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Impact of an educational workshop upon attitudes towards pharmacotherapy for delirium

Published online by Cambridge University Press:  07 April 2010

David J. Meagher
David J. Meagher*
Affiliation:
Department of Adult Psychiatry, Midwestern Regional Hospital, Limerick, and University of Limerick Medical School, Limerick, Ireland
*
Correspondence should be addressed to: Professor David Meagher, University of Limerick Medical School, Ireland. Phone: +353-61-315177. Email: [email protected].
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Abstract

Background: There is uncertainty regarding the optimal use of pharmacological strategies in delirium particularly regarding preferred agents, duration of treatment and effectiveness in different populations.

Methods: Attitudes towards delirium pharmacotherapy were investigated before and after an educational workshop using the format of a televison game show.

Results: Most respondents (65/66) reported psychotropic use with variable frequency (median 60%). Antipsychotic use was inversely related to perception of supporting evidence (p = 0.02). Respondents rated sedative (38%) and antipsychotic (33%) effects as the principal mechanism of action rather than a specific neurochemical anti-delirium effect (21%). Haloperidol was the preferred first-line agent (65%). Suggested continuation treatment after symptom resolution was three days. Eleven respondents had used psychotropics prophylactically. Antipsychotic use was influenced by concerns regarding potential for extrapyramidal (52%), sedative (32%), cerebrovascular (30%) and metabolic (8%) effects. Post-workshop concerns regarding extrapyramidal effects were reduced with a more positive general attitude towards pharmacological interventions, especially in hypoactive presentations (61%) and prophylactically in high-risk patients (56%).

Conclusions: Attitudes towards key aspects of delirium pharmacotherapy vary considerably and relate to concerns regarding side effect potential more than perceived mechanism of action. Educational interventions can impact positively upon attitudes.

Keywords

deliriumtreatmentpharmacotherapyeducationgames
Type
Special Issue Articles
Information
International Psychogeriatrics , Volume 22 , Special Issue 6: Focus on training in psychogeriatrics , September 2010 , pp. 938 - 946
Copyright
Copyright © International Psychogeriatric Association 2010

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References

Akl, E. A. et al. (2008). Educational games for health professionals. Cochrane Database of Systematic Reviews, 1. Art No.:CD006411. doi: 10.1002/14651858.CD006411.pub2.CrossRefGoogle Scholar
Alexopoulos, G. S. et al. (2004). Using antipsychotic agents in older patients. Journal of Clinical Psychiatry, 65 (Suppl. 2), 5–99.Google ScholarPubMed
American Psychiatric Association (1999). Practice guideline for the treatment of patients with delirium. American Journal of Psychiatry, 156 (Suppl.), 1–20.Google Scholar
Bhoopathi, P. S. and Sheoran, R. (2006). Educational games for mental health professionals. Cochrane Database of Systematic Reviews 2006, 2. doi: 10.1002/14651858.CD001471.pub2.CrossRefGoogle Scholar
Boettger, S., Alici-Evcimen, Y., Breitbart, W. and Passik, S. (2007a). An open label trial of aripiprazole I the treatment of delirium. Proceedings of the Academy of Psychosomatic Medicine, 54th Annual Meeting, Academy of Psychosomatic Medicine.Google Scholar
Boettger, S., Alici-Evcimen, Y., Breitbart, W. and Passik, S. (2007b). Risperidone in the treatment of hypoactive and hyperactive delirium. Proceedings of the Academy of Psychosomatic Medicine, 54th Annual Meeting, Academy of Psychosomatic Medicine.Google Scholar
Breitbart, W. et al. (1996) A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. American Journal of Psychiatry, 153, 231–237.Google ScholarPubMed
Breitbart, W., Tremblay, A. and Gibson, C. (2002). An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients. Psychosomatics, 43, 175–182.CrossRefGoogle ScholarPubMed
Briskman, I., Dubinski, R. and Barak, Y. (2009). Treating delirium in a general hospital: a descriptive study of prescribing patterns and outcomes. International Psychogeriatrics, 29, 1–4.Google Scholar
British Geriatrics Society and Royal College of Physicians (2006) Guidelines for the Prevention, Diagnosis, and Management of Delirium in Older People. London: Royal College of Physicians of LondonGoogle Scholar
Burke, C. T. (2001). The influences of teaching strategies and reinforcement techniques on health care workers’ learning and retention. Unpublished dissertation, University of Southern Mississippi.Google Scholar
D'Alessandro, D. M., Ellsbury, D. L., Kreiter, C. D. and Starner, T. (2002). Pediatric jeopardy may increase residents’ medical reading. Ambulatory Pediatrics, 2, 1–3.2.0.CO;2>CrossRefGoogle ScholarPubMed
Fick, D. M., Kolanowski, A. M., Waller, J. L. and Inouye, S. K. (2005). Delirium superimposed on dementia in a community-dwelling managed care population: a three-year retrospective study of occurrence, costs and utilization. Journal of Gerontology and Medical Sciences, 60A, 748–753.CrossRefGoogle Scholar
Gamberini, M. et al. (2009). Rivastigmine for the prevention of postoperative delirium in elderly patients undergoing elective cardiac surgery–a randomized controlled trial. Critical Care Medicine, 37, 1762–1768.CrossRefGoogle ScholarPubMed
Gaudreau, J. D. et al. (2005). Psychoactive medications and risk of delirium in hospitalized cancer patients. Journal of Clinical Oncology, 23, 6712–6718.CrossRefGoogle ScholarPubMed
Hally, O., and Cooney, C. (2005). Delirium in the hospitalized elderly: an audit of NCHD prescribing practice. Irish Journal of Psychological Medicine, 22, 133–136.CrossRefGoogle ScholarPubMed
Horizon Report (2006). Edition. http//www.nmc.org/pdf/2006_Horizon_Report.pdf 2006.Google Scholar
Howell, K. (2005). Games for Health Conference 2004: issues, trends, and needs unique to games for health. Cyberpsychology and Behavior, 8, 103–109.CrossRefGoogle ScholarPubMed
Hu, H. et al. (2006). Olanzapine and haloperidol for senile delirium: a randomised controlled observation. Chinese Journal of Clinical Rehabilitation, 10, 188–190.Google Scholar
Kalisvaart, K. J. et al. (2005). Haloperidol prophylaxis for elderly hip surgery patients at risk for delirium: a randomized, placebo-controlled study. Journal of the American Geriatrics Society, 53, 1658–1666.CrossRefGoogle ScholarPubMed
Larsen, K., Kelly, S. and Stern, T. (2007). A double-blind, randomized, placebo-controlled study of perioperative administration of olanzapine to prevent postoperative delirium in joint replacement patients. Proceedings of the Academy of Psychosomatic Medicine, 54th Annual Meeting, Academy of Psychosomatic Medicine.Google Scholar
Liptzin, B., Laki, A., Garb, J. L., Fingeroth, R. and Krushell, R. (2005). Donepezil in the prevention and treatment of post-surgical delirium. American Journal of Geriatric Psychiatry, 13, 1100–1106.CrossRefGoogle ScholarPubMed
Lonergan, E., Luxenberg, J. and Areosa Sastre, A. (2009). Benzodiazepines for delirium. Cochrane Systematic Review, 4, CD006379.Google Scholar
MacLullich, A. M., Meagher, D. J., Laurila, J. V. and Kalisvaart, K. J. (2007). The European Delirium Association. Journal of Psychosomatic Research, 62, 397–398.CrossRefGoogle ScholarPubMed
Meagher, D. (2009). More attention, less confusion: time to lessen the burden of delirium. International Review of Psychiatry, 21, 1–3.CrossRefGoogle ScholarPubMed
Meagher, D. and Leonard, M. (2008). The active management of delirium: improving detection and treatment. Advances in Psychiatric Treatments, 14, 292–301.CrossRefGoogle Scholar
Meagher, D., O'Hanlon, D., O'Mahony, E. and Casey, P. (1996). The use of environmental strategies and psychotropic medications in the management of delirium. British Journal of Psychiatry, 168, 512–515.CrossRefGoogle ScholarPubMed
National Institute for Health and Clinical Excellence (2009). Delirium: Diagnosis, Prevention and Management – Draft for Consultation, November 2009. Available at: http://www.nice.org.uk/nicemedia/pdf/DeliriumDraftFullGuideline061109.pdf.Google Scholar
Ogershok, P. R. and Cottrell, S. (2004). The Pediatric Board Game. Medical Teacher, 26, 514–517.CrossRefGoogle ScholarPubMed
Pandharipande, P. et al. (2006). Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology, 104, 21–26.CrossRefGoogle ScholarPubMed
Patel, J. (2008). Using game format in small group classes for pharmacotherapeutics case studies. American Journal of Pharmaceutical Education, 72, 21.CrossRefGoogle ScholarPubMed
Platt, M. M. et al. (1994). Efficacy of neuroleptics for hypoactive delirium. Journal of Neuropsychiatry and Clinical Neuroscience, 6, 66–67.Google ScholarPubMed
Prakanrattana, U. and Prapaitrakool, S. (2007). Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery. Anaesthesia and Intensive Care, 5, 714–719.CrossRefGoogle Scholar
Rockwood, K. et al. (1994). Increasing the recognition of delirium in elderly patients. Journal of the American Geriatrics Society, 42, 252–256.CrossRefGoogle ScholarPubMed
Ryan, K., Leonard, M., Guerin, S., Donnelly, S., Conroy, M. and Meagher, D. (2009). Validation of the confusion assessment method in the palliative care setting. Palliative Medicine, 23, 40–45.CrossRefGoogle ScholarPubMed
Sampson, E. L. et al. (2006). A randomized, double-blind, placebo-controlled trial of donepezil hydrochloride (Aricept) for reducing the incidence of postoperative delirium after elective total hip replacement. International Journal of Geriatric Psychiatry, 22, 343–349.CrossRefGoogle Scholar
Siddiqi, N., House, A. O. and Holmes, J. D. (2006). Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age and Ageing, 35, 350–364.CrossRefGoogle ScholarPubMed
Thomson-O'Brien, M. A. et al. (2002). Interactive continuing education workshops or conferences can improve professional practice and patient outcomes. Evidence Based Nursing, 5, 26.Google Scholar
Tropea, J., Slee, J., Holmes, A. C., Gorelik, A. and Brand, C. A. (2008). Use of antipsychotic medications for the management of delirium: an audit of current practice in the acute care setting. International Psychogeriatrics, 21, 172–179.CrossRefGoogle ScholarPubMed
Trzepacz, P. T. (2000). Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Seminars in Clinical Neuropsychiatry, 5,132–148.Google Scholar
van der Cammen, T. J. M., Tiemeier, H., Engelhart, M. J. and Fekkes, D. (2006). Abnormal neurotransmitter metabolite levels in Alzheimer patients with a delirium. International Journal of Geriatric Psychiatry, 21, 838–843.CrossRefGoogle ScholarPubMed
Zisook, S. et al. (2005). Alternate methods of teaching psychopharmacology. Academic Psychiatry, 29, 141–154.CrossRefGoogle ScholarPubMed