Institutional address Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seoul 120-752 Seodaemun-gu, Korea.
BMC Psychiatry. 2013 Sep 30;13:240. doi: 10.1186/1471-244X-13-240.
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.
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.
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.
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.
Clinical Research Information Service, Republic of Korea, (http://cris.nih.go.kr/cris/en/search/basic_search.jsp, Registered Trial No. KCT0000632).
大多数关于抗精神病药物治疗谵妄疗效的先前研究报告称，典型和非典型抗精神病药物之间没有显著差异。然而，众所周知，年龄较大可能是抗精神病药物治疗谵妄反应不佳的预测因素。本研究的目的是比较氟哌啶醇与三种非典型抗精神病药物（利培酮、奥氮平、喹硫平）治疗谵妄的疗效和安全性，并考虑患者年龄。
这是一项为期 6 天的前瞻性、比较性临床观察性研究，比较了三级医院中氟哌啶醇与非典型抗精神病药物（利培酮、奥氮平、喹硫平）治疗谵妄的疗效，患者在谵妄时被转介至联络精神病学服务进行管理，并在入组前进行了筛选。共有 80 名患者被分配接受氟哌啶醇（N=23）、利培酮（N=21）、奥氮平（N=18）或喹硫平（N=18）治疗。使用韩国版谵妄评定量表修订版-98（DRS-K）和韩国版简易精神状态检查（K-MMSE）评估疗效。使用 Udvalg Kliniske Undersogelser 副作用评定量表评估安全性。
在基线时，四组患者的 DRS-K 严重程度或 K-MMSE 评分均无显著差异。在所有组中，DRS-K 严重程度评分在研究期间均降低，K-MMSE 评分均升高。然而，四组之间 DRS-K 或 K-MMSE 评分的改善无显著差异。同样，认知和非认知 DRS-K 亚量表评分均降低，与治疗组无关。75 岁以上患者的治疗反应率低于 75 岁以下患者。特别是，奥氮平在老年组的反应率较差。15 名受试者出现了一些不良事件，但四组之间的不良事件谱无显著差异。
氟哌啶醇、利培酮、奥氮平、喹硫平治疗谵妄同样有效且安全。然而，年龄是治疗谵妄时选择抗精神病药物时需要考虑的一个因素。
韩国临床研究信息服务机构（http://cris.nih.go.kr/cris/en/search/basic_search.jsp，注册试验号 KCT0000632）。
