Skip to main content Accessibility help

Paliperidone in the treatment of delirium: results of a prospective open-label pilot trial

  • Ho-Kyoung Yoon (a1), Yong-Ku Kim (a1), Changsu Han (a1), Young-Hoon Ko (a1), Heon-Jeong Lee (a1), Do-Young Kwon (a2) and Leen Kim (a1)...


Yoon H-K, Kim Y-K, Han C, Ko Y-H, Lee H-J, Kwon D-Y, Kim L. Paliperidone in the treatment of delirium: results of a prospective open-label pilot trial.

Objective: Delirium is a life-threatening neuropsychiatric syndrome characterised by disturbances in consciousness, attention, cognition and perception. Antipsychotics are considered the drugs of choice in managing the symptoms of delirium. Paliperidone is a benzisoxazole derivative and the principal active metabolite of risperidone. In this study, we aimed to evaluate the efficacy of paliperidone for the treatment of delirium.

Methods: A prospective open-label study of paliperidone for delirium treatment was performed with 6-day follow-up. Fifteen patients who met Diagnostic and Statistical Manual of Mental disorders, Fourth Edition criteria for delirium and had a score of 13 on the Delirium Rating Scale were recruited. The starting dose was 3 mg once a day and the dose was adjusted depending on the status of delirium. Daily assessments of the severity of delirium were evaluated using Memorial Delirium Assessment Scale (MDAS).

Results: The mean daily maintenance dose of paliperidone was 3.75 ± 1.06. The MDAS scores before and after treatment (day 7) were 23.60 ± 6.31 and 11.33 ± 5.45 (t = 6.78, p < 0.001), respectively. The intensity of delirium showed a statistically significant reduction in MDAS scores from the first day of treatment. No serious adverse effects were observed, and none of the patients discontinued paliperidone because of adverse effects.

Conclusions: This study shows that low-dose paliperidone is effective in reducing behavioural disturbances and symptoms in delirium and is well tolerated in delirious patients. This trial is an open-label study with a small sample size, and further controlled studies will be necessary.


Corresponding author

Professor Leen Kim, Department of Psychiatry, College of Medicine, Korea University Anam Hospital, Anam-Dong, Sungbuk-Gu, Seoul 136-705, South Korea. Tel: +82 2 920 5815; Fax: +82 2 927 2836; E-mail:


Hide All
1.American Psychiatric Association. Practice guideline for the treatment of patients with delirium. American Psychiatric Association. Am J Psychiatry 1999;156:120.
2.Michaud, L, Büla, C, Berney, A et al. Delirium: guidelines for general hospitals. J Psychosom Res 2007;62:371383.
3.Meagher, DJ.Delirium: optimising management. BMJ 2001;322:144149.
4.Peritogiannis, V, Stefanou, E, Lixouriotis, C, Gkogkos, C, Rizos, D.Atypical antipsychotics in the treatment of delirium. Psychiatry Clin Neurosci 2009;63:623631.
5.Han, C-S, Kim, Y-K.A double-blind trial of risperidone and haloperidol for the treatment of delirium. Psychosomatics 2004;45:297301.
6.Rea, R, Battistone, S, Fong, J, Devlin, J.Atypical antipsychotics versus haloperidol for treatment of delirium in acutely ill patients. Pharmacotherapy 2007;27:588594.
7.Schwartz, T, Masand, P.The role of atypical antipsychotics in the treatment of delirium. Psychosomatics 2002;43:171174.
8.Richelson, E, Souder, T.Binding of antipsychotic drugs to human brain receptors focus on newer generation compounds. Life Sci 2000;68:2939.
9.Janssen Pharmaceutica Products L. Invega (paliperidone) extended-release tablets, package insert. Titusville, 2007.
10.Ozbolt, L, Paniagua, M, Kaiser, R.Atypical antipsychotics for the treatment of delirious elders. J Am Med Dir Assoc 2008;9:1828.
11.Prakanrattana, U, Prapaitrakool, S.Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery. Anaesth Intensive Care 2007;35:714719.
12.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington DC: American Psychiatric Press, 1994.
13.Trzepacz, PT, Baker, RW, Greenhouse, J.A symptom rating scale for delirium. Psychiatry Res 1988;23:8997.
14.Breitbart, W, Rosenfeld, B, Roth, A, Smith, MJ, Cohen, K, Passik, S.The Memorial Delirium Assessment Scale. J Pain Symptom Manage 1997;13:128137.
15.Rosen, J, Sweet, RA, Mulsant, BH, Rifai, AH, Pasternak, R, Zubenko, GS.The Delirium Rating Scale in a psychogeriatric inpatient setting. J Neuropsychiatry Clin Neurosci 1994;6:3035.
16.Canuso, C, Youssef, E, Bossie, C, Turkoz, I, Schreiner, A, Simpson, G.Paliperidone extended-release tablets in schizophrenia patients previously treated with risperidone. Int Clin Psychopharmacol 2008;23:209215.
17.Canuso, CM, Bossie, CA, Turkoz, I, Alphs, L.Paliperidone extended-release for schizophrenia: effects on symptoms and functioning in acutely ill patients with negative symptoms. Schizophr Res 2009;113:5664.
18.Marino, J, Caballero, J.Paliperidone extended-release for the treatment of schizophrenia. Pharmacotherapy 2008;28: 12831298.
19.Tueth, MJ.Emergencies caused by side effects of psychiatric medications. Am J Emerg Med 1994;12:212216.
20.Tune, L.The role of antipsychotics in treating delirium. Curr Psychiatry Rep 2002;4:209212.
21.Tune, LE.Serum anticholinergic activity levels and delirium in the elderly. Semin Clin Neuropsychiatry 2000;5: 149153.
22.Schotte, A, Janssen, PF, Gommeren, W et al. Risperidone compared with new and reference antipsychotic drugs: in vitro and in vivo receptor binding. Psychopharmacology (Berl) 1996;124:5773.
23.Leysen, JE, Janssen, PM, Megens, AA, Schotte, A.Risperidone: a novel antipsychotic with balanced serotonin-dopamine antagonism, receptor occupancy profile, and pharmacologic activity. J Clin Psychiatry 1994;55(Suppl.):512.
24.Megens, AA, Awouters, FH, Schotte, A et al. Survey on the pharmacodynamics of the new antipsychotic risperidone. Psychopharmacology (Berl) 1994;114:923.
25.Luthringer, R, Staner, L, Noel, N et al. A double-blind, placebo-controlled, randomized study evaluating the effect of paliperidone extended-release tablets on sleep architecture in patients with schizophrenia. Int Clin Psychopharmacol 2007;22:299308.
26.Miller, D.Atypical antipsychotics: sleep, sedation, and efficacy. Prim Care Companion J Clin Psychiatry 2004; 6:37.
27.Vermeir, M, Naessens, I, Remmerie, B et al. Absorption, metabolism, and excretion of paliperidone, a new monoaminergic antagonist, in humans. Drug Metab Dispos 2008;36: 769779.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Acta Neuropsychiatrica
  • ISSN: 0924-2708
  • EISSN: 1601-5215
  • URL: /core/journals/acta-neuropsychiatrica
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed