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Am J Psychiatry 1996; 153:231-237
Copyright © 1996 by American Psychiatric Association
A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients
W Breitbart, R Marotta, MM Platt, H Weisman, M Derevenco, C Grau, K Corbera, S Raymond, S Lund and P Jacobson
Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
OBJECTIVE: The purpose of this study was to examine the efficacy and side
effects of haloperidol, chlorpromazine, and lorazepam for the treatment of
the symptoms of delirium in adult AIDS patients in a randomized,
double-blind, comparison trial. METHOD: Nondelirious, medically
hospitalized AIDS patients (N = 244) consented to participate in the study
and were monitored prospectively for the development of delirium. Patients
entered the treatment phase of the study if they met DSM-III-R criteria for
delirium and scored 13 or greater on the Delirium Rating Scale. Thirty
patients were randomly assigned to treatment with haloperidol (N = 11),
chlorpromazine (N = 13), or lorazepam (N = 6). Efficacy and side effects
associated with the treatment were measured with repeated assessments using
the Delirium Rating Scale, the Mini-Mental State, and the Extrapyramidal
Symptom Rating Scale. RESULTS: Treatment with either haloperidol or
chlorpromazine in relatively low doses resulted in significant improvement
in the symptoms of delirium as measured by the Delirium Rating Scale. No
improvement in the symptoms of delirium was found in the lorazepam group.
Cognitive function, as measured by the Mini-Mental State, improved
significantly from baseline to day 2 for patients receiving chlorpromazine.
Treatment with haloperidol or chlorpromazine was associated with an
extremely low prevalence of extrapyramidal side effects. All patients
receiving lorazepam, however, developed treatment- limiting adverse
effects. Although only a small number of patients had been treated with
lorazepam, the authors became sufficiently concerned with the adverse
effects to terminate that arm of the protocol early. CONCLUSIONS: Symptoms
of delirium in medically hospitalized AIDS patients may be treated
efficaciously with few side effects by using low-dose neuroleptics
(haloperidol or chlorpromazine). Lorazepam alone appears to be ineffective
and associated with treatment-limiting adverse effects.
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