Abstract
Objective: Delirium is one of the most common complications in patients admitted to intensive care units (ICUs). Delirium is a definite cause for more extended hospital stays, higher mortality rates, and possibly persistent cognitive decline in the future. Antipsychotics have been frequently evaluated as first drugs of choice, but the most appropriate, evidence-based treatment is yet to be discovered. This study aims to compare the efficacy of haloperidol and olanzapine in patients admitted to our toxicology ICU. Methods: This double-blind, randomized controlled clinical trial was undertaken on 35 ICU admitted patients with delirium in Loghman Hakim hospital in Tehran, Iran. The diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria for delirium, and clinical toxicologists included the patients according to the study’s inclusion and exclusion criteria. Patients received either haloperidol or olanzapine based on computerized randomization. The severity of delirium was measured with the Memorial Delirium Assessment Scale (MDAS) scoring on days 0 and 3 of ICU-admission. Results: The total sample size was 35 in which 16 patients received haloperidol, and 19 patients received olanzapine. The doses of haloperidol and olanzapine were 3 mg three times a day and 5 mg three times a day, respectively. There was no significant difference in baseline characteristics and the scores of MDAS between groups. Conclusion: Olanzapine and haloperidol have the same efficacy in the management of delirium in toxicology ICU-admitted patients. They can be interchangeably used for delirium treatment in these patients.
Highlights
Based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), delirium is defined as a disturbance in the level of consciousness with reduced ability to direct, focus, sustain or shift attention, which has an abrupt onset with a fluctuating quiddity [1]
One-third of intensive care units (ICUs) admitted patients are diagnosed with delirium, and delirium is associated with more extended hospital stays, higher mortality rates, and a higher risk for the development of cognitive impairments after discharge [5]
We found that pharmacotherapy of delirium in the toxicology ICU admitted patients with haloperidol and olanzapine had statistically no significant difference in terms of Memorial Delirium Assessment Scale (MDAS) score improvement
Summary
Based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), delirium is defined as a disturbance in the level of consciousness with reduced ability to direct, focus, sustain or shift attention, which has an abrupt onset with a fluctuating quiddity [1]. Delirium has three subtypes: hyperactive, hypoactive, and mixed. Only the hyperactive subtype of delirium responds to antipsychotic therapy [2,3]. Patients admitted to the intensive care unit (ICU) are susceptible for the development of delirium. One-third of ICU admitted patients are diagnosed with delirium, and delirium is associated with more extended hospital stays, higher mortality rates, and a higher risk for the development of cognitive impairments after discharge [5]. The possibility of side effects such as extrapyramidal side effects has drawn the attention of researchers towards second-generation antipsychotics, including olanzapine [8]
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