Wolfson Medical Center, Holon, Israel.
Int Psychogeriatr. 2010 Mar;22(2):328-31. doi: 10.1017/S1041610209990986. Epub 2009 Sep 29.
Delirium exemplifies the interface between medicine and psychiatry. The mainstay of treatment of delirium are the antipsychotic drugs. These are efficacious and safe for the treatment of delirium. In the last decade the use of second generation antipsychotics has been advocated at the expense of the classical drugs, particularly haloperidol. We thus aimed to compare the outcome of delirium treatment in a large, university-affiliated general hospital.
We used retrospective medical charts analysis over a one-year period. Those included were all patients who had been admitted to an acute internal medicine ward for delirium or who had developed delirium during their hospital stay.
191 patients' records were analysed. Mean age for the group was 78.8 +/- 1.1 years. There were 108 males (56.5%) and 83 (43.5%) female patients. The most frequent co-morbid psychiatric diagnosis was that of dementia (106; 56%). The most common physical conditions were: cardiovascular (75 patients) and sepsis (24 patients). Patients suffering from delirium were mostly treated with an antipsychotic: 147 (77%) were treated either with risperidone (73 patients) or classical antipsychotics (74 patients). The most frequently used classical antipsychotic was haloperidol (59/74). Mean risperidone dose was 1.7 +/- 0.4 mg/daily. Mean haloperidol dose was 7.8 +/- 1.9 mg/daily. Mean duration of antipsychotic treatment was 3.8 days for the classical antipsychotics group and 2.6 for the risperidone group (p = 0.04). In the untreated group, mean delirium episodes lasted 5.6 days - significantly longer than that of either treated groups, p = 0.02.Mean hospital stay (days) for the group was 12.8 +/- 1.4. In the risperidone treated group the mean stay was 10.8 days while in the classical antipsychotics group it was 13.5 and in the untreated group it was 15.5 (p = 0.008). Fourteen patients (7.3%) died during the delirium episode: 10 untreated, 3 treated by classical antipsychotics and 1 risperidone treated (p = 0.04). The majority of patients (65%) were discharged to the community.
The present study adds to the growing body of evidence favoring risperidone as the drug of choice for the treatment of delirium. However, due to the limitations inherent in a retrospective analysis, prospective large-scale trials are needed to support this recommendation.
谵妄是医学和精神病学之间的交叉点。谵妄的主要治疗方法是使用抗精神病药物。这些药物对于治疗谵妄是有效且安全的。在过去的十年中，第二代抗精神病药物的使用已经取代了经典药物，尤其是氟哌啶醇。因此，我们旨在比较一家大型大学附属医院中谵妄治疗的结果。
我们使用了为期一年的回顾性病历分析。纳入的所有患者均因谵妄或在住院期间发生谵妄而被收入急性内科病房。
分析了 191 名患者的记录。该组的平均年龄为 78.8 ± 1.1 岁。男性 108 例（56.5%），女性 83 例（43.5%）。最常见的合并精神科诊断是痴呆症（106 例；56%）。最常见的躯体疾病是心血管疾病（75 例）和脓毒症（24 例）。患有谵妄的患者大多接受了抗精神病药物治疗：147 例（77%）接受了利培酮（73 例）或经典抗精神病药物（74 例）治疗。最常使用的经典抗精神病药物是氟哌啶醇（59/74）。利培酮的平均剂量为 1.7 ± 0.4 mg/天。氟哌啶醇的平均剂量为 7.8 ± 1.9 mg/天。经典抗精神病药物组的平均抗精神病药物治疗持续时间为 3.8 天，利培酮组为 2.6 天（p = 0.04）。在未治疗组中，平均谵妄发作持续 5.6 天，明显长于任何治疗组，p = 0.02。该组的平均住院时间（天）为 12.8 ± 1.4。利培酮治疗组的平均住院时间为 10.8 天，经典抗精神病药物组为 13.5 天，未治疗组为 15.5 天（p = 0.008）。14 名患者（7.3%）在谵妄发作期间死亡：10 名未治疗，3 名接受经典抗精神病药物治疗，1 名接受利培酮治疗（p = 0.04）。大多数患者（65%）出院到社区。
本研究为支持利培酮作为治疗谵妄的首选药物的越来越多的证据增添了新内容。然而，由于回顾性分析固有的局限性，需要进行大规模的前瞻性试验来支持这一建议。
