Haloperidol and risperidone in the treatment of delirium and its subtypes

Background and Objectives: To compare the safety and efficacy of haloperidol and risperidone in the treatment of delirium and its subtypes Methods: We collected sociodemographic data and medical variables in addition to systematically rating all patients with delirium with the Memorial Delirium Assessment Scale (MDAS), Karnofsky Performance Status Scale (KPS) and abbreviated Udvalg for Kliniske Undersogelser (UKU) at baseline (T1), 2-3 days (T2) and 4-7 days (T3) and created an IRB-approved delirium database. For this secondary analysis we extracted all data containing haloperidol (HAL) and risperidone (RIS). Results: We were able to retrieve 32 patients treated with haloperidol (HAL) and risperidone (RIS) each. Both samples did not significantly differ in respect to age, cancer diagnoses or etiologies. The MDAS scores at baseline were higher in HAL treated subjects (20.2) compared to RIS treated subjects (17.7). The treatment results between HAL and RIS were not significantly different: Over the course of treatment MDAS scores improved from 20.2 to 8.3 (HAL) and 17.7 to 7.5 in (RIS), delirium resolution rates were 68.8% (HAL) and 84.4% (RIS). In hypoactive delirium the MDAS scores improved from 18.5 to 9.3 (HAL) and from 15.3 to 6.6 (RIS), delirium resolution rates were 64.3% (HAL) and 91.3% (RIS). In hyperactive delirium the MDAS scores improved from 22.5 to 6.6 (HAL) and 20.1 to 8.4 (RIS), delirium resolution rates were 72.2% (HAL) and 75% (RIS). There were no significant differences in KPS scores at all observation times. Treatment with HAL caused more EPS. Conclusions: Both haloperidol and risperidone may be equally effective in the treatment of delirium and its subtypes. Treatment with haloperidol resulted in more side effects. Received: 26 October 2009 Revised: 2 November 2010 Accepted: 18 December 2010 60 SOENKE BOETTGER, WILLIAM BREITBART AND STEVE PASSIK