Eduardo Ballesteros

Purpose of review: Hypoactive delirium is a frequently underrecognized subtype associated with increased morbidity and mortality, yet it lacks clearly established pharmacologic treatment strategies. This scoping review aimed to map and critically examine the existing evidence on pharmacological interventions specifically evaluated for hypoactive delirium in hospitalized adults, focusing on symptom severity and clinical outcomes. Recent findings: The available literature is limited and heterogeneous. Identified studies included randomized controlled trials, observational studies, and recent systematic reviews evaluating agents such as antipsychotics, dexmedetomidine, melatonin, flumazenil, and methylphenidate. However, most trials were small, methodologically diverse, and not specifically powered for the hypoactive subtype. Evidence supporting atypical antipsychotics remains inconsistent, and no high-quality randomized trials demonstrate clear benefit for routine use in hypoactive delirium. Alternative agents such as flumazenil and methylphenidate have been explored in limited or exploratory contexts, without consistent improvement in clinically meaningful outcomes. Summary: Current evidence does not support the routine use of any pharmacologic agent as a standard treatment for hypoactive delirium. Existing studies are constrained by small sample sizes, heterogeneity in diagnostic criteria and outcome measures, and overlap across systematic reviews and primary trials. Further well-designed, subtype-specific randomized controlled trials are needed to determine whether targeted pharmacologic strategies can improve outcomes in this vulnerable population.

Objective: To assess the impact of psychotherapy on obesity treatment in outpatient settings. Methods: The study targets adults with a BMI of 30 or higher, comparing psychotherapeutic interventions to usual care or no treatment. Key outcomes include weight loss, adverse events, depression, quality of life, and long-term BMI changes. Extensive database searches were conducted. Results: Out of 1,334 articles reviewed, only 3 studies met the inclusion criteria, emphasizing the scarcity of relevant research. These studies primarily focused on behavioral and cognitive-behavioral strategies. Results showed that combining behavior therapy with diet/exercise led to greater weight loss than diet/exercise alone. Studies on cognitive therapy and general psychotherapy were less frequent and yielded weaker evidence. Despite varied methodologies, the findings suggest that behavioral therapy combined with dietary and exercise interventions offers improved outcomes, though more research is needed to strengthen these conclusions. Conclusions: The study found that combining behavioral therapy with diet and exercise resulted in greater weight loss than diet and exercise alone. However, research on the impact of psychotherapy on obesity is limited, as only 3 studies met the inclusion criteria. Cognitive therapies and general psychotherapy provided weaker evidence. Therefore, further research is necessary to validate these findings and investigate alternative psychotherapeutic methods for treating obesity.