[A new approach to the treatment of delirium: atypical antipsychotics]

Delirium is a common neuropsychiatric syndrome that involves a number of symptoms including diffuse cognitive impairment, delusions, hallucinations, mood lability and disturbances in the sleep-wake cycle. It occurs in 10-30% of hospitalized medically ill patients. Delirium is also associated with a prolonged hospital stay and increased functional decline and morbidity and mortality rates, particularly if it is unrecognized and untreated. Management of the symptoms of delirium involves non-pharmacological and pharmacological interventions. Until recently, typical antipsychotics and benzodiazepines were commonly used in the pharmacological treatment of delirium. The extrapyramidal and anticholinergic side effects of typical antipsychotics and the negative effects of benzodiazepines on cognitive functions limit their use in delirium patients, who are generally old and who have other medical problems. Atypical antipsychotics have been shown to be effective in the treatment of psychotic symptoms. Although there are a number of studies showing their efficacy, most studies have some limitations such as small sample size and absence of control groups. Upon reviewing the studies of the treatment of delirium with atypical antipsychotics, it has been observed that the efficacy and safety of risperidone and olanzapine were shown in randomized trials, and the efficacy and safety of quetiapine were shown in case reports and retrospective studies, and it was shown that the side effect over the QT interval limits the use of ziprasidone in delirium treatment. Suggestions were made in the light of the literature on the use of atypical antipsychotics in the treatment of delirium.