Quetiapine versus haloperidol in the treatment of delirium: a double-blind, randomized, controlled trial

Abstract

BackgroundAtypical antipsychotic drugs may have low propensity to induce extrapyramidal side effects in delirious patients. This study aimed to compare the efficacy and tolerability between quetiapine and haloperidol in controlling delirious behavior.MethodsA 7-day prospective, double-blind, randomized controlled trial was conducted from June 2009 to April 2011 in medically ill patients with delirium. Measures used for daily assessment included the Delirium Rating Scale-revised-98 (DRS-R-98) and total sleep time. The Clinical Global Impression, Improvement (CGI–I) and the Modified (nine-item) Simpson– Angus Scale were applied daily. The primary outcome was the DRS-R-98 severity scores. The data were analyzed on an intention-to-treat basis.ResultsFifty-two subjects (35 males and 17 females) were randomized to receive 25–100 mg/day of quetiapine (n = 24) or 0.5–2.0 mg/day of haloperidol (n = 28). Mean (standard deviation) doses of quetiapine and haloperidol were 67.6 (9.7) and 0.8 (0.3) mg/day, respectively. Over the trial period, means (standard deviation) of the DRS-R-98 severity scores were not significantly different between the quetiapine and haloperidol groups (−22.9 [6.9] versus −21.7 [6.7]; P = 0.59). The DRS-R-98 noncognitive and cognitive subscale scores were not significantly different. At end point, the response and remission rates, the total sleep time, and the Modified (nine-item) Simpson–Angus scores were also not significantly different between groups. Hypersomnia was common in the quetiapine-treated patients (33.3%), but not significantly higher than that in the haloperidol-treated group (21.4%).LimitationsPatients were excluded if they were not able to take oral medications, and the sample size was small.ConclusionLow-dose quetiapine and haloperidol may be equally effective and safe for controlling delirium symptoms.Clinical trials registration numberclinicaltrials.gov NCT00954603.

Yokukansan, a traditional Japanese medicine, decreases head-twitch behaviors and serotonin 2A receptors in the prefrontal cortex of isolation-stressed mice

“…In addition, polymorphisms within 5-HT 2A receptors have been reported to be associated with schizophrenic patients (Williams et al, 1996;Golimbet et al, 2007;Quednow et al, 2008) or BPSD of AD patients (Pritchard et al, 2008), who frequently exhibit hallucinations, delusions, and psychosis. In delirium, similar to schizophrenia and BPSD, atypical antipsychotic drugs such as olanzapine and quetiapine having a strong 5-HT 2A receptor antagonistic action, are usually used to treat the symptoms including hallucination, delusion, and excitation (Maneeton et al, 2013;Wang et al, 2013;Yoon et al, 2013). In animals, several hallucinogenic compounds such as lysergic acid diethylamide and mescaline, can induce the head-twitch response in normal mice (Corne et al, 1963;Corne and Pickering, 1967) or htr2A þ / þ but not htr2A À / À mice (González-Maeso et al, 2007).…”

Management of Delirium in Palliative Care: a Review

“…Risperidone is also used in the treatment of delirium [57], with comparative efficacy with respect to haloperidol and olanzapine [58] and independent of the severity of the underlying illness [59]. Data have also accumulated on the use of quetiapine [60•], with recent reports indicating a comparable efficacy and safety as haloperidol for controlling delirium symptoms [61] and an increase of its use in general hospital settings [44]. Ziprasidone, a further atypical AP, showed to be as effective as haloperidol in the treatment of delirium in intensive care unit [62], also when used intravenously [63], although no study is available in palliative care settings.…”

Effectiveness of Antipsychotics on Delirium in Elderly Patients

“…Compared to haloperidol, patients with delirium on quetiapine showed similar improvement on the DRS and quetiapine was better tolerated [10]. An open-label trial using quetiapine at a mean dosage of 44.9 ± 31.0 mg/day demonstrated that it was effective and that it improved delirium severity and cognition that were measured by the DRS and MMSE, respectively [22].…”

“…Typical antipsychotics, primarily haloperidol, have been used empirically to control symptoms of delirium. Recently, researchers have begun reporting that atypical antipsychotics, such as olanzapine, quetiapine, and risperidone, might be as effective as haloperidol in delirium treatment [10,11,18,19].…”