ABSTRACT
The present study aimed to examine the relationship between plasma concentration levels of risperidone and clinical effects in the treatment of delirium. We conducted a prospective, open-label, flexible-dose study of risperidone oral solution. Ten patients with delirium were assessed using Delirium Rating Scales. Plasma concentration levels of risperidone were measured 30 min after the first administration of a 0.5 mg dose. Two patients with high plasma levels had adverse effects and one patient with the lowest plasma level did not achieve remission; the remaining seven patients achieved remission without any adverse effects. A highly significant negative correlation was observed in these responders without adverse effects between the plasma levels and durations of treatment until remission (r=-0.861, P=0.0095). The plasma concentration level of risperidone at 30 min after the first 0.5 mg dose may be a favourable response predictor in the treatment of delirium. Further studies in larger samples are needed to verify this preliminary finding.
Subject(s)
Antipsychotic Agents/therapeutic use , Delirium/drug therapy , Risperidone/therapeutic use , Administration, Oral , Aged , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/blood , Delirium/blood , Female , Humans , Male , Middle Aged , Prospective Studies , Psychiatric Status Rating Scales , Risperidone/administration & dosage , Risperidone/blood , Time FactorsSubject(s)
Antipsychotic Agents/adverse effects , Antipsychotic Agents/therapeutic use , Dibenzothiazepines/therapeutic use , Dystonia/chemically induced , Dystonia/drug therapy , Adult , Drug Administration Schedule , Dyskinesia, Drug-Induced/drug therapy , Dyskinesia, Drug-Induced/etiology , Humans , Male , Quetiapine Fumarate , Schizophrenia/drug therapy , Treatment OutcomeABSTRACT
BACKGROUND: Delirium is an organic psychiatric syndrome characterized by fluctuating consciousness and impaired cognitive functioning. High-potency typical neuroleptics have traditionally been used as first-line drugs in the treatment of delirium. However, these drugs are frequently associated with undesirable adverse events including extrapyramidal symptoms (EPS). The purpose of the present open-label, flexible-dose study was to provide preliminary data on the usefulness and safety of quetiapine for patients with delirium. METHOD: Twelve patients with DSM-IV delirium were treated with flexible doses of open-label quetiapine (mean +/- SD dosage = 44.9 +/- 31.0 mg/day). To evaluate the usefulness and safety of quetiapine, scores from the Delirium Rating Scale, Japanese version, were assessed every day (for 1 outpatient, at least twice per week), and scores from the Mini-Mental State Examination, Japanese version, and the Drug-Induced Extrapyramidal Symptom Scale were assessed at baseline and after remission of delirium. Data were gathered from April to October 2001. RESULTS: All patients achieved remission of delirium several days after starting quetiapine (mean +/- SD duration until remission = 4.8 +/- 3.5 days). Quetiapine treatment was well tolerated, and no clinically relevant change in EPS was detected. CONCLUSION: Quetiapine may be a useful alternative to conventional neuroleptics in the treatment of delirium due to its rapid onset and relative lack of adverse events. Further double-blind, placebo-controlled studies are warranted.