First- and second-line pharmacological treatment for delirium in general hospital setting-Retrospective analysis.

Aim: We examined the first- and second-line pharmacological treatment for delirium to determine which drugs were chosen, how and when second-line drugs were started, and the effectiveness and tolerability of those treatments.

Methods: A retrospective medical chart review was performed for delirium inpatients referred to the Department of Psychiatry, Hiroshima Citizens Hospital, from October 2011 to September 2012. Clinical diagnoses were based on ICD-10. We compared the baseline severity of delirium, duration needed for improvement, and rescue with antipsychotics between subjects given only first-line drugs and those switched to second-line drugs.

Results: We studied 194 consecutive patients including 127 men and 67 women whose average age was 76.5±9.8years. For first-line drugs, trazodone was most frequently prescribed (n=100, 51.5%), followed by quetiapine (n=57, 29.4%). Among patients treated with trazodone or quetiapine as first line treatment, 59 of 100 (59%) continued trazodone and 52 of 57 (91.2%) continued quetiapine. Duration needed for improvement did not differ significantly between patients treated with trazodone as a first line drug and those with quetiapine as same.

Conclusion: Trazodone can be a candidate drug as one of the first line drugs for delirium.