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Haloperidol, risperidone, olanzapine and aripiprazole in the management of delirium: A comparison of efficacy, safety, and side effects

Published online by Cambridge University Press:  05 September 2014

Soenke Boettger ,
Josef Jenewein  and
William Breitbart
Soenke Boettger*
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
Josef Jenewein
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
William Breitbart
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
*
Address correspondence and reprint requests to: Soenke Boettger, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland. E-Mail: soenke.boettger@usz.ch
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Abstract

Objective:

The aim of this study was to compare the efficacy and side-effect profile of the typical antipsychotic haloperidol with that of the atypical antipsychotics risperidone, olanzapine, and aripiprazole in the management of delirium.

Method:

The Memorial Delirium Assessment Scale (MDAS), the Karnofsky Performance Status (KPS) scale, and a side-effect rating were recorded at baseline (T1), after 2–3 days (T2), and after 4–7 days (T3). Some 21 cases were case-matched by age, preexisting dementia, and baseline MDAS scores, and subsequently analyzed.

Results:

The baseline characteristics of the medication groups were not different: The mean age of the patients ranged from 64.0 to 69.6 years, dementia was present in between 23.8 and 28.6%, and baseline MDAS scores were 19.9 (haloperidol), 18.6 (risperidone), 19.4 (olanzapine), and 18.0 (aripiprazole). The doses of medication at T3 were 5.5 mg haloperidol, 1.3 mg risperidone, 7.1 mg olanzapine, and 18.3 mg aripiprazole. Over one week, the decline in MDAS scores between medications was equal, and no differences between individual MDAS scores existed at T2 or T3. After one week, the MDAS scores were 6.8 (haloperidol), 7.1 (risperidone), 11.7 (olanzapine), and 8.3 (aripiprazole). At T2, delirium resolution occurred in 42.9–52.4% of cases and at T3 in 61.9–85.7%; no differences in assessments between medications existed. Recorded side effects were extrapyramidal symptoms (EPSs) in haloperidol- and risperidone-managed patients (19 and 4.8%, respectively) and sedation with olanzapine (28.6%).

Significance of Results:

Haloperidol, risperidone, aripiprazole, and olanzapine were equally effective in the management of delirium; however, they differed in terms of their side-effect profile. Extrapyramidal symptoms were most frequently recorded with haloperidol, and sedation occurred most frequently with olanzapine.

Keywords

DeliriumAripiprazoleHaloperidolOlanzapineRisperidoneAntipsychotics.
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 4 , August 2015 , pp. 1079 - 1085
Copyright
Copyright © Cambridge University Press 2014 

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