Abstract：
BACKGROUND: Antipsychotics are commonly used to treat delirium but can adversely affect the extrapyramidal and cardiac conduction systems. Antipsychotic use has also been reported to be associated with increased mortality in older adults. Therefore, alternative and adjunct medications for delirium are necessary. We retrospectively assessed the efficacy and safety of gabapentin (GBP) as an alternative and adjunct medication for delirium.
METHODS: We retrospectively investigated the records of patients with delirium treated with GBP (71 patients; median age, 81 years; interquartile range, 76-87.5 years; 54.9% males) at a general hospital. We examined duration to delirium improvement, as assessed by the Intensive Care Delirium Screening Checklist (ICDSC) and DSM-5 criteria, as well as adverse events.
RESULTS: The median (interquartile range) GBP dose was 200 mg (150-350 mg) /day. A total of 71.8% and 85.9% of the patients failed to meet the diagnostic criteria for delirium at 2 days and 5 days after initial administration, respectively (p<0.05). In subgroup analysis, patients with a history of epilepsy or cerebrovascular disease responded better to GBP than did those without such histories, suggesting that patients with abnormal/borderline neuronal activity respond to GBP even though they do not exhibit seizures. GBP did not induce extrapyramidal symptoms, cardiac conduction disturbances, hyperglycemia, or epilepsy but caused sleepiness and myoclonus.
CONCLUSIONS: GBP may improve delirium with fewer adverse effects and may be a safe alternative or adjunct treatment for delirium. Dosage adjustment may be necessary to prevent sleepiness.
METHODS: We retrospectively investigated the records of patients with delirium treated with GBP (71 patients; median age, 81 years; interquartile range, 76-87.5 years; 54.9% males) at a general hospital. We examined duration to delirium improvement, as assessed by the Intensive Care Delirium Screening Checklist (ICDSC) and DSM-5 criteria, as well as adverse events.
RESULTS: The median (interquartile range) GBP dose was 200 mg (150-350 mg) /day. A total of 71.8% and 85.9% of the patients failed to meet the diagnostic criteria for delirium at 2 days and 5 days after initial administration, respectively (p<0.05). In subgroup analysis, patients with a history of epilepsy or cerebrovascular disease responded better to GBP than did those without such histories, suggesting that patients with abnormal/borderline neuronal activity respond to GBP even though they do not exhibit seizures. GBP did not induce extrapyramidal symptoms, cardiac conduction disturbances, hyperglycemia, or epilepsy but caused sleepiness and myoclonus.
CONCLUSIONS: GBP may improve delirium with fewer adverse effects and may be a safe alternative or adjunct treatment for delirium. Dosage adjustment may be necessary to prevent sleepiness.
摘要：
背景：抗精神病药通常用于治疗谵妄，但会对锥体外系和心脏传导系统产生不利影响。据报道，抗精神病药的使用也与老年人死亡率增加有关。因此,替代和辅助药物治疗谵妄是必要的。我们回顾性评估了加巴喷丁（GBP）作为谵妄的替代和辅助药物的疗效和安全性。
方法：我们回顾性调查了接受GBP治疗的谵妄患者的记录（71例；中位年龄，81年；四分位数范围，76-87.5岁；男性占54.9%）在综合医院。我们检查了谵妄改善的持续时间，根据重症监护谵妄筛查清单（ICSC）和DSM-5标准评估，以及不良事件。
结果：GBP剂量的中位数（四分位距）为200mg（150-350mg）/天。分别有71.8%和85.9%的患者在初次给药后2天和5天未能达到谵妄的诊断标准,分别为(p<0.05)。在亚组分析中，有癫痫或脑血管疾病病史的患者对GBP的反应比没有癫痫或脑血管疾病病史的患者好。提示具有异常/临界神经元活动的患者对GBP有反应,即使他们没有表现出癫痫发作.GBP没有诱发锥体外系症状，心脏传导紊乱,高血糖症,或癫痫，但引起嗜睡和肌阵挛症。
结论：GBP可以改善谵妄，不良反应较少，可能是谵妄的安全替代或辅助治疗。可能需要调整剂量以防止嗜睡。
方法：我们回顾性调查了接受GBP治疗的谵妄患者的记录（71例；中位年龄，81年；四分位数范围，76-87.5岁；男性占54.9%）在综合医院。我们检查了谵妄改善的持续时间，根据重症监护谵妄筛查清单（ICSC）和DSM-5标准评估，以及不良事件。
结果：GBP剂量的中位数（四分位距）为200mg（150-350mg）/天。分别有71.8%和85.9%的患者在初次给药后2天和5天未能达到谵妄的诊断标准,分别为(p<0.05)。在亚组分析中，有癫痫或脑血管疾病病史的患者对GBP的反应比没有癫痫或脑血管疾病病史的患者好。提示具有异常/临界神经元活动的患者对GBP有反应,即使他们没有表现出癫痫发作.GBP没有诱发锥体外系症状，心脏传导紊乱,高血糖症,或癫痫，但引起嗜睡和肌阵挛症。
结论：GBP可以改善谵妄，不良反应较少，可能是谵妄的安全替代或辅助治疗。可能需要调整剂量以防止嗜睡。
