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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 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.
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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.
- 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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