Delirium is a symptom of an underlying injury or mental condition characterized by changes to perception, confusion, and inability to pay attention. Elderly people are more likely to experience delirium, and cognitive impairments likewise increase the odds of developing the condition. Because it is such a common condition in elderly people, doctors sometimes have difficulty distinguishing delirium from dementia. In general, delirium represents a fluctuating state of consciousness while dementia is relatively stable. Making the distinction between the two is crucial to delivering appropriate treatment. In hospital settings, the presence of delirium predicts a higher than average mortality rate. The mortality rate for patients experiencing delirium is more than 10%. That number is even higher among elderly patients and those with severe health conditions.
Treatment of delirium usually includes the use of a typical or atypical antipsychotic medication. These medications, normally reserved for use in schizophrenia and psychotic disorders, work by reducing the activity of certain chemicals in the brain. The typical antipsychotics were developed in the 1950s and 1960s and have demonstrated their effectiveness in treating delirium. Haldol (haloperidol) remains the most commonly used typical antipsychotic for delirium, but at least one study has suggested that Navane (thiothixene) is equally effective. Other studies have shown little difference between typical and atypical antipsychotics in terms of how well they manage delirium in seriously ill patients. However, medications like Navane can have adverse effects that argue against their use. For one thing, all typical antipsychotics carry the risk of movement disorders. These include twitches, tics, and spasms that can interfere with normal functioning. Typical antipsychotics can also cause heart rhythm abnormalities in some people. For all of these reasons, Navane and the other typical antipsychotics may not be the best choice for treating delirium, especially in the gravely ill or elderly.
Research is ongoing into whether the so-called atypical antipsychotics might offer a safer and equally reliable alternative to Haldol, Navane, and similar medications. Clinical trials suggest that atypical antipsychotics offer equal effectiveness and greater safety margins. These medications cause neither movement disorders nor heart problems. However, some patients do not tolerate these medications well. As more information is gathered, attending physicians will be able to make informed decisions about how to treat individual cases of delirium as safely as possible.
References
- Markowitz, J. D., Narasimhan, M. (2008). Delirium and antipsychotics: a systematic review of epidemiology and somatic treatment options. Psychiatry, 5(10), 29-36.
- PubMed Health. (n.d.). National Center for Biotechnology Information. Thiothixene. Retrieved May 2, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000797/
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