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Does Haldol Cause The Symptoms It Is Used To Treat?

by — 2015-07-23 in Drugs & Medications
In many intensive care units and nursing homes nurses have a "PRN" or "when necessary" order for Haldol, the antipsychotic medication also known as by its generic name haloperidol. Using too much Haldol, however, may cause as many problems as it treats.

Haldol, or its generic equivalent haloperidol, is a standard medication in many long-term care facilities. Often doctors prescribe Haldol PRN ("pro Re nata," or "as needed") for difficult patients who need ongoing care. More specifically, Haldol is used to treat delirium, which is associated with a variety of morbidities and mortalities, that is, delirium can foreshadow worsening condition or death.

What Is Delirium?

Delirium is a short-term, usually reversible, form of brain dysfunction. Sometimes delirium is mistaken for depression. Delirious patients may become sad and withdrawn. They express feelings of hopelessness. They may become suicidal.
 
 
In other situations, delirium causes grandiosity. Patients may believe they possess superpowers. Alternatively, patients may believe they are being persecuted. The nurse or the doctor or the hospital or some nefarious individual or organization is out to kill them. The condition may cause hallucinations, such as seeing puppies floating in the air, or delusions, such as the idea that an IV line is a snake sucking blood out of a vein.
 
The sleep cycle may be reversed, with sleepiness during the day and wakefulness at night. Usually there is also a problem with attention span, so delirious people do not cause harm to themselves or to others, but sometimes delirious patients attempt to elope from care, so that their beds and their bodies have to be fitted with alarms. There may be a bed alarm, which sounds a loud alarm when the patient gets out of bed, or a body alarm, which locks doors when the patient approaches.

Delirium Has Warning Signs

Usually delirium does not come on immediately upon admission to an intensive care unit or nursing home. There may be at first just an unusually large number of requests for assistance. The patient may report vivid dreams, or hallucinations that are recognized as hallucinations. Anxiety almost always accompanies delirium. There may also be increased blood pressure, heart rate, respiration, and urination, and difficulty with short-term memory and concentration.

Prevention of Delirium

Some very simple interventions can greatly reduce the risk of delirium. Patients who are in a room with others, with twenty-four hour noise and light and interruptions for vital signs and blood work, quickly wear out and become delirious. One study found that noise reduction with nothing more than ear plugs reduced the rate of delirium by 53 percent. Patients who are in private rooms are far less likely to develop delirium. Patients who are not awakened in the middle of the night for blood draws so the doctor can have lab results early in the morning are less likely to develop delirium.

READ Schizophrenia Symptoms: Beyond Hearing Voices In Your Head

Why is preventing delirium so important? A friend of mine recounts the story of his father's pulling out his IV lines, blood spurting all over the bed and the floor, when he became delirious. Patients in a state of delirium may become violent. They may make sexual overtures they would never make when psychologically well, and ruin relationships and their self-esteem for the rest of their lives. Delirious patients may pull stitches and damage vital organs after surgery, and some delirious patients die as the result of leaving their beds too soon. Rister also tells the story of a man in ICU who decided he would go out for a hamburger several hours after brain surgery, who fell in the floor and died.

Do Medications for Delirium Really Work?

Haldol is almost universally used to treat delirium in the United States, despite the fact that medical guidelines state that it should not be used for either prevention or treatment of the condition. In clinical research, some studies have found that Haldol works, others have found that other medications work better, still others have found that it has no effect at all, and one found that it makes delirium worse. Using an analysis technique known as marginal structural modeling, taking into account factors such as time in hospital and the administration of other medications, one research team has found that up to 9 percent of patients who are given Haldol become more delirious, not less, as a result of getting the drug.
 
 
To be sure, Haldol is not the greatest risk factor for delirium in standard medical care. Spending time on a mechanical ventilator is 500 percent more likely to result in delirium. Muscle relaxants in the benzodiazepine class (Librium, Ativan, and Valium, for example) are more likely to trigger delirium than Haldol. However, if there is a significant chance that a drug for delirium will actually make it worse, clearly some other treatments are needed.

What Are These Other Treatments?

  • Risperidone (Risperdal) is far less likely to cause muscle problems, and it is much safer for people who have Parkinson's disease or schizophrenia. It is also less likely to induce sugar cravings or to activate libido (need for sex).
  • The B vitamin folic acid is important in the management of delirium in far more cases than researchers used to think. There is a condition called Wernicke's aphasia that results from a deficiency of folic acid, usually accompanying alcoholism. However, the treatment for this problem, or possibly "subclinical" cases of folic acid deficiency in the brain is not to take more folic acid. That is because up to 20 percent of the population, depending on ancestry, lacks an enzyme that enables the brain to convert folic acid, the form of the vitamin in food, into methylfolate, the form of the vitamin brain cells need to use it to make energy. Supplementation with methylfolate makes the condition better, but supplementation with folic acid (or eating flour and cereals that North American companies fortify with folic acid) makes the condition worse.
  • Vitamin B12, also known as Cyanocobalamin, is also essential to normal brain function and the prevention of delirium and dementia. Older people can become deficient in this vitamin because their stomach don't produce enough acid to break down food to release it. Vitamin B12 shots, followed by a daily dose of supplemental vitamin B12, may be necessary to prevent subtle and obvious symptoms of dementia and delirium in the elderly, and in people who have had gastric bypass surgery.

READ The Key Differences Between Bipolar Disorder And Borderline Personality Disorder

If your family member or friend has delirium, one of the kindest things you can do is to keep him or her from embarrassment. Don't let them get into a situation in which they might make a sexual proposition to a visiting nun or priest, or walk around naked, or assault a nurse or healthcare worker. Plan for getting better, and minimize the memories that may cause distress when recovery has been achieved.

Sources & Links

  • Barr J, Pandharipande PP: The pain, agitation, and delirium care bundle: Synergistic benefits of implementing the 2013 Pain, Agitation, and Delirium Guidelines in an integrated and interdisciplinary fashion. Crit Care Med 2013. 41:S99–115.
  • Kiberd M, Hall R. Does Haloperidol Cause Delirium? Crit Care Med. 2015.43(5):1143-1144.
  • By LHcheM (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
  • By LHcheM (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
  • Photo courtesy of Gatanass via Flickr: www.flickr.com/photos/georgeatanassov/4195413671

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