificial Respiration (Mechanical Ventilation) 11/01/2021 - "The management and monitoring of sedoanalgesia are important measures in improving the efficacy of procedures and mechanical ventilation, as well as reducing adverse effects and preventing withdrawal syndrome, and delirium in pediatric intensive care units (PICUs). " 01/01/2019 - "The objective of this systematic review was to identify effective and safe interventions to wean patients that are difficult-to-wean from mechanical ventilation due to delirium, agitation, or anxiety. " 08/16/2022 - "Progressive early rehabilitation training reduced the incidence of delirium and complications in ICU patients with mechanical ventilation, which improved prognosis and quality of life." 04/01/2022 - "This multicomponent intervention strategy has been associated with lower probabilities of delirium, improved functional outcomes and shorter duration of mechanical ventilation. " 09/01/2015 - "Health care organizations that implement the ABCDE bundle have improved patient outcomes such as decreased ICU and hospital lengths of stay, decreased duration of mechanical ventilation, decreased prevalence and duration of delirium, and decreased health care costs. "
5.	Analgesia 04/01/2020 - "Ultrasound-guided continuous thoracic paravertebral block improved analgesia, reduced the inflammatory reaction and decreased the occurrence of delirium after surgery." 11/01/2011 - "The implementation of regular assessment of sedation, analgesia, and delirium must be improved. " 09/11/2023 - "Enhancing European Management of Analgesia, Sedation, and Delirium: A Multinational, Prospective, Interventional Before-After Trial." 01/01/2023 - "Fourteen out of 149 studies were conducted in clinical settings who actively implemented some form of non-pharmacological delirium prevention bundles, most of them as part of ICU sedation-analgesia protocols. " 04/01/2022 - "Sedation, analgesia, and delirium management in Portugal: a survey and point prevalence study."