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Original article

Vol. 147 No. 2930 (2017)

Pipamperone and delirium: a preliminary evaluation of its effectiveness in the management of delirium and its subtypes

DOI
https://doi.org/10.4414/smw.2017.14471
Cite this as:
Swiss Med Wkly. 2017;147:w14471
Published
24.07.2017

Summary

INTRODUCTION

Delirium has been recognised as an underdiagnosed and undermanaged syndrome with substantial prevalence rates and potentially deleterious consequences in the medically ill population. Despite its frequent administration in the management of delirium, the effectiveness of pipamperone has not yet been evaluated.

METHODS

In this retrospective, descriptive cohort study of 192 patients, pipamperone as monotherapy and as an adjunct to haloperidol, haloperidol alone, or atypical antipsychotics were compared with respect to their effectiveness in the management of delirium and its subtypes over the course of 20 days.

RESULTS

In this elderly patient population, pipamperone alone and as an adjunct to haloperidol was as effective as haloperidol or atypical antipsychotics in the management of delirium. Management with low-dose pipamperone monotherapy achieved delirium resolution in 70% of patients, over a mean of 6.4 (2–20) days. With pipamperone as an adjunct to haloperidol, delirium resolved in 59% of patients, over a mean of 7.4 (2–20) days. When haloperidol or atypical antipsychotics (risperidone, olanzapine or quetiapine) were used, the delirium resolution rates were 72 and 67%, over a mean of 5.2 (2–11) and 6.4 (2–20) days, respectively. The addition of pipamperone to haloperidol decreased the requirement for lorazepam. Pipamperone proved to be equally effective in all delirium subtypes – hypoactive, hyperactive and mixed. Nonetheless, potential bias could not be excluded in this observational design.

CONCLUSION

From these initial results, low-dose pipamperone was as effective as haloperidol or atypical antipsychotics in the management of delirium and its subtypes, and was benzodiazepine-sparing when used as an adjunct to haloperidol.

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association. 2000. 124–127
  2. Trzepacz PT, Breitbart W, Franklin J, Levenson J, Martini R, Wang P ; American Psychiatric Association. Practice guideline for the treatment of patients with delirium. Am J Psychiatry. 1999;156(5, Suppl):1–20.
  3. Voyer P, McCusker J, Cole MG, St-Jacques S, Khomenko L. Factors associated with delirium severity among older patients. J Clin Nurs. 2007;16(5):819–31. doi:.https://doi.org/10.1111/j.1365-2702.2006.01808.x
  4. Zaal IJ, Devlin JW, Peelen LM, Slooter AJ. A systematic review of risk factors for delirium in the ICU. Crit Care Med. 2015;43(1):40–7. doi:.https://doi.org/10.1097/CCM.0000000000000625
  5. Vasilevskis EE, Han JH, Hughes CG, Ely EW. Epidemiology and risk factors for delirium across hospital settings. Best Pract Res Clin Anaesthesiol. 2012;26(3):277–87. doi:.https://doi.org/10.1016/j.bpa.2012.07.003
  6. Morandi A, Jackson JC, Ely EW. Delirium in the intensive care unit. Int Rev Psychiatry. 2009;21(1):43–58. doi:.https://doi.org/10.1080/09540260802675296
  7. Mehta S, Cook D, Devlin JW, Skrobik Y, Meade M, Fergusson D, et al.; SLEAP Investigators; Canadian Critical Care Trials Group. Prevalence, risk factors, and outcomes of delirium in mechanically ventilated adults. Crit Care Med. 2015;43(3):557–66. doi:.https://doi.org/10.1097/CCM.0000000000000727
  8. Inouye SK. Delirium in hospitalized older patients. Clin Geriatr Med. 1998;14(4):745–64.
  9. Inouye SK. Delirium in older persons. N Engl J Med. 2006;354(11):1157–65. doi:.https://doi.org/10.1056/NEJMra052321
  10. Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol. 2009;5(4):210–20. doi:.https://doi.org/10.1038/nrneurol.2009.24
  11. Marcantonio E, Ta T, Duthie E, Resnick NM. Delirium severity and psychomotor types: their relationship with outcomes after hip fracture repair. J Am Geriatr Soc. 2002;50(5):850–7. doi:.https://doi.org/10.1046/j.1532-5415.2002.50210.x
  12. Kiely DK, Jones RN, Bergmann MA, Murphy KM, Orav EJ, Marcantonio ER. Association between delirium resolution and functional recovery among newly admitted postacute facility patients. J Gerontol A Biol Sci Med Sci. 2006;61(2):204–8. doi:.https://doi.org/10.1093/gerona/61.2.204
  13. McCusker J, Cole M, Dendukuri N, Belzile E, Primeau F. Delirium in older medical inpatients and subsequent cognitive and functional status: a prospective study. CMAJ. 2001;165(5):575–83.
  14. McCusker J, Cole M, Dendukuri N, Han L, Belzile E. The course of delirium in older medical inpatients: a prospective study. J Gen Intern Med. 2003;18(9):696–704. doi:.https://doi.org/10.1046/j.1525-1497.2003.20602.x
  15. Kiely DK, Marcantonio ER, Inouye SK, Shaffer ML, Bergmann MA, Yang FM, et al. Persistent delirium predicts greater mortality. J Am Geriatr Soc. 2009;57(1):55–61. doi:.https://doi.org/10.1111/j.1532-5415.2008.02092.x
  16. Lee KH, Ha YC, Lee YK, Kang H, Koo KH. Frequency, risk factors, and prognosis of prolonged delirium in elderly patients after hip fracture surgery. Clin Orthop Relat Res. 2011;469(9):2612–20. doi:.https://doi.org/10.1007/s11999-011-1806-1
  17. Meagher DJ, Trzepacz PT. Motoric subtypes of delirium. Semin Clin Neuropsychiatry. 2000;5(2):75–85.
  18. Abraha I, Rimland JM, Trotta F, Pierini V, Cruz-Jentoft A, Soiza R, et al. Non-Pharmacological Interventions to Prevent or Treat Delirium in Older Patients: Clinical Practice Recommendations The SENATOR-ONTOP Series. J Nutr Health Aging. 2016;20(9):927–36. doi:.https://doi.org/10.1007/s12603-016-0719-9
  19. Siddiqi N, Harrison JK, Clegg A, Teale EA, Young J, Taylor J, et al. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. 2016;3:CD005563.
  20. Friedman JI, Soleimani L, McGonigle DP, Egol C, Silverstein JH. Pharmacological treatments of non-substance-withdrawal delirium: a systematic review of prospective trials. Am J Psychiatry. 2014;171(2):151–9. doi:.https://doi.org/10.1176/appi.ajp.2013.13040458
  21. Kishi T, Hirota T, Matsunaga S, Iwata N. Antipsychotic medications for the treatment of delirium: a systematic review and meta-analysis of randomised controlled trials. J Neurol Neurosurg Psychiatry. 2016;87(7):767–74. doi:.https://doi.org/10.1136/jnnp-2015-311049
  22. Ellenbroek BA, Cools AR. Atypical Antipsychotics. Basel: Birkhäuser; 2012.
  23. Rothenhäusler HB. Klinik, Diagnostik und Therapie des nicht entzugsbedingten Delirs. Psychosom Konsiliarpsychiatr. 2008;2(3):160–7. doi:.https://doi.org/10.1007/s11800-008-0114-4
  24. Rothenhäusler HB. Psychopharmakotherapie bei somatischen Patienten im Allgemeinkrankenhaus. Spektrum Psychiatrie. 2010;1:20–3.
  25. Scheffer AC, van Munster BC, Schuurmans MJ, de Rooij SE. Assessing severity of delirium by the Delirium Observation Screening Scale. Int J Geriatr Psychiatry. 2011;26(3):284–91. doi:.https://doi.org/10.1002/gps.2526
  26. Schuurmans MJ, Shortridge-Baggett LM, Duursma SA. The Delirium Observation Screening Scale: a screening instrument for delirium. Res Theory Nurs Pract. 2003;17(1):31–50. doi:.https://doi.org/10.1891/rtnp.17.1.31.53169
  27. Inouye SK, Kosar CM, Tommet D, Schmitt EM, Puelle MR, Saczynski JS, et al. The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts. Ann Intern Med. 2014;160(8):526–33. doi:.https://doi.org/10.7326/M13-1927
  28. Böhmdorfer B, Rohleder S, Wawruch M, van der Cammen TJ, Frühwald T, Jagsch C, et al. DEL-FINE: a new tool for assessing the delirogenic properties of drugs of relevance for European pharmacotherapy. Z Gerontol Geriatr. 2016;49(5):416–22. doi:.https://doi.org/10.1007/s00391-015-0941-9
  29. Gaudreau JD, Gagnon P, Harel F, Roy MA, Tremblay A. Psychoactive medications and risk of delirium in hospitalized cancer patients. J Clin Oncol. 2005;23(27):6712–8. doi:.https://doi.org/10.1200/JCO.2005.05.140
  30. Boettger S, Breitbart W, Passik S. Haloperidol and risperidone in the treatment of delirium and its subtypes. Eur J Psychiatry. 2011;25(2):25–57.
  31. Liu CY, Juang YY, Liang HY, Lin NC, Yeh EK. Efficacy of risperidone in treating the hyperactive symptoms of delirium. Int Clin Psychopharmacol. 2004;19(3):165–8. doi:.https://doi.org/10.1097/00004850-200405000-00008
  32. Boettger S, Friedlander M, Breitbart W, Passik S. Aripiprazole and haloperidol in the treatment of delirium. Aust N Z J Psychiatry. 2011;45(6):477–82. doi:.https://doi.org/10.3109/00048674.2011.543411
  33. Breitbart W, Tremblay A, Gibson C. An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients. Psychosomatics. 2002;43(3):175–82. doi:.https://doi.org/10.1176/appi.psy.43.3.175
  34. Pourhoseingholi MA, Baghestani AR, Vahedi M. How to control confounding effects by statistical analysis. Gastroenterol Hepatol Bed Bench. 2012;5(2):79–83.

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