GUIDA DA PONTE
Centro Hospitalar Barreiro-Montijo, Psychiatry and Mental Health, Barreiro, Barreiro, Portugal
Many guidelines suggest the use of antipsychotics as the treatment of delirium, being haloperidol as first line agent.
The problem of the management of delirium is that each type is different or the same case can have a completely different evolution. So, sometimes, haloperidol is ineffective and/or insufficient, obliging the physician to take the best decision considering the evidence-based and the patient itself.
With the novel antipsychotics, as olanzapine or quetiapine, we can gain a more sedative effect than with haloperidol, what appropriate in hyperactive delirium. But, a common problem is the hyperactive delirium that don´t respond to high doses of antipsychotics. Some guidelines suggest the addition of lorazepam and some studies demonstrated the efficacy of sodium valproate as augmentation or the use of phenobarbital. Another option is polypharmacology with antipsychotics. In the end, the procedure must take into account the specific disease of the patient and the choice of the less prejudicial drug.
Hypoactive delirium remains a difficult case of treatment without specific guidelines. Some studies suggest the absence of medication but others suggest the use of aripiprazole, antidepressants or stimulants.