Amisulpride versus quetiapine for the treatment of delirium: a randomized, open prospective study.
ABSTRACT The present study aimed to: (i) provide preliminary data on the effectiveness and tolerability of atypical antipsychotics, amisulpride (AMSP) and quetiapine (QTP) for patients with delirium and (ii) investigate whether the two drugs affect sleep differently and further relation with the recovery time of delirium. Forty patients with delirium were randomly assigned to either AMSP or QTP groups, with a flexible dosing schedule. The Delirium Rating Scale-revised-98 (DRS-R-98) and clinical global impression-severity (CGI-S), total sleep time and quality of sleep were assessed daily. Sixteen subjects in the AMSP group and 15 subjects in the QTP group completed the study. The mean daily dose was 156.4 mg/day and 113 mg/day in the AMSP and QTP groups, respectively. There was no significant difference in the baseline DRS-R-98 and CGI scores. After treatment, DRS-R-98 scores were significantly decreased from the baseline in both treatment groups (P<0.001) without group difference. The mean duration of stabilization were 6.3+/-4.4 days for the AMSP group and 7.4+/-4.1 days for the QTP group without group differences. There was no group difference in the mean quality of sleep score and the mean total sleep time. The duration of stabilization was inversely correlated with the mean sleep quality score and the mean total sleep time (P<0.001). Both atypical antipsychotics were generally well tolerated. The present study shows that both amisulpride and quetiapine may be useful drugs for the treatment of delirium on the basis of effectiveness and relative lack of adverse events. Further systematic controlled studies are required.
Article: [Delirium and Dementia.][Show abstract] [Hide abstract]
ABSTRACT: Delirium and dementia as organically caused mental disorders exhibit similarities in the clinical and neurological sense and often occur together. The existence of one appears to increase the risk for the development of the other. Although delirium is a very common disorder especially among the elderly, it is often not recognized. For the diagnosis of delirium, an exact family and case history including medication, clinical examination and determination of routine laboratory values are not infrequently necessary. Causal treatment of delirium is possible and not necessarily complicated. Both non-medicative and medicative measures are available for the symptomatic treatment. The non-medicative measures are to a large extent applied by nursing staff and comprise, among others, orientation guidance and attaining a balance between perceptual overload and deprivation. A good knowledge of symptomatology is decisive, also from the prevention point of view (nurses specialized in delirium). For symptomatic medicative treatment neuroleptic agents appear to be favorable. With regard to extrapyramidal side effects atypical neuroleptics are better than the typical ones. The use of cholinesterase inhibitors is not robustly supported by the literature. The use of benzodiazepines is rather discouraged except for the treatment of withdrawal delirium. Preparations with short half-lives and absence of active metabolites can be used as accompanying measures for a short time. Prevention appears to be extremely important for which the treating personnel require a good knowledge of risk factors and their management. The occurrence of delirium among cases of alpha-synucleinopathies represents a special case. Both international and German guidelines on the management of delirium are available.Fortschritte der Neurologie · Psychiatrie 09/2014; 82(9):492-501. DOI:10.1055/s-0034-1366626 · 0.76 Impact Factor
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ABSTRACT: The aim of this study was to review the efficacy and safety of atypical antipsychotics, comparing within class, placebo, or compared to another active treatment for delirium. A literature search was conducted using PubMed, EMBASE, and the Cochrane database (1 January 1990–5 November 2012). Selection criteria for review were prospective, controlled studies (comparison studies), using validated delirium rating scales as outcome measures. A total of six prospective, randomized controlled studies were included in the review. It was found that atypical antipsychotics are effective and safe in treating delirium, even though there seemed to be no difference between each agent. In particular, comparison studies with haloperidol showed that the efficacy of atypical antipsychotics was similar to that of low-dose haloperidol. It was concluded that atypical antipsychotics appear to be effective and tolerable in the management of delirium, even though the evidence is limited.Psychiatry and Clinical Neurosciences 07/2013; 67(5). DOI:10.1111/pcn.12066 · 1.62 Impact Factor