0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Reviews and Overviews   |    
Pharmacological Treatments of Non-Substance-Withdrawal Delirium: A Systematic Review of Prospective Trials
Joseph I. Friedman, M.D.; Laili Soleimani, M.D.; Daniel P. McGonigle, M.D.; Claudine Egol, M.D.; Jeffrey H. Silverstein, M.D.
Am J Psychiatry 2014;171:151-159. doi:10.1176/appi.ajp.2013.13040458
View Author and Article Information

Dr. Silverstein reports receiving support from the National Institute on Aging for an ongoing clinical trial of dexmedetomidine for the prevention of delirium and postoperative cognitive dysfunction; Hospira provides dexmedetomidine for that study free of charge but has no control over the results; Covidean provides processed EEG monitors (BIS) and CasMed provides cerebral oximetry monitors (foreSight) for the study, but neither has any control over the results. The other authors report no financial relationships with commercial interests.

From the Department of Psychiatry, the Department of Anesthesiology, the Department of Geriatrics, and the Department of Surgery, Icahn School of Medicine at Mount Sinai, New York; and the Clinical Neuroscience Center, Pilgrim Psychiatric Center, West Brentwood, N.Y.

Address correspondence to Dr. Friedman (jfriedman1@rcn.com).

Copyright © 2014 by the American Psychiatric Association

Received April 05, 2013; Revised August 21, 2013; Accepted October 07, 2013.

Abstract

Objective  Most reviews of pharmacological strategies for delirium treatment evaluate the effectiveness of these interventions for delirium prevention, reduction in duration and severity of ongoing delirium, and other outcomes that extend beyond the recommendations of expert treatment guidelines. However, little if any attention is given to substantiating the potential benefits of such treatment or addressing the methodological weaknesses that, in part, limit the pharmacological recommendations made by expert treatment guidelines. Therefore, the authors conducted a systematic review to provide the most up-to-date and inclusive review of published prospective trials of potential pharmacological interventions for the prevention and treatment of delirium, and they discuss potential benefits of pharmacological prevention of delirium and/or reduction of ongoing delirium episode duration and severity.

Method  The analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including prospective randomized and nonrandomized double-blind, single-blind, and open-label clinical trials of any pharmacological agent for the prevention or treatment of delirium and reviewing them systematically for effectiveness on several predefined outcomes.

Results  The pharmacological strategies reviewed showed greater success in preventing delirium than in treating it. Significant delirium prevention effects are associated with haloperidol, second-generation antipsychotics, iliac fascia block, gabapentin, melatonin, lower levels of intraoperative propofol sedation, and a single dose of ketamine during anesthetic induction and with dexmedetomidine compared with other sedation strategies for mechanically ventilated patients.

Conclusions  These promising results warrant further study with consideration of the methodological weaknesses and inconsistencies of studies to date.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

+

References

Inouye  SK;  Viscoli  CM;  Horwitz  RI;  Hurst  LD;  Tinetti  ME:  A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics.  Ann Intern Med 1993; 119:474–481
[CrossRef] | [PubMed]
 
Inouye  SK;  Charpentier  PA:  Precipitating factors for delirium in hospitalized elderly persons: predictive model and interrelationship with baseline vulnerability.  JAMA 1996; 275:852–857
[CrossRef] | [PubMed]
 
Inouye  SK;  Bogardus  ST  Jr;  Charpentier  PA;  Leo-Summers  L;  Acampora  D;  Holford  TR;  Cooney  LM  Jr:  A multicomponent intervention to prevent delirium in hospitalized older patients.  N Engl J Med 1999; 340:669–676
[CrossRef] | [PubMed]
 
Liberati  A;  Altman  DG;  Tetzlaff  J;  Mulrow  C;  Gøtzsche  PC;  Ioannidis  JP;  Clarke  M;  Devereaux  PJ;  Kleijnen  J;  Moher  D:  The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.  BMJ 2009; 339:b2700
[CrossRef] | [PubMed]
 
Wang  W;  Li  HL;  Wang  DX;  Zhu  X;  Li  SL;  Yao  GQ;  Chen  KS;  Gu  XE;  Zhu  SN:  Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial.  Crit Care Med 2012; 40:731–739
[CrossRef] | [PubMed]
 
Kaneko  T;  Cai  J;  Ishikura  KT;  Cai  J;  Ishikura  T;  Kobayashi  M:  Prophylactic consecutive administration of haloperidol can reduce the occurrence of postoperative delirium in gastrointestinal surgery.  Yonago Acta Med 1999; 42:179–184
 
Kalisvaart  KJ;  de Jonghe  JF;  Bogaards  MJ;  Vreeswijk  R;  Egberts  TC;  Burger  BJ;  Eikelenboom  P;  van Gool  WA:  Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study.  J Am Geriatr Soc 2005; 53:1658–1666
[CrossRef] | [PubMed]
 
Prakanrattana  U;  Prapaitrakool  S:  Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery.  Anaesth Intensive Care 2007; 35:714–719
[PubMed]
 
Hakim  SM;  Othman  AI;  Naoum  DO:  Early treatment with risperidone for subsyndromal delirium after on-pump cardiac surgery in the elderly: a randomized trial.  Anesthesiology 2012; 116:987–997
[CrossRef] | [PubMed]
 
Larsen  KA;  Kelly  SE;  Stern  TA;  Bode  RH  Jr;  Price  LL;  Hunter  DJ;  Gulczynski  D;  Bierbaum  BE;  Sweeney  GA;  Hoikala  KA;  Cotter  JJ;  Potter  AW:  Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial.  Psychosomatics 2010; 51:409–418
[PubMed]
 
Liptzin  B;  Laki  A;  Garb  JL;  Fingeroth  R;  Krushell  R:  Donepezil in the prevention and treatment of post-surgical delirium.  Am J Geriatr Psychiatry 2005; 13:1100–1106
[PubMed]
 
Sampson  EL;  Raven  PR;  Ndhlovu  PN;  Vallance  A;  Garlick  N;  Watts  J;  Blanchard  MR;  Bruce  A;  Blizard  R;  Ritchie  CW:  A randomized, double-blind, placebo-controlled trial of donepezil hydrochloride (Aricept) for reducing the incidence of postoperative delirium after elective total hip replacement.  Int J Geriatr Psychiatry 2007; 22:343–349
[CrossRef] | [PubMed]
 
Marcantonio  ER;  Palihnich  K;  Appleton  P;  Davis  RB:  Pilot randomized trial of donepezil hydrochloride for delirium after hip fracture.  J Am Geriatr Soc 2011; 59(suppl 2):S282–S288
[CrossRef] | [PubMed]
 
Zaslavsky  A;  Haile  M;  Kline  R;  Iospa  A;  Frempong-Boadu  A;  Bekker  A:  Rivastigmine in the treatment of postoperative delirium: a pilot clinical trial.  Int J Geriatr Psychiatry 2012; 27:986–988
[CrossRef] | [PubMed]
 
Gamberini  M;  Bolliger  D;  Lurati Buse  GA;  Burkhart  CS;  Grapow  M;  Gagneux  A;  Filipovic  M;  Seeberger  MD;  Pargger  H;  Siegemund  M;  Carrel  T;  Seiler  WO;  Berres  M;  Strebel  SP;  Monsch  AU;  Steiner  LA:  Rivastigmine for the prevention of postoperative delirium in elderly patients undergoing elective cardiac surgery—a randomized controlled trial.  Crit Care Med 2009; 37:1762–1768
[CrossRef] | [PubMed]
 
Berggren  D;  Gustafson  Y;  Eriksson  B;  Bucht  G;  Hansson  LI;  Reiz  S;  Winblad  B:  Postoperative confusion after anesthesia in elderly patients with femoral neck fractures.  Anesth Analg 1987; 66:497–504
[PubMed]
 
Papaioannou  A;  Fraidakis  O;  Michaloudis  D;  Balalis  C;  Askitopoulou  H:  The impact of the type of anaesthesia on cognitive status and delirium during the first postoperative days in elderly patients.  Eur J Anaesthesiol 2005; 22:492–499
[CrossRef] | [PubMed]
 
Beaussier  M;  Weickmans  H;  Parc  Y;  Delpierre  E;  Camus  Y;  Funck-Brentano  C;  Schiffer  E;  Delva  E;  Lienhart  A:  Postoperative analgesia and recovery course after major colorectal surgery in elderly patients: a randomized comparison between intrathecal morphine and intravenous PCA morphine.  Reg Anesth Pain Med 2006; 31:531–538
[PubMed]
 
Mouzopoulos  G;  Vasiliadis  G;  Lasanianos  N;  Nikolaras  G;  Morakis  E;  Kaminaris  M:  Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study.  J Orthop Traumatol 2009; 10:127–133
[CrossRef] | [PubMed]
 
Leung  JM;  Sands  LP;  Rico  M;  Petersen  KL;  Rowbotham  MC;  Dahl  JB;  Ames  C;  Chou  D;  Weinstein  P:  Pilot clinical trial of gabapentin to decrease postoperative delirium in older patients.  Neurology 2006; 67:1251–1253
[CrossRef] | [PubMed]
 
Riker  RR;  Shehabi  Y;  Bokesch  PM;  Ceraso  D;  Wisemandle  W;  Koura  F;  Whitten  P;  Margolis  BD;  Byrne  DW;  Ely  EW;  Rocha  MG; SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) Study Group:  Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial.  JAMA 2009; 301:489–499
[CrossRef] | [PubMed]
 
Maldonado  JR;  Wysong  A;  van der Starre  PJ;  Block  T;  Miller  C;  Reitz  BA:  Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery.  Psychosomatics 2009; 50:206–217
[CrossRef] | [PubMed]
 
Pandharipande  PP;  Pun  BT;  Herr  DL;  Maze  M;  Girard  TD;  Miller  RR;  Shintani  AK;  Thompson  JL;  Jackson  JC;  Deppen  SA;  Stiles  RA;  Dittus  RS;  Bernard  GR;  Ely  EW:  Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial.  JAMA 2007; 298:2644–2653
[CrossRef] | [PubMed]
 
Shehabi  Y;  Grant  P;  Wolfenden  H;  Hammond  N;  Bass  F;  Campbell  M;  Chen  J:  Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine–DEXCOM Study).  Anesthesiology 2009; 111:1075–1084
[CrossRef] | [PubMed]
 
Dubois  MJ;  Bergeron  N;  Dumont  M;  Dial  S;  Skrobik  Y:  Delirium in an intensive care unit: a study of risk factors.  Intensive Care Med 2001; 27:1297–1304
[CrossRef] | [PubMed]
 
Ersek  M;  Cherrier  MM;  Overman  SS;  Irving  GA:  The cognitive effects of opioids.  Pain Manag Nurs 2004; 5:75–93
[CrossRef] | [PubMed]
 
Sieber  FE;  Zakriya  KJ;  Gottschalk  A;  Blute  MR;  Lee  HB;  Rosenberg  PB;  Mears  SC:  Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair.  Mayo Clin Proc 2010; 85:18–26; correction, 2010; 85:400
[CrossRef] | [PubMed]
 
Hudetz  JA;  Patterson  KM;  Iqbal  Z;  Gandhi  SD;  Byrne  AJ;  Hudetz  AG;  Warltier  DC;  Pagel  PS:  Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass.  J Cardiothorac Vasc Anesth 2009; 23:651–657
[CrossRef] | [PubMed]
 
Al-Aama  T;  Brymer  C;  Gutmanis  I;  Woolmore-Goodwin  SM;  Esbaugh  J;  Dasgupta  M:  Melatonin decreases delirium in elderly patients: a randomized, placebo-controlled trial.  Int J Geriatr Psychiatry 2011; 26:687–694
[CrossRef] | [PubMed]
 
Girard  TD;  Pandharipande  PP;  Carson  SS;  Schmidt  GA;  Wright  PE;  Canonico  AE;  Pun  BT;  Thompson  JL;  Shintani  AK;  Meltzer  HY;  Bernard  GR;  Dittus  RS;  Ely  EW; MIND Trial Investigators:  Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial.  Crit Care Med 2010; 38:428–437
[CrossRef] | [PubMed]
 
Devlin  JW;  Roberts  RJ;  Fong  JJ;  Skrobik  Y;  Riker  RR;  Hill  NS;  Robbins  T;  Garpestad  E:  Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study.  Crit Care Med 2010; 38:419–427
[CrossRef] | [PubMed]
 
Tahir  TA;  Eeles  E;  Karapareddy  V;  Muthuvelu  P;  Chapple  S;  Phillips  B;  Adyemo  T;  Farewell  D;  Bisson  JI:  A randomized controlled trial of quetiapine versus placebo in the treatment of delirium.  J Psychosom Res 2010; 69:485–490
[CrossRef] | [PubMed]
 
Boettger  S;  Friedlander  M;  Breitbart  W;  Passik  S:  Aripiprazole and haloperidol in the treatment of delirium.  Aust NZ J Psychiatry 2011; 45:477–482
[CrossRef]
 
Skrobik  YK;  Bergeron  N;  Dumont  M;  Gottfried  SB:  Olanzapine vs haloperidol: treating delirium in a critical care setting.  Intensive Care Med 2004; 30:444–449
[CrossRef] | [PubMed]
 
Sipahimalani  A;  Masand  PS:  Olanzapine in the treatment of delirium.  Psychosomatics 1998; 39:422–430
[CrossRef] | [PubMed]
 
Grover  S;  Kumar  V;  Chakrabarti  S:  Comparative efficacy study of haloperidol, olanzapine and risperidone in delirium.  J Psychosom Res 2011; 71:277–281
[CrossRef] | [PubMed]
 
Han  CS;  Kim  YK:  A double-blind trial of risperidone and haloperidol for the treatment of delirium.  Psychosomatics 2004; 45:297–301
[CrossRef] | [PubMed]
 
Breitbart  W;  Marotta  R;  Platt  MM;  Weisman  H;  Derevenco  M;  Grau  C;  Corbera  K;  Raymond  S;  Lund  S;  Jacobson  P:  A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients.  Am J Psychiatry 1996; 153:231–237
[PubMed]
 
Kim  SW;  Yoo  JA;  Lee  SY;  Kim  SY;  Bae  KY;  Yang  SJ;  Kim  JM;  Shin  IS;  Yoon  JS:  Risperidone versus olanzapine for the treatment of delirium.  Hum Psychopharmacol 2010; 25:298–302
[CrossRef] | [PubMed]
 
Lee  KU;  Won  WY;  Lee  HK;  Kweon  YS;  Lee  CT;  Pae  CU;  Bahk  WM:  Amisulpride versus quetiapine for the treatment of delirium: a randomized, open prospective study.  Int Clin Psychopharmacol 2005; 20:311–314
[CrossRef] | [PubMed]
 
van Eijk  MM;  Roes  KC;  Honing  ML;  Kuiper  MA;  Karakus  A;  van der Jagt  M;  Spronk  PE;  van Gool  WA;  van der Mast  RC;  Kesecioglu  J;  Slooter  AJ:  Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomised trial.  Lancet 2010; 376:1829–1837
[CrossRef] | [PubMed]
 
Reade  MC;  O’Sullivan  K;  Bates  S;  Goldsmith  D;  Ainslie  WR;  Bellomo  R:  Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial.  Crit Care 2009; 13:R75
[CrossRef] | [PubMed]
 
Pae  CU;  Lee  SJ;  Lee  CU;  Lee  C;  Paik  IH:  A pilot trial of quetiapine for the treatment of patients with delirium.  Hum Psychopharmacol 2004; 19:125–127
[CrossRef] | [PubMed]
 
Kim  KY;  Bader  GM;  Kotlyar  V;  Gropper  D:  Treatment of delirium in older adults with quetiapine.  J Geriatr Psychiatry Neurol 2003; 16:29–31
[CrossRef] | [PubMed]
 
Breitbart  W;  Tremblay  A;  Gibson  C:  An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients.  Psychosomatics 2002; 43:175–182
[CrossRef] | [PubMed]
 
Zhang  Z;  Pan  L;  Ni  H:  Impact of delirium on clinical outcome in critically ill patients: a meta-analysis.  Gen Hosp Psychiatry 2013; 35:105–111
[CrossRef] | [PubMed]
 
Jackson  JC;  Gordon  SM;  Hart  RP;  Hopkins  RO;  Ely  EW:  The association between delirium and cognitive decline: a review of the empirical literature.  Neuropsychol Rev 2004; 14:87–98
[CrossRef] | [PubMed]
 
MacLullich  AM;  Beaglehole  A;  Hall  RJ;  Meagher  DJ:  Delirium and long-term cognitive impairment.  Int Rev Psychiatry 2009; 21:30–42
[CrossRef] | [PubMed]
 
Lundström  M;  Edlund  A;  Bucht  G;  Karlsson  S;  Gustafson  Y:  Dementia after delirium in patients with femoral neck fractures.  J Am Geriatr Soc 2003; 51:1002–1006
[CrossRef] | [PubMed]
 
Morandi  A;  Rogers  BP;  Gunther  ML;  Merkle  K;  Pandharipande  P;  Girard  TD;  Jackson  JC;  Thompson  J;  Shintani  AK;  Geevarghese  S;  Miller  RR  3rd;  Canonico  A;  Cannistraci  CJ;  Gore  JC;  Ely  EW;  Hopkins  ROVISIONS Investigation, VISualizing Icu SurvivOrs Neuroradiological Sequelae:  The relationship between delirium duration, white matter integrity, and cognitive impairment in intensive care unit survivors as determined by diffusion tensor imaging: the VISIONS prospective cohort magnetic resonance imaging study.  Crit Care Med 2012; 40:2182–2189
[CrossRef] | [PubMed]
 
Gunther  ML;  Morandi  A;  Krauskopf  E;  Pandharipande  P;  Girard  TD;  Jackson  JC;  Thompson  J;  Shintani  AK;  Geevarghese  S;  Miller  RR  3rd;  Canonico  A;  Merkle  K;  Cannistraci  CJ;  Rogers  BP;  Gatenby  JC;  Heckers  S;  Gore  JC;  Hopkins  RO;  Ely  EWVISIONS Investigation, VISualizing Icu SurvivOrs Neuroradiological Sequelae:  The association between brain volumes, delirium duration, and cognitive outcomes in intensive care unit survivors: the VISIONS cohort magnetic resonance imaging study.  Crit Care Med 2012; 40:2022–2032
[CrossRef] | [PubMed]
 
Girard  TD;  Jackson  JC;  Pandharipande  PP;  Pun  BT;  Thompson  JL;  Shintani  AK;  Gordon  SM;  Canonico  AE;  Dittus  RS;  Bernard  GR;  Ely  EW:  Delirium as a predictor of long-term cognitive impairment in survivors of critical illness.  Crit Care Med 2010b; 38:1513–1520
[CrossRef] | [PubMed]
 
Neufeld  KJ;  Leoutsakos  JM;  Sieber  FE;  Wanamaker  BL;  Gibson Chambers  JJ;  Rao  V;  Schretlen  DJ;  Needham  DM:  Outcomes of early delirium diagnosis after general anesthesia in the elderly.  Anesth Analg 2013; 117:471–478
[CrossRef] | [PubMed]
 
Meagher  D;  Adamis  D;  Trzepacz  P;  Leonard  M:  Features of subsyndromal and persistent delirium.  Br J Psychiatry 2012; 200:37–44
[CrossRef] | [PubMed]
 
Marcantonio  ER;  Kiely  DK;  Simon  SE;  John Orav  E;  Jones  RN;  Murphy  KM;  Bergmann  MA:  Outcomes of older people admitted to postacute facilities with delirium.  J Am Geriatr Soc 2005; 53:963–969
[CrossRef] | [PubMed]
 
Cole  M;  McCusker  J;  Dendukuri  N;  Han  L:  The prognostic significance of subsyndromal delirium in elderly medical inpatients.  J Am Geriatr Soc 2003; 51:754–760
[CrossRef] | [PubMed]
 
Lawlor  P;  Gagnon  B;  Mancini  IL;  Pereira  J;  Bruera  E:  Phenomenology of delirium and its subtypes in advanced cancer patients: a prospective study (abstract).  Palliat Care 1998; 14:106
 
Webster  R;  Holroyd  S:  Prevalence of psychotic symptoms in delirium.  Psychosomatics 2000; 41:519–522
[CrossRef] | [PubMed]
 
Liptzin  B;  Levkoff  SE:  An empirical study of delirium subtypes.  Br J Psychiatry 1992; 161:843–845
[CrossRef] | [PubMed]
 
Inouye  SK:  The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients.  Am J Med 1994; 97:278–288
[CrossRef] | [PubMed]
 
American Psychiatric Association:  Practice Guideline for the Treatment of Patients With Delirium.  Am J Psychiatry 1999; 156(May suppl):1–20
 
National Institute for Health and Clinical Excellence: Delirium: Diagnosis, Prevention and Management: Clinical Guideline 103. http://guidance.nice.org.uk/CG103.
 
Clinical Epidemiology and Health Service Evaluation Unit, Victoria, Australia: Clinical Practice Guidelines for the Management of Delirium in Older People, October 2006. http://docs.health.vic.gov.au/docs/doc/Clinical-Practice-Guidelines-for-the-Management-of-Delirium-in-Older-People---October-2006
 
O’Keeffe  ST:  Clinical subtypes of delirium in the elderly.  Dement Geriatr Cogn Disord 1999; 10:380–385
[CrossRef] | [PubMed]
 
Platt  MM;  Breitbart  W;  Smith  M;  Marotta  R;  Weisman  H;  Jacobsen  PB:  Efficacy of neuroleptics for hypoactive delirium.  J Neuropsychiatry Clin Neurosci 1994; 6:66–67
[PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Web of Science® Times Cited: 1

Related Content
Books
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 27.  >
The American Psychiatric Publishing Textbook of Psychiatry, 6th Edition > Chapter 24.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 25.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 27.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 25.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles