Antipsikotik ile Deliryum Profilaksisi – Metaanaliz

Deliryumun perioperatif antipsikotik uygulaması ile önlenebileceğini öne süren çalışmaların bir metanalizi :

Prophylaxis with antipsychotic medication reduces the risk of post-operative delirium in elderly patients: a meta-analysis.

Polina Teslyar, MD, Veronika Stock, MD, Christopher M. Wilk, MD, Ulas Camsari, MD1

1Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland

Context: Delirium is a common occurrence in hospitalized elderly patients and can result in increased morbidity and mortality, prolonged hospitalization, and a net increase in health care costs. Although there is a considerable evidence available for the treatment of delirium, the evidence supporting pharmacologic prevention of delirium in a high risk patient population is limited.

Objective: This review aims to determine whether delirium in at risk patients can be prevented with antipsychotic prophylaxis in the inpatient setting.

Data Sources : A systematic literature review of articles from January 1950 to November 2011 was conducted in Pubmed and PsychInfo databases.

Study Selection: Four studies met our inclusion criteria for analysis. Medication administered included haloperidol (2 studies), risperidone (1 study), and olanzapine (1 study). All four studies examined elderly surgical patients (2 orthopedic, 1 cardiac, 1 gastrointestinal), spanning four different countries (USA, Japan, Netherlands, Thailand).

Data Extraction: Only randomized controlled trials of typical or atypical antipsychotic medication used to prevent the onset of delirium were included for analysis. Key words used in the search were: “delirium”, “encephalopathy”, “ICU psychosis”, “prevention”, and “prophylaxis”. Studies had to include a validated  method of assessing for delirium. Data analysis was performed using the metan command in STATA (StataCorp LP, College Station, Texas).

Results: Three of four studies showed a significant decrease in the relative risk of delirium. The overall treatment effect size was 0.528 (0.411- 0.679) suggesting a significant protective effect of antipsychotic prophylaxis.

Conclusions: Although there are few studies in the literature that have examined the impact of the prophylactic use of antipsychotic medications, this analysis suggests that either pre or peri-operative use of prophylactic antipsychotics may be an effective strategy to reduce the overall risk of post-operative delirium in high risk elderly patients.



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