Department of Psychiatry, General Hospital Sint-Maarten, Mechelen, Belgium.
Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium; Leiden University Medical Center (LUMC), The Netherlands.
Psychosomatics. 2019 Jan-Feb;60(1):18-26. doi: 10.1016/j.psym.2018.05.011. Epub 2018 May 31.
Although haloperidol is the most widely used drug in the treatment of delirium, evidence on the relevance of atypical antipsychotics (AAPs) is growing.
To review the literature on the efficacy and tolerability of AAPs in the treatment of delirium.
A systematic search of the literature published before April 2018 was performed on PubMed using the following search strings: "Delirium" and "Atypical antipsychotics", "Novel antipsychotics", "New antipsychotics", "Quetiapine", "Olanzapine", "Aripiprazole", "Risperidone", "Paliperidone", "Clozapine", "Asenapine", "Iloperidone", "Amisulpiride", "Ziprasidone", "Zotepine", "Sertindole", "Lurasidone" or "Perospirone".
Twelve randomized controlled trials (RCTs) and 22 open trials were considered. Despite an overall lack of large-scale RCTs, there is some evidence supporting the efficacy of olanzapine and quetiapine in placebo controlled trials. In a recent and large RCT in elderly patients, risperidone and/or haloperidol were associated with a significantly worse outcome than placebo. While preliminary, the current comparative studies suggest that haloperidol and the AAPs olanzapine, quetiapine and risperidone are similarly effective, although treatment with AAPs is associated with a reduced incidence of extrapyramidal symptoms. Ziprasidone was not shown to be effective. No RCTs are available for other AAPs.
Although the current evidence of the efficacy and tolerability of AAPs in the treatment of delirium is limited and the heterogeneity of the data precluded a meta-analysis, olanzapine and quetiapine seem to be adequate alternatives to haloperidol, especially in patients who are vulnerable for extrapyramidal symptoms, who require sedation or who have a history of haloperidol intolerance. Evidently, larger-scale RCTs are urgently required.
尽管氟哌啶醇是治疗谵妄最常用的药物，但越来越多的证据表明非典型抗精神病药（AAPs）具有相关性。
综述 AAPs 治疗谵妄的疗效和耐受性的文献。
使用以下搜索词在 PubMed 上对截至 2018 年 4 月之前发表的文献进行了系统搜索：“谵妄”和“非典型抗精神病药”，“新型抗精神病药”，“新型抗精神病药”，“喹硫平”，“奥氮平”，“阿立哌唑”，“利培酮”，“帕利哌酮”，“氯氮平”，“阿塞那平”，“依匹哌唑”，“氨磺必利”，“齐拉西酮”，“佐替平”，“曲拉唑酮”，“鲁拉西酮”或“哌罗匹隆”。
共考虑了 12 项随机对照试验（RCT）和 22 项开放试验。尽管缺乏大规模 RCT，但仍有一些证据支持奥氮平和喹硫平在安慰剂对照试验中的疗效。在最近一项针对老年患者的大型 RCT 中，利培酮和/或氟哌啶醇与安慰剂相比，结果明显较差。虽然初步，但目前的比较研究表明，氟哌啶醇和 AAPs 奥氮平、喹硫平和利培酮的疗效相似，尽管 AAPs 治疗与锥体外系症状发生率降低有关。齐拉西酮未显示出疗效。没有 RCT 可用于其他 AAPs。
尽管目前关于 AAPs 治疗谵妄的疗效和耐受性的证据有限，并且数据的异质性排除了荟萃分析，但奥氮平和喹硫平似乎是氟哌啶醇的合适替代品，尤其是在易发生锥体外系症状、需要镇静或有氟哌啶醇不耐受史的患者中。显然，迫切需要进行更大规模的 RCT。
