Randomized Controlled Trial
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Sep 22, 2016; 6(3): 365-371
Published online Sep 22, 2016. doi: 10.5498/wjp.v6.i3.365
Comparative effectiveness of quetiapine and haloperidol in delirium: A single blind randomized controlled study
Sandeep Grover, Sudhir Mahajan, Subho Chakrabarti, Ajit Avasthi
Sandeep Grover, Sudhir Mahajan, Subho Chakrabarti, Ajit Avasthi, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Author contributions: All authors contributed to this paper.
Institutional review board statement: The study was approved by the Institute Ethics Committee.
Informed consent statement: Proxy written informed consent was obtained from the primary caregivers of the patients who were staying with the patient during the hospitalization prior to randomization. The purpose of the study was explained to the caregivers. The caregivers were told about the currently available pharmacotherapy for management of delirium. The caregivers were explained about the commonly used pharmacological agents along with their efficacy and side effect profile. They were informed about the evidence available for quetiapine for management of delirium. The primary caregivers were informed that they could withdraw consent at any stage.
Conflict-of-interest statement: None.
Data sharing statement: No.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Sandeep Grover, MD, Additional Professor, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Cobalt Block, Nehru Hospital, Chandigarh 160012, India. drsandeepg2002@yahoo.com
Telephone: +91-172-2756807 Fax: +91-172-2744401
Received: May 17, 2016
Peer-review started: May 19, 2016
First decision: July 5, 2016
Revised: August 5, 2016
Accepted: August 27, 2016
Article in press: August 29, 2016
Published online: September 22, 2016
Processing time: 124 Days and 15.5 Hours
Abstract
AIM

To evaluate the effectiveness of quetiapine and haloperidol in patients of delirium referred to psychiatry consultation liaison services.

METHODS

The study followed a single blind randomised controlled trial design. Thirty-two patients in the haloperidol group and 31 patients in the quetiapine group were assessed at the baseline and 6 consecutive days. Flexible dosing regimen (haloperidol: 0.25-1.25 mg; quetiapine 12.5-75 mg/d) was used. Delirium Rating Scale-Revised-98 (DRS-R-98) and mini mental status examination (MMSE) were the primary and secondary efficacy measures respectively.

RESULTS

Baseline DRS-R-98 severity score and MMSE scores did not differ between the 2 study groups. From baseline to day 6, there was significant reduction in the total DRS-R-98 scores, DRS-R-98 cognitive domain scores, DRS-R-98 non-cognitive domain scores and significant increase in the MMSE scores in both the groups. Both the groups did not differ on any of the assessments in terms of DRS-R98 and MMSE scores. The effectiveness of both the medications was similar in adult and elderly (≥ 60 years) patients. At the end of the trial, 68.75% and 67.74% of subjects in the haloperidol and quetiapine group respectively had mean DRS-R-98 scores below 10. By 6th day, 12 (37.5%) patients in haloperidol group and 9 (29.03%) patients in the quetiapine group had DRS-R98 score of “0” with no significant difference between the two groups (P = 0.47).

CONCLUSION

Quetiapine is as effective as haloperidol in the management of delirium.

Keywords: Delirium; Quetiapine; Effectiveness; Atypical antipsychotics

Core tip: This Comparative study showed that quetiapine when used in the doses of 12.5-75 mg/d is as effective as haloperidol in the doses of 0.25-1.25 mg in management of delirium. The effectiveness of both the medications was similar in adult and elderly (≥ 60 years) patients. By 6th day, 37.5% patients in haloperidol group and 29.03% patients in the quetiapine group had Delirium Rating Scale-Revised-98 score of “0” with no significant difference between the two groups. Accordingly, this study suggests that quetiapine is as effective as haloperidol in the management of delirium.