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Antipsychotics for delirium.

E Lonergan, A M Britton, J Luxenberg

The Cochrane Database of Systematic Reviews

|April 20, 2007

Summary

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See all related articles

Low-dose haloperidol (a typical antipsychotic) is as effective as atypical antipsychotics for delirium treatment with similar side effects. High-dose haloperidol increased adverse effects, particularly parkinsonism.

Area of Science:

Pharmacology
Clinical Medicine
Geriatrics

Background:

Delirium affects up to 30% of hospitalized patients, increasing mortality and morbidity.
Haloperidol, a typical antipsychotic, is standard for delirium but causes extrapyramidal symptoms.
Atypical antipsychotics (risperidone, olanzapine, quetiapine) may offer similar efficacy with fewer side effects.

Purpose of the Study:

To compare the efficacy and adverse effect incidence of haloperidol versus atypical antipsychotics (risperidone, olanzapine, quetiapine) in delirium treatment.

Main Methods:

Systematic review of randomized controlled trials identified through specialized database searches.
Inclusion criteria: unconfounded, randomized trials with concealed allocation, pre- and post-treatment assessments.

Related Experiment Videos

Data extraction and analysis focused on intention-to-treat data, calculating odds ratios for efficacy and adverse events.

Main Results:

Low-dose haloperidol (<3.0 mg/day) showed no significant difference in delirium score reduction compared to olanzapine and risperidone.
Low-dose haloperidol did not have a higher incidence of adverse effects than atypical antipsychotics.
High-dose haloperidol (>4.5 mg/day) was linked to increased extrapyramidal adverse effects compared to olanzapine.

Conclusions:

Low-dose haloperidol efficacy and safety are comparable to olanzapine and risperidone for delirium management.
High-dose haloperidol is associated with more side effects, primarily parkinsonism.
Low-dose haloperidol may reduce delirium severity and duration in post-operative patients, but findings require further validation due to study limitations.