Antipsychotic medication for prevention and treatment of delirium in hospitalized adults: a systematic review and meta-analysis
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Objectives: To evaluate the effectiveness of antipsychotic medications in preventing and treating delirium. Design: Systematic review and meta‐analysis. Setting: PubMed, EMBASE , CINAHL , and ClinicalTrials.gov databases were searched from January 1, 1988, to November 26, 2013. Participants: Adult surgical and medical inpatients. Intervention: Antipsychotic administration for delirium prevention or treatment in randomized controlled trials or cohort studies. Measurements: Two authors independently reviewed all citations, extracted relevant data, and assessed studies for potential bias. Heterogeneity was considered as chi‐square P < .1 or I 2 > 50%. Using a random‐effects model (I 2 > 50%) or a fixed‐effects model (I 2 < 50%), odds ratios ( OR s) were calculated for dichotomous outcomes (delirium incidence and mortality), and mean or standardized mean difference for continuous outcomes (delirium duration, severity, hospital and intensive care unit ( ICU ) length of stay ( LOS )). Sensitivity analyses included postoperative prevention studies only, exclusion of studies with high risk of bias, and typical versus atypical antipsychotics. Results: Screening of 10,877 eligible records identified 19 studies. In seven studies comparing antipsychotics with placebo or no treatment for delirium prevention after surgery, there was no significant effect on delirium incidence ( OR = 0.56, 95% confidence interval ( CI ) = 0.23–1.34, I 2 = 93%). Using data reported from all 19 studies, antipsychotic use was not associated with change in delirium duration, severity, or hospital or ICU LOS , with high heterogeneity among studies. No association with mortality was detected ( OR = 0.90, 95% CI = 0.62–1.29, I 2 = 0%). Conclusion: Current evidence does not support the use of antipsychotics for prevention or treatment of delirium. Additional methodologically rigorous studies using standardized outcome measures are needed.
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In the UK, detection rates have increased over the past 10 years.
“In the UK however, detection rates have increased over the past 10 years.281”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [281]
The Methods (Data Analysis; page unavailable) and Results (Mortality; page unavailable) address antipsychotic treatment outcomes, not UK delirium detection trends. Searches for UK detection rates and changes over a decade found no passage in our copy addressing the claim. (LLM, conf=0.75)
Experimental — accuracy not yet measuredWhile antipsychotics such as risperidone, haloperidol, ziprasidone and olanzapine are sometimes used to manage agitation or psychotic symptoms in delirium, there is a lack of strong evidence to support their use.
“While antipsychotics such as risperidone, haloperidol, ziprasidone and olanzapine are sometimes used to manage agitation or psychotic symptoms in delirium, there is a lack of strong evidence to support their use 194 .”
From Mental health care for older adults: recent advances and new directions in clinical practice and research (2022) · cites this paper as [194]
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- Authors
- Neufeld, K. J., Yue, J., Robinson, T. N., Inouye, S. K., & Needham, D. M.
- Affiliations
- Johns Hopkins University (US)
- Sichuan University (CN)
- University of Colorado Anschutz (US)
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Neufeld, Karin J.
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2016-03-23
- Volume
- 64
- Issue
- 4
- Pages
- 705-714
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC4840067
- OpenAlex
- W2310520207
- Cited by
- 505
- References
- 46
- Citations by year
- 2026: 29 · 2025: 39 · 2024: 58 · 2023: 52 · 2022: 41 · 2021: 42 · 2020: 59 · 2019: 65 · 2018: 56 · 2017: 49 · 2016: 15
- FWCI
- 9.64
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- John A. Hartford Foundation (2009–0079)
- National Institute on Aging (K07AG041835, P01AG031720)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Neurology › Alcoholism and Thiamine Deficiency
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Keywords
- antipsychotic drugs, delirium, delirium prevention, delirium management, hospitalized adults, surgical patients, medical inpatients, postoperative delirium, delirium duration, delirium severity, length of hospital stay, mortality, atypical antipsychotics, typical antipsychotics
- MeSH terms
- Adult, Delirium, Hospitalization, Humans, Antipsychotic Agents
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