Antipsychotic prescribing pattern for geriatric patients with delirium in Thailand

Abstract

Objective: To describe the antipsychotic prescribing pattern for the treatment of delirium among hospitalized elderly patients when compared to those younger adults referred to a psychiatric consultation-liaison service in Thailand Methods: All psychiatric consultations performed upon hospitalized patients at a university hospital in Bangkok, Thailand, during a one-year period were reviewed. We collected the data from consultation request forms and medical records. Results: Among all 840 patients referred for psychiatric consultation, 656 of them had complete medical records available. The consultant psychiatrists diagnosed 172 (26.2%) of them with delirium. After excluding 16 patients with substance-withdrawal delirium, data on antipsychotics prescription of 156 (23.8%) patients were analyzed. The mean age was 61.3+17.6 years old (22-95); 91 (61.9%) were 60 years old or more, and 103 (70.1%) were male. Antipsychotics were prescribed for 85.3% of all patients. Atypical antipsychotics were more commonly prescribed for the elderly (60 years or older) than for the young (51.6% vs 35.4%, p=0.038). Risperidone was the most frequently prescribed antipsychotic for elderly patients accounting for 44% of prescriptions. We found negative correlation between age of the patients and the dose of haloperidol; r=0.233, p=0.043. Conclusion: To our knowledge, this is the first study on current antipsychotics prescribing practice for the hospitalized elderly with delirium in a consultation-liaison service in Asia. Although the current evidence show no superiority for atypical antipsychotics over haloperidol, as well as limited evidence of their efficacy and safety in managing delirium, most doctors had the tendency to prescribe atypical antipsychotics for the hospitalized elderly patients with delirium. Further study is required to determine the optimal pharmacological therapies for delirium in the elderly. Copyright ©2010, Korean College of Neuropsychopharmacology.