Breitbart W, Marotta R, Platt M M, Weisman H, Derevenco M, Grau C, Corbera K, Raymond S, Lund S, Jacobson P
Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Am J Psychiatry. 1996 Feb;153(2):231-7. doi: 10.1176/ajp.153.2.231.
The purpose of this study was to examine the efficacy and side effects of haloperidol, chlorpromazine, and lorazepam for the treatment of the symptoms of delirium in adult AIDS patients in a randomized, double-blind, comparison trial.
Nondelirious, medically hospitalized AIDS patients (N = 244) consented to participate in the study and were monitored prospectively for the development of delirium. Patients entered the treatment phase of the study if they met DSM-III-R criteria for delirium and scored 13 or greater on the Delirium Rating Scale. Thirty patients were randomly assigned to treatment with haloperidol (N = 11), chlorpromazine (N = 13), or lorazepam (N = 6). Efficacy and side effects associated with the treatment were measured with repeated assessments using the Delirium Rating Scale, the Mini-Mental State, and the Extrapyramidal Symptom Rating Scale.
Treatment with either haloperidol or chlorpromazine in relatively low doses resulted in significant improvement in the symptoms of delirium as measured by the Delirium Rating Scale. No improvement in the symptoms of delirium was found in the lorazepam group. Cognitive function, as measured by the Mini-Mental State, improved significantly from baseline to day 2 for patients receiving chlorpromazine. Treatment with haloperidol or chlorpromazine was associated with an extremely low prevalence of extrapyramidal side effects. All patients receiving lorazepam, however, developed treatment-limiting adverse effects. Although only a small number of patients had been treated with lorazepam, the authors became sufficiently concerned with the adverse effects to terminate that arm of the protocol early.
Symptoms of delirium in medically hospitalized AIDS patients may be treated efficaciously with few side effects by using low-dose neuroleptics (haloperidol or chlorpromazine). Lorazepam alone appears to be ineffective and associated with treatment-limiting adverse effects.
本研究旨在通过一项随机、双盲、对照试验，考察氟哌啶醇、氯丙嗪和劳拉西泮治疗成年艾滋病患者谵妄症状的疗效及副作用。
非谵妄的住院艾滋病患者（N = 244）同意参与本研究，并对其谵妄的发生进行前瞻性监测。符合《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）谵妄标准且谵妄评定量表得分≥13分的患者进入研究的治疗阶段。30名患者被随机分配接受氟哌啶醇治疗（N = 11）、氯丙嗪治疗（N = 13）或劳拉西泮治疗（N = 6）。使用谵妄评定量表、简易精神状态检查表和锥体外系症状评定量表进行重复评估，以测量与治疗相关的疗效和副作用。
根据谵妄评定量表测量，使用相对低剂量的氟哌啶醇或氯丙嗪治疗可使谵妄症状得到显著改善。劳拉西泮组的谵妄症状未得到改善。接受氯丙嗪治疗的患者，其简易精神状态检查表所测量的认知功能从基线到第2天有显著改善。氟哌啶醇或氯丙嗪治疗导致锥体外系副作用的发生率极低。然而，所有接受劳拉西泮治疗的患者均出现了限制治疗的不良反应。尽管接受劳拉西泮治疗的患者数量较少，但作者对这些不良反应极为关注，因此提前终止了该治疗组的试验。
对于住院治疗的艾滋病患者，使用低剂量抗精神病药物（氟哌啶醇或氯丙嗪）可有效治疗谵妄症状，且副作用较少。单独使用劳拉西泮似乎无效，并会产生限制治疗的不良反应。
