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Haloperidol, risperidone, olanzapine and aripiprazole in the management of delirium: A comparison of efficacy, safety, and side effects

Published online by Cambridge University Press:  05 September 2014

Soenke Boettger ,
Josef Jenewein  and
William Breitbart
Soenke Boettger*
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
Josef Jenewein
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
William Breitbart
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
*
Address correspondence and reprint requests to: Soenke Boettger, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland. E-Mail: [email protected]
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Abstract

Objective:

The aim of this study was to compare the efficacy and side-effect profile of the typical antipsychotic haloperidol with that of the atypical antipsychotics risperidone, olanzapine, and aripiprazole in the management of delirium.

Method:

The Memorial Delirium Assessment Scale (MDAS), the Karnofsky Performance Status (KPS) scale, and a side-effect rating were recorded at baseline (T1), after 2–3 days (T2), and after 4–7 days (T3). Some 21 cases were case-matched by age, preexisting dementia, and baseline MDAS scores, and subsequently analyzed.

Results:

The baseline characteristics of the medication groups were not different: The mean age of the patients ranged from 64.0 to 69.6 years, dementia was present in between 23.8 and 28.6%, and baseline MDAS scores were 19.9 (haloperidol), 18.6 (risperidone), 19.4 (olanzapine), and 18.0 (aripiprazole). The doses of medication at T3 were 5.5 mg haloperidol, 1.3 mg risperidone, 7.1 mg olanzapine, and 18.3 mg aripiprazole. Over one week, the decline in MDAS scores between medications was equal, and no differences between individual MDAS scores existed at T2 or T3. After one week, the MDAS scores were 6.8 (haloperidol), 7.1 (risperidone), 11.7 (olanzapine), and 8.3 (aripiprazole). At T2, delirium resolution occurred in 42.9–52.4% of cases and at T3 in 61.9–85.7%; no differences in assessments between medications existed. Recorded side effects were extrapyramidal symptoms (EPSs) in haloperidol- and risperidone-managed patients (19 and 4.8%, respectively) and sedation with olanzapine (28.6%).

Significance of Results:

Haloperidol, risperidone, aripiprazole, and olanzapine were equally effective in the management of delirium; however, they differed in terms of their side-effect profile. Extrapyramidal symptoms were most frequently recorded with haloperidol, and sedation occurred most frequently with olanzapine.

Keywords

DeliriumAripiprazoleHaloperidolOlanzapineRisperidoneAntipsychotics.
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 4 , August 2015 , pp. 1079 - 1085
Copyright
Copyright © Cambridge University Press 2014 

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References

REFERENCES

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, 4th ed., Text Revision (DSM–IV–TR). Washington, DC, American Psychiatric Association (see esp. pp. 124–127).Google Scholar
Boettger, S., Friedlander, M., Breitbart, W., et al. (2011 a). Aripiprazole and haloperidol in the treatment of delirium. The Australian and New Zealand Journal of Psychiatry, 45, 477–482.Google Scholar
Boettger, S., Passik, S. & Breitbart, W. (2011 b). Treatment characteristics of delirium superimposed on dementia. International Psychogeriatrics, 23, 1671–1676.Google Scholar
Breitbart, W., Rosenfeld, B., Roth, A., et al. (1997). The Memorial Delirium Assessment Scale. Journal of Pain and Symptom Management, 13, 128–137.Google Scholar
Bucht, G., Gustafson, Y. & Sandberg, O. (1999). Epidemiology of delirium. Dementia and Geriatric Cognitive Disorders, 10, 315–318.Google Scholar
Camus, V., Burtin, B., Simeone, I., et al. (2000). Factor analysis supports the evidence of existing hyperactive and hypoactive subtypes of delirium. International Journal of Geriatric Psychiatry, 15, 313–316.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
Elie, M., Cole, M.G., Primeau, F.J., et al. (1998). Delirium risk factors in elderly hospitalized patients. Journal of General Internal Medicine, 13, 204–212.CrossRefGoogle ScholarPubMed
Grover, S., Kumar, V. & Chakrabarti, S. (2011). Comparative efficacy study of haloperidol, olanzapine, and risperidone in delirium. Journal of Psychosomatic Research, 71, 277–281.Google Scholar
Han, C.S. & Kim, Y.K. (2004). A double-blind trial of risperidone and haloperidol for the treatment of delirium. Psychosomatics, 45, 297–301.Google Scholar
Hu, H., Deng, W. & Yang, H. (2004). A prospective random control study comparison of olanzapine and haloperidol in senile delirium. Chongqing Medical Journal, 8, 1234–1237.Google Scholar
Jeste, D.V., Blazer, D., Casey, D., et al. (2008). ACNP white paper: Update on use of antipsychotic drugs in elderly persons with dementia. Neuropsychopharmacology, 33, 957–970.Google Scholar
Karnofsky, D.A. & Burchenal, J.H. (1949). The clinical evaluation of chemotherapeutic agents in cancer. In Evaluation of chemotherapeutic agents. Macleod, C.M. (ed.), pp. 191–205. New York: Columbia University Press.Google Scholar
Kazmierski, J., Kowman, M., Banach, M., et al. (2008). Clinical utility and use of DSM–IV and ICD–10 criteria and the Memorial Delirium Assessment Scale in establishing a diagnosis of delirium after cardiac surgery. Psychosomatics, 49, 73–76.Google Scholar
Kim, J.Y., Jung, I.K., Han, C., et al. (2005). Antipsychotics and dopamine transporter gene polymorphisms in delirium patients. Psychiatry and Clinical Neurosciences, 59, 183–188.Google Scholar
Kim, S.W., Yoo, J.A., Lee, S.Y., et al. (2010). Risperidone versus olanzapine for the treatment of delirium. Human Psychopharmacology, 25, 298–302.Google Scholar
Lawlor, P.G., Nekolaichuk, C., Gagnon, B., et al. (2000). Clinical utility, factor analysis, and further validation of the Memorial Delirium Assessment Scale in patients with advanced cancer: Assessing delirium in advanced cancer. Cancer, 88, 2859–2867.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
Lingjaerde, O., Ahlfors, U.G., Bech, P., et al. (1987). 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 Psychiatrica Scandinavica, 334 (Suppl.), 1–100.CrossRefGoogle Scholar
Lipowski, Z.J. (1989). Delirium in the elderly patient. The New England Journal of Medicine, 320, 578–582.Google ScholarPubMed
Liu, C.Y., Juang, Y.Y., Liang, H.Y., et al. (2004). Efficacy of risperidone in treating the hyperactive symptoms of delirium. International Clinical Psychopharmacology, 19, 165–168.Google Scholar
Lonergan, E., Britton, A.M., Luxenberg, J., et al. (2007). Antipsychotics for delirium. The Cochrane Database of Systematic Reviews, 18(2), CD005594.CrossRefGoogle Scholar
Meagher, D.J., O'Hanlon, D., O'Mahony, E., et al. (2000). Relationship between symptoms and motoric subtype of delirium. The Journal of Neuropsychiatry and Clinical Neurosciences, 12, 51–56.Google Scholar
Rea, R.S., Battistone, S., Fong, J.J., et al. (2007). Atypical antipsychotics versus haloperidol for treatment of delirium in acutely ill patients. Pharmacotherapy, 27, 588–594.Google Scholar
Schneider, L.S., Dagerman, K.S. & Insel, P. (2005). Risk of death with atypical antipsychotic drug treatment for dementia: Metaanalysis of randomized placebo-controlled trials. The Journal of the American Medical Association, 19(294), 1934–1943.Google Scholar
Skrobik, Y.K., Bergeron, N., Dumont, M., et al. (2004). Olanzapine vs. haloperidol: Treating delirium in a critical care setting. Intensive Care Medicine, 30, 444–449.Google Scholar
Trzepacz, P.T., Breitbart, W., Franklin, J., et al. (1999). Practice guideline for the treatment of patients with delirium: American Psychiatric Association. The American Journal of Psychiatry, 156, 1–20.Google Scholar
Yoon, H.J., Park, K.M., Choi, W.J., et al. (2013). Efficacy and safety of haloperidol versus atypical antipsychotic medications in the treatment of delirium. BMC Psychiatry, 13, 240.Google Scholar