Efficacy of risperidone in the treatment of delirium in elderly patients

Abstract

Background: Despite increasing recognition of delirium as a serious complication of physical illness, little has been reported in this area. Interest has been raised in treatment options other than haloperidol, such as atypical antipsychotic agents. Methods: A 2-week open-label trial of risperidone for the treatment of delirium was conducted to assess the efficacy and tolerance of this medication in elderly patients. Twenty-two patients with DSM-IV-defined delirium were investigated. All patients had the hyperactive-hyperalert variant of delirium. Patients received a fixed dose of risperidone (mean 1.5 1 0.7 mg; range 0.5-3 mg). Delirium was assessed using the Delirium Rating Scale (DRS) at baseline and on Days 1, 3, 5, 7, and 14 after the initiation of risperidone treatment. Clinical and demographic data, as well as risperidone therapy related information, were collected. Results: Delirium resolved in all patients over the course of treatment. The mean period over which delirium resolved was 4.0 1 2.9 days. The mean DRS score at baseline was 20.7 1 3.0. The DRS score improved from baseline to Day 1 of treatment and continued to improve until the study end-point. Mild side-effects were present in 27.3% of patients. Stepwise logistic regression identified a decrease of 2 points or higher on the DRS on Day 1 associated with side-effects. There were no significant differences in the response to treatment with the different doses of risperidone used. Conclusion: Our findings indicate that low-dose risperidone (0.5-3.0 mg/ day) is effective and safe for the treatment of delirium in elderly patients, and that an early response on Day 1 of treatment may be associated with side-effects in these patients.

Usefulness of Atypical Antipsychotics and Choline Esterase Inhibitors in Delirium: A Review

“…Ikezawa et al [14] prospective, open label study 22 elderly subjects with DSM-IV hyperactive delirium with mean baseline DRS score at 20.7 ± 3.0 fi xed dose 0.5 -3 mg (mean 1.5 ± 0.7) DRS -mean duration for delirium resolution was 4.0 ± 2.9 days.…”

Pharmacogenomics of antipsychotics efficacy for schizophrenia

“…The Ser9Gly polymorphism of dopamine receptor D3 (DRD3) could disturb the membrane insertion of Psychiatry and Clinical Neurosciences 2011; 65: [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Pharmacogenomics of schizophrenia 7 this receptor molecule with biological consequence. Studies with FGA treatment response showed the Gly allele is more frequent among poor responders, however, recent studies with SGA showed a positive link of the Gly allele with a better response.…”

“…The neurobiology of DISC1 in the normal developing and adult brain and its roles in SCZ are not well understood. The biological role of DISC1 is, however, speculated from the following findings: (i) downregulation of DISC1 accelerates morphological development of adult-born neurons resulting in soma hypertrophy and enhancement of dendritic outgrowth; (ii) inhibition of DISC1 leads to mispo-Psychiatry and Clinical Neurosciences 2011; 65: [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Pharmacogenomics of schizophrenia 9 sitioning of new neurons in the molecular layer from overextended migration, suggesting that DISC1 serves as an interpreter that relays positional signals to the intracellular migratory machinery rather than a direct mediator of neuronal migration; (iii) new neurons with DISC1 knockdown exhibit more mature neuronal firing patterns; and (iv) downregulation of DISC1 accelerates synapse formation of newborn neurons. Taken together, these results indicate that DISC1 controls the tempo of the entire process of neuronal integration in the adult brain as a master regulator.…”

“…Genome-wide expression profiling using microarrays, performed to study effects of FGA and SGA in the postmortem liver of SCZ patients, revealed that FGA affected genes associated with nuclear protein, stress responses and phosphorylation, whereas SGA affected genes associated with Golgi/endoplasmic reticulum and cytoplasm transport. Comparison between FGA and SGA further identified genes asso-Psychiatry and Clinical Neurosciences 2011; 65: [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Pharmacogenomics of schizophrenia 11 ciated with lipid metabolism and mitochondrial function. Analyses on individual antipsychotics identified a set of genes (151 transcripts) that are differentially regulated by four antipsychotics, particularly by phenothiazines, in the liver of SCZ patients.…”

“…Even though second-generation antipsychotics (SGA) have been introduced to reduce side-effects, 5,6 there are still many cases with SGA-related adverse side-effects, with vulnerable subjects in particular. [7][8][9][10][11][12] SGA are widely used in elderly patients with various diagnosis, such as delirium, [13][14][15] delusion, 16 hallucination, 17 catatonia, 18 and behavioral and psychological problems of many types of dementia. [19][20][21][22][23][24] Due to adverse side-effects, SGA are no longer recommended to elderly subjects.…”