Mind Over Matter: Antipsychotics for Intensive Care Unit-Associated Delirium and Fluoxetine after Acute Stroke

Jonathan Gravel, family medicine resident at the University of Toronto, is joined by Matthew Jefkins, internal medicine resident at Queen’s University, on this week’s episode of The Rounds Table. Together they are covering the use of haloperidol and ziprasidone for delirium in critical illness and fluoxetine on functional outcomes after acute stroke (FOCUS trial).

Delirium affects 50 to 75% of patients who receive mechanical ventilation in the intensive care unit.  Patients with delirium have higher mortality, lengthier hospitalizations, and higher risk of long-term cognitive impairment and other psychiatric illnesses.  What is the evidence behind the use of antipsychotics in patients with delirium and critical illness?  Matt covers a study by the MIND-USA group on haloperidol and ziprasidone compared to placebo in patients with hypoactive or hyperactive delirium and acute respiratory failure or shock.  Researches studied whether or not these medications reduced the duration of intensive care unit-associated delirium.

Research has suggested that selective serotonin reuptake inhibitors (SSRIs) might improve overall outcomes after stroke.  Do the benefits on functional outcomes outweigh the risks in terms of systematically using SSRIs post-stroke?  Jon covers a trial on the effects of fluoxetine compared to placebo on functional outcomes after an acute stroke (FOCUS).

Next, the Good Stuff segment.  Matt tells listeners about an article on performance under pressure and Jon discusses whether medical editors are responsible if articles that they publish cause harm.

Like what you hear?  Rate us on iTunes!  Chat with us on Twitter at @roundstable and tweet at Jonathan Gravel @gravel_jon and Matthew Jefkins @m_jefkins.

Interested in helping us evaluate our podcast episodes? We’re currently recruiting a panel of residents to serve as regular reviewers for the show. If you’re interested, email wkwong@qmed.ca.

The Papers

1. ICU and Delirium: https://www.nejm.org/doi/full/10.1056/NEJMoa1808217

2. FOCUS: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32823-X/fulltext

Good Stuff

1. Performance under pressure: https://first10em.com/performance-under-pressure-mental-practice-and-how-to-use-first10em/

2. Medical editors: http://www.cmaj.ca/content/191/3/E89.long

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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