19, 20 Therefore, it is of research interest to evaluate a medication related to circadian patterns in delirium. 17, 18 Further, sleep-wake cycle disturbances including insomnia, excessive daytime napping, and disintegration of the expected circadian patterns have been described as a characteristic component of delirium for decades and demonstrated to be a core symptom domain of delirium.
There is some emerging literature suggesting that melatonin prophylaxis may reduce delirium incidence or a long-lasting episode of delirium 12-16 and that PER Clock gene function may be disturbed in delirium. Almost all trials of cholinesterase inhibitors failed, 2 and effects of antipsychotics are controversial. Despite some success of multicomponent nonpharmacologic interventions, 3, 4 no highly effective pharmacologic interventions to prevent delirium have been identified. 2 Further increase seems likely with the increase in the aged population. 1 The prevalence of delirium is 18% to 50% on admission, and the incidence during hospitalization is 10% to 82% in general medical and geriatric wards, the intensive care unit (ICU), and postoperative and palliative care settings. * Corresponding author: Kotaro Hatta, MD, PhD, Department of Psychiatry, Juntendo University Nerima Hospital, Takanodai 3-1-10, Nerima-ku, Tokyo 177-8521, Japan ( represents a disturbance in attention, awareness, and cognition that develops over a short period of time and tends to fluctuate. © Copyright 2017 Physicians Postgraduate Press, Inc.ĪDepartment of Psychiatry, Juntendo University Nerima Hospital, Tokyo, JapanīDepartment of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki, JapanĬDepartment of Psychiatry, Hiroshima City Hospital, Hiroshima, JapanĭDepartment of Psychiatry, Tokyo Medical and Dental University, Tokyo, JapanĮDepartment of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, JapanįDepartment of Environmental and Preventive Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
#JCP ONLINE TIME CLOCK TRIAL#
Trial Registration: UMIN Clinical Trials Registry identifier: UMIN000015681 Larger studies are needed to show the potential of suvorexant to improve the circadian core domain of delirium. There were no significant differences in adverse events.Ĭonclusions: Suvorexant administered nightly to elderly patients admitted for acute care may provide protection against delirium. 053) on the sleep-wake cycle disturbance score (item 1) o f t he Japanese version o f t he Delirium Rating Scale-Revised-98 (DRS-R-98-J). Analysis of variance revealed a tendency for main effect o f t reatment ( F = 3.79, P =. Comparison by log-rank test also showed that delirium developed significantly less often among patients taking suvorexant than among those taking placebo (χ 2 = 6.46, P =. Results: We found that delirium developed significantly less often among patients taking suvorexant than among those taking placebo (0% vs 17%, respectively, P =. Trained psychiatrists assessed for delirium.
The primary outcome measure was incidence of delirium as determined by the DSM-5. Seventy-two patients were randomly assigned using the sealed envelope method to receive suvorexant (15 mg/d 36 patients) or placebo (36 patients) every night for 3 days. Eligible patients were 65 to 89 years old, newly admitted due to emergency, and able to take medicine orally and had an expected stay or life expectancy of 48 hours or more. Methods: We conducted a multicenter, rater-blinded, randomized, placebo-controlled clinical trial in intensive care units and regular acute wards between April 2015 and March 2016. We examined whether suvorexant, a potent and selective orexin receptor antagonist, is effective for the prevention of delirium. Objective: No highly effective pharmacologic interventions to prevent delirium have been identified.
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