Video

Brief Oral Papers

Session: Oral Presentation Session 08: Neurocognitive Disorders, Delirium and Neuropsychiatry

A Retrospective Study of The Use of Clonidine in the Management of Delirium

Friday, November 11, 2022

2:15 PM – 3:45 PM

Location: Room 204-205

Presenting Author(s)

Aniruddha Deka, MD

Consultation-Liaison Psychiatry Fellow
Yale School of Medicine
Chicago, Illinois

PDF

Co-Author(s)

James Naughton, MD

Resident Physician
Rush University Medical Center
Chicago, Illinois
TJ

Taymaz Joneydian, MD

Resident Physician
Rush University Hospital
Chicago, Illinois
AS

Andrew Schiller, DO

Psychiatry Resident
Rush University
Chicago, Illinois
Charles Hebert, MD

Chief, Section of Psychiatry and Medicine; Director, Psychiatric Consultation Service
Rush University Medical Center
Chicago, Illinois

Abstract:

Background: Delirium occurs in about 20% of hospitalized patients and up to 87% of patients in intensive care units (ICU). Although there are no definitive pharmacological treatments for delirium, antipsychotics, mood stabilizers and benzodiazepines are often used to manage delirium-associated behavioral disturbances. They carry risks, including increased all-cause mortality in the elderly, anticholinergic toxicity, and extrapyramidal symptoms. Better alternatives are needed. Dexmedetomidine, an alpha-2 agonist, is emerging as a preferred agent in the ICU to address delirium-associated agitation (Ng, 2019). Another alpha-2 agonist, clonidine, has been anecdotally used in delirium, however, there is a paucity of data available. One recent randomized controlled trial was inconclusive (Hov, 2019). In light of this, it behooves us to re-examine older, economical alpha-agonists such as clonidine. We are conducting this retrospective study to evaluate the efficacy of clonidine in delirium and associated agitation.

Methods: We retrospectively screened and identified 30 patients diagnosed with delirium who received clonidine for ≥48 hours. Patients were excluded if they were < 18 years of age, clonidine was used for reasons other than delirium or agitation, or they were already on clonidine before hospitalization. Primary outcomes include improvement in delirium-severity measured as change in retrospectively-assigned Clinical Global Index-Severity scores (Lally, 2021) (inter-rater reliability will be maintained), change in frequency of additional pro-re-nata medications for agitation, and times to step-down from ICU and to discharge after starting clonidine. Secondary outcomes include changes in daily chlorpromazine-, lorazepam- and morphine-equivalents used, frequency of hypotension/bradycardia, and clonidine doses. We collected data regarding demographics, other psychotropics, adverse events, reasons for admission, psychiatric and medical comorbidities, concurrent substance use/withdrawal, recent intubation and/or dexmedetomidine use. We will use two-sample t-tests, ANOVA repeated measures, Friedman, Kruskal-Wallis and Wilcoxon Rank Sum tests as appropriate. Institutional Review Board exemption was procured.

Results: We are currently in the data analysis phase. We will present data on the identified outcomes and any other moderating factors that become apparent and statistically significant. We anticipate completing the analysis by June 2022.

Discussion: In this retrospective review, we will analyze the utility of clonidine in delirium and agitation. Once data is analyzed, we will discuss our findings.

Implications: This study will help define the role of clonidine in the management of delirium.

References:

Ng, K. T., C. J. Shubash, and J. S. Chong. "The effect of dexmedetomidine on delirium and agitation in patients in intensive care: systematic review and meta‐analysis with trial sequential analysis." Anaesthesia 74.3 (2019): 380-392.

Hov, Karen R., et al. "The Oslo Study of Clonidine in Elderly Patients with Delirium; LUCID: a randomised placebo‐controlled trial." International Journal of Geriatric Psychiatry 34.7 (2019): 974-981.

Lally, John, et al. "Augmentation of clozapine with ECT: a retrospective case analysis." Acta neuropsychiatrica 33.1 (2021): 31-36.