Efficacy and safety of haloperidol versus atypical antipsychotic medications in the treatment of delirium

BMC Psychiatry

Jeong-Ho Seok¹  Jae-Jin Kim¹  Jin-Young Park¹  Soo-Hee Choi¹  Won-Jung Choi¹  Kyoung-Min Park¹  Hyung-Jun Yoon¹ 

[1] Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea

关键词: Quetiapine;    Olanzapine;    Risperidone;    Haloperidol;    Delirium;   

Others  :  1123953
DOI  :  10.1186/1471-244X-13-240

 received in 2013-01-11, accepted in 2013-09-23,  发布年份 2013

【 摘 要 】

Background

Most previous studies on the efficacy of antipsychotic medication for the treatment of delirium have reported that there is no significant difference between typical and atypical antipsychotic medications. It is known, however, that older age might be a predictor of poor response to antipsychotics in the treatment of delirium. The objective of this study was to compare the efficacy and safety of haloperidol versus three atypical antipsychotic medications (risperidone, olanzapine, and quetiapine) for the treatment of delirium with consideration of patient age.

Methods

This study was a 6-day, prospective, comparative clinical observational study of haloperidol versus atypical antipsychotic medications (risperidone, olanzapine, and quetiapine) in patients with delirium at a tertiary level hospital. The subjects were referred to the consultation-liaison psychiatric service for management of delirium and were screened before enrollment in this study. A total of 80 subjects were assigned to receive either haloperidol (N = 23), risperidone (N = 21), olanzapine (N = 18), or quetiapine (N = 18). The efficacy was evaluated using the Korean version of the Delirium Rating Scale-Revised-98 (DRS-K) and the Korean version of the Mini Mental Status Examination (K-MMSE). The safety was evaluated by the Udvalg Kliniske Undersogelser side effect rating scale.

Results

There were no significant differences in mean DRS-K severity or K-MMSE scores among the four groups at baseline. In all groups, the DRS-K severity score decreased and the K-MMSE score increased significantly over the study period. However, there were no significant differences in the improvement of DRS-K or K-MMSE scores among the four groups. Similarly, cognitive and non-cognitive subscale DRS-K scores decreased regardless of the treatment group. The treatment response rate was lower in patients over 75 years old than in patients under 75 years old. Particularly, the response rate to olanzapine was poorer in the older age group. Fifteen subjects experienced a few adverse events, but there were no significant differences in adverse event profiles among the four groups.

Conclusions

Haloperidol, risperidone, olanzapine, and quetiapine were equally efficacious and safe in the treatment of delirium. However, age is a factor that needs to be considered when making a choice of antipsychotic medication for the treatment of delirium.

Trial registration

Clinical Research Information Service, Republic of Korea, (http://cris.nih.go.kr/cris/en/search/basic_search.jsp webcite, Registered Trial No. KCT0000632).

【 授权许可】

   
2013 Yoon et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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【 参考文献 】

• [1]Inouye SK, Charpentier PA: Precipitating factors for delirium in hospitalized elderly persons: predictive model and interrelationship with baseline vulnerability. JAMA 1996, 275(11):852-857.
• [2]Inouye SK: Delirium in hospitalized older patients. Clin Geriatr Med 1998, 14(4):745-764.
• [3]Fong TG, Tulebaev SR, Inouye SK: Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol 2009, 5(4):210-220.
• [4]Dyer CB, Ashton CM, Teasdale TA: Postoperative delirium: a review of 80 primary data-collection studies. Arch Intern Med 1995, 155(5):461-465.
• [5]Marcantonio ER, Goldman L, Orav EJ, Cook EF, Lee TH: The association of intraoperative factors with the development of postoperative delirium. Am J Med 1998, 105(5):380-384.
• [6]Minagawa H, Uchitomi Y, Yamawaki S, Ishitani K: Psychiatric morbidity in terminally ill cancer patients. A prospective study. Cancer 1996, 78(5):1131-1137.
• [7]Pereira J, Hanson J, Bruera E: The frequency and clinical course of cognitive impairment in patients with terminal cancer. Cancer 1997, 79(4):835-842.
• [8]Lawlor PG, Gagnon B, Mancini IL, Pereira JL, Hanson J, Suarez-Almazor ME, Bruera ED: Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med 2000, 160(6):786-794.
• [9]Burns A, Gallagley A, Byrne J: Delirium. J Neurol Neurosur Ps 2004, 75(3):362-367.
• [10]Jain G, Chakrabarti S, Kulhara P: Symptoms of delirium: an exploratory factor analytic study among referred patients. Gen Hosp Psychiatry 2011, 33(4):377-385.
• [11]Gupta N, de Jonghe J, Schieveld J, Leonard M, Meagher D: Delirium phenomenology: what can we learn from the symptoms of delirium? J Psychosom Res 2008, 65(3):215-222.
• [12]Lipowski ZJ: Delirium (acute confusional states). JAMA (Chicago, Ill) 1987, 258(13):1789-1792.
• [13]Inouye SK: Delirium in older persons. N Engl J Med 2006, 354(11):1157-1165.
• [14]Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE, Inouye SK, Bernard GR, Dittus RS: Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA (Chicago, Ill) 2004, 291(14):1753-1762.
• [15]McCusker J, Cole MG, Dendukuri N, Belzile E: Does delirium increase hospital stay? J Am Geriatr Soc 2003, 51(11):1539-1546.
• [16]Siddiqi N, House AO, Holmes JD: Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing 2006, 35(4):350-364.
• [17]Kean J, Ryan K: Delirium detection in clinical practice and research: critique of current tools and suggestions for future development. J Psychosom Res 2008, 65(3):255-259.
• [18]Pae C, Marks DM, Han C, Patkar A, Masand P: Delirium: where do we stand? Curr Psychiatry Rep 2008, 10(3):240-248.
• [19]Lacasse H, Perreault M, Williamson DR: Systematic review of antipsychotics for the treatment of hospital-associated delirium in medically or surgically ill patients. Ann Pharmacother 2006, 40(11):1966-1973.
• [20]Grover S, Mattoo SK, Gupta N: Usefulness of atypical antipsychotics and choline esterase inhibitors in delirium: a review. Pharmacopsychiatry 2011, 44(2):43-54.
• [21]Ozbolt LB, Paniagua MA, Kaiser RM: Atypical antipsychotics for the treatment of delirious elders. J Am Med Dir Assoc 2008, 9(1):18-28.
• [22]Metzger E, Friedman R: Prolongation of the corrected QT and torsades de pointes cardiac arrhythmia associated with intravenous haloperidol in the medically ill. J Clin Psychopharmacol 1993, 13(2):128-132.
• [23]Glassman AH, Bigger JT Jr: Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death. Am J Psychiatry 2001, 158(11):1774-1782.
• [24]Casey D: Acute extrapyramidal syndrome. Washington, DC: Contemporary Use in the Treatement of Schizophrenia American Psychiatric Press; 1995:535-550.
• [25]Breitbart W, Alici Y: Agitation and delirium at the end of life: “We couldn’t manage him”. JAMA (Chicago, Ill) 2008, 300(24):2898-2910. E2891
• [26]Yoo J, Lee S, Kim S, Bae K, Yang S, Kim J, Shin I, Yoon J: Risperidone versus olanzapine for the treatment of delirium. Hum Psychopharm 2010, 25(4):298-302.
• [27]Schwartz TL, Masand PS: The role of atypical antipsychotics in the treatment of delirium. Psychosomatics 2002, 43(3):171-174.
• [28]Skrobik YK, Bergeron N, Dumont M, Gottfried SB: Olanzapine vs haloperidol: treating delirium in a critical care setting. Intens Care Med 2004, 30(3):444-449.
• [29]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(2):125-127.
• [30]Peritogiannis V, Stefanou E, Lixouriotis C, Gkogkos C, Rizos DV: Atypical antipsychotics in the treatment of delirium. Psychiat Clin Neuros 2009, 63(5):623-631.
• [31]Bourne RS, Tahir TA, Borthwick M, Sampson EL: Drug treatment of delirium: past, present and future. J Psychosom Res 2008, 65(3):273-282.
• [32]Grover S, Kumar V, Chakrabarti S: Comparative efficacy study of haloperidol, olanzapine and risperidone in delirium. J Psychosom Res 2011, 71(4):277-281.
• [33]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(5):485-490.
• [34]Devlin JW, Roberts RJ, Fong J, Skrobik Y, Riker R, 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(2):419-427.
• [35]Kim J, Jung I, Han C, Cho S, Kim L, Kim S, Lee B, Lee H, Kim Y: Antipsychotics and dopamine transporter gene polymorphisms in delirium patients. Psychiat Clin Neuros 2005, 59(2):183-188.
• [36]Han C, Kim Y: A double-blind trial of risperidone and haloperidol for the treatment of delirium. Psychosomatics 2004, 45(4):297-301.
• [37]Lee K, Won W, Lee H, Kweon Y, Lee CT, Pae C, Bahk W: Amisulpride versus quetiapine for the treatment of delirium: a randomized, open prospective study. Int Clin Psychopharm 2005, 20(6):311-314.
• [38]Hu H, Deng W, Yang H: A prospective random control study comparison of olanzapine and haloperidol in senile delirium. Chongqing Med J 2004, 8:1234-1237.
• [39]Hu H, Deng W, Yang H, Liu Y: Olanzapine and haloperidol for senile delirium: a randomized controlled observation. Chinese J Clin Rehabil 2006, 10(42):188-190.
• [40]Breitbart W, Tremblay A, Gibson C: An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients. Psychosomatics 2002, 43(3):175-182.
• [41]Roose SP, Sackeim HA, Krishnan KR, Pollock BG, Alexopoulos G, Lavretsky H, Katz IR, Hakkarainen H: Antidepressant pharmacotherapy in the treatment of depression in the very old: a randomized, placebo-controlled trial. Am J Psychiat 2004, 161(11):2050-2059.
• [42]Cheng S, Yu EC, Lee SY, Wong JY, Lau KH, Chan LK, Chan H: The geriatric depression scale as a screening tool for depression and suicide ideation: a replication and extention. Am J Geriat Psychiat 2010, 18(3):256-265.
• [43]Paraschakis A, Douzenis A, Michopoulos I, Christodoulou C, Vassilopoulou K, Koutsaftis F, Lykouras L: Late onset suicide: distinction between “young-old” vs. “old-old” suicide victims. How different populations are they? Arch Gerontol Geriat 2012, 54(1):136-139.
• [44]Lonergan E, Britton AM, Luxenberg J, Wyller T: Antipsychotics for delirium. Cochrane Database Syst Rev 2007., 2CD005594
• [45]American Psychiatric Association., American Psychiatric Association. Task Force on DSM-IV: Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th edition. Washington, DC: American Psychiatric Association; 2000.
• [46]Yudofsky SC, Hales RE, American Psychiatric Publishing: The American psychiatric publishing textbook of neuropsychiatry and behavioral neurosciences. 5th edition. Washington, DC: American Psychiatric Pub; 2008.
• [47]Grover S, Kate N, Agarwal M, Mattoo SK, Avasthi A, Malhotra S, Kulhara P, Chakrabarti S, Basu D: Delirium in elderly people: a study of a psychiatric liaison service in north India. Int Psychogeriatr 2012, 24(1):117-127.
• [48]Lee Y, Ryu J, Lee J, Kim H, Shin IH, Kim J, Trzepacz PT: Korean version of the delirium rating scale-revised-98: reliability and validity. Psychiat Invest 2011, 8(1):30-38.
• [49]Trzepacz PT, Mittal D, Torres R, Kanary K, Norton J, Jimerson N: Validation of the delirium rating scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium. J Neuropsych Clin N 2001, 13(2):229-242.
• [50]Meagher DJ, Leonard M, Donnelly S, Conroy M, Adamis D, Trzepacz PT: A longitudinal study of motor subtypes in delirium: relationship with other phenomenology, etiology, medication exposure and prognosis. J Psychosom Res 2011, 71(6):395-403.
• [51]Kang YND, Hahn S: A validity study on the Korean mini-mental state examination (K-MMSE) in dementia patients. J Korean Neurol Assoc 1997, 15(2):300-308.
• [52]Folstein MF, Folstein SE, McHugh PR: Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiat Res 1975, 12(3):189-198.
• [53]Lingjaerde O, Ahlfors UG, Bech P, Dencker SJ, Elgen K: The UKU side effect rating scale: a new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatr Scand Suppl 1987, 334:1-100.
• [54]Brown H, Prescott R: Applied mixed models in medicine. Chichester: Wiley; 1999.
• [55]Adamis D: Statistical methods for analysing longitudinal data in delirium studies. Int Rev Psychiatry 2009, 21(1):74-85.
• [56]Adamis D, Morrison C, Treloar A, Macdonald AJ, Martin FC: The performance of the clock drawing test in elderly medical inpatients: does it have utility in the identification of delirium? J Geriatr Psychiatry Neurol 2005, 18(3):129-133.
• [57]Liu C, Juang Y, Liang H, Lin N, Yeh E: Efficacy of risperidone in treating the hyperactive symptoms of delirium. Int Clin Psychopharm 2004, 19(3):165-168.
• [58]Schwartz TL, Masand PS: Treatment of delirium with Quetiapine. Prim Care Companion J Clin Psychiat 2000, 2(1):10-12.
• [59]Sipahimalani A, Masand PS: Olanzapine in the treatment of delirium. Psychosomatics 1998, 39(5):422-430.
• [60]Sasaki Y, Matsuyama T, Inoue S, Sunami T, Inoue T, Denda K, Koyama T: A prospective, open-label, flexible-dose study of quetiapine in the treatment of delirium. J Clin Psychiat 2003, 64(11):1316-1321.
• [61]Omura K, Amano N: Clinical experience of quetiapine in 24 elderly patients with delirium. Psychogeriatrics 2003, 3(2):69-72.
• [62]Gupta N, Sharma P, Mattoo SK: Effectiveness of risperidone in delirium. Can J Psychiat 2005, 50(1):75-75.
• [63]Lundstrom M, Edlund A, Karlsson S, Brannstrom B, Bucht G, Gustafson Y: A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. J Am Geriatr Soc 2005, 53(4):622-628.
• [64]Sadock BJ, Kaplan HI, Sadock VA: Kaplan & Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatry. 10th edition. Philadelphia: Wolter Kluwer/Lippincott Williams & Wilkins; 2007.
• [65]Gardner DM, Baldessarini RJ, Waraich P: Modern antipsychotic drugs: a critical overview. Can Med Assoc J; CMAJ 2005, 172(13):1703-1711.
• [66]Chew ML, Mulsant BH, Pollock BG, Lehman ME, Greenspan A, Kirshner MA, Bies R, Kapur S, Gharabawi G: A model of anticholinergic activity of atypical antipsychotic medications. Schizophrenia Res 2006, 88(1–3):63-72.
• [67]Katz PR, Grossberg GT, Potter JF, Solomon DH: Geriatrics syllabus for specialists. New York: American Geriatrics Society; 2002.