Effect of haloperidol dosing frequencies on the duration and severity of delirium in elderly hip fracture patients. A prospective randomized trial

Donders, E.; Tillemans, M.; Vreeswijk, Ralph; Grootendorst, Diana C.; Kalisvaart, Kees J.

doi:10.1016/j.eurger.2012.07.285

Cited by 2 publications

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“…A small RCT in 47 hip surgery patients aged 70 and older demonstrated that a haloperidol treatment regimen of 1 mg three times daily was more effective in reducing severity of established delirium than 1.5 mg twice-daily or 3 mg once-daily (mean highest DRS-R-98 score ± standard deviation of 15.8 ± 5.2, versus 21.3 ± 4.7, and 19.2 ± 6.1 respectively), while duration of delirium tended to be shorter in the twice-daily dosing group (2.3 ± 1.8 days, versus 3.9 ± 2.6 and 4.1 ± 1.9 days in the three times daily and once-daily group respectively). No side effects were noted in the total study population (total haloperidol dose 3 mg/day) [ 34 ]. In a large placebo-controlled RCT in 430 hip surgery patients aged 70 years and older, a three times daily prophylactic regimen with haloperidol (total dose 1.5 mg/day, maximum intervention period six days) did not significantly reduce postoperative delirium incidence in hip surgery patients, though it did significantly reduce delirium severity (mean highest DRS-R-98 score 14.4 ± 3.4 versus 18.4 ± 4.3) and duration (5.4 versus 11.8 days, 95% CI = 2.0-5.8; p < 0.001) in the haloperidol compared to the placebo group respectively [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of haloperidol prophylaxis for delirium prevention in older medical and surgical at-risk patients acutely admitted to hospital through the emergency department: study protocol of a multicenter, randomised, double-blind, placebo-controlled clinical trial

et al. 2014

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BackgroundDelirium is associated with substantial morbidity and mortality rates in elderly hospitalised patients, and a growing problem due to increase in life expectancy. Implementation of standardised non-pharmacological delirium prevention strategies is challenging and adherence remains low. Pharmacological delirium prevention with haloperidol, currently the drug of choice for delirium, seems promising. However, the generalisability of randomised controlled trial results is questionable since studies have only been performed in selected postoperative hip-surgery and intensive care unit patient populations. We therefore present the design of the multicenter, randomised, double-blind, placebo-controlled clinical trial on early pharmacological intervention to prevent delirium: haloperidol prophylaxis in older emergency department patients (The HARPOON study).Methods/DesignIn six Dutch hospitals, at-risk patients aged 70 years or older acutely admitted through the emergency department for general medicine and surgical specialties are randomised (n = 390) for treatment with prophylactic haloperidol 1 mg or placebo twice daily for a maximum of seven consecutive days. Primary outcome measure is the incidence of in-hospital delirium within seven days of start of the study intervention, diagnosed with the Confusion Assessment Method, and the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria for delirium. Secondary outcome measures include delirium severity and duration assessed with the Delirium Rating Scale Revised 98; number of delirium-free days; adverse events; hospital length-of-stay; all-cause mortality; new institutionalisation; (Instrumental) Activities of Daily Living assessed with the Katz Index of ADL, and Lawton IADL scale; cognitive function assessed with the Six-item Cognitive Impairment Test, and the Dutch short form Informant Questionnaire on Cognitive Decline in the Elderly. Patients will be contacted by telephone three and six months post-discharge to collect data on cognitive- and physical function, home residency, all-cause hospital admissions, and all-cause mortality.DiscussionThe HARPOON study will provide relevant information on the efficacy and safety of prophylactic haloperidol treatment for in-hospital delirium and its effects on relevant clinical outcomes in elderly at-risk medical and surgical patients.Trial registrationEudraCT Number: 201100476215; ClinicalTrials.gov Identifier: NCT01530308; Dutch Clinical Trial Registry: NTR3207

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of haloperidol prophylaxis for delirium prevention in older medical and surgical at-risk patients acutely admitted to hospital through the emergency department: study protocol of a multicenter, randomised, double-blind, placebo-controlled clinical trial

et al. 2014

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Drug Treatment of Other Psychiatric Conditions

2021

The Maudsley Prescribing Guidelines in Psychiatry

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Borderline personality disorder (BPD) is common in psychiatric settings, affecting 20% of community psychiatric patients. Common co‐morbid conditions affecting patients with BPD include affective disorders anxiety spectrum disorders, eating disorders, and drug and alcohol misuse, and the lifetime risk of having at least one co‐morbid mental disorder approaches 100%. Although classified as a personality disorder, several aspects of BPD have been assumed to be responsive to drug treatment. Drug treatments are often used during periods of crisis when symptoms can be severe, distressing and potentially life‐threatening. Psychiatric conditions often coexist with eating disorders, and this may in part explain the benefit sometimes seen with medication. Drugs have limited activity in anorexia nervosa, and none is currently licensed for this condition. Delirium is a common neuropsychiatric condition that presents in medical and surgical settings and is known by various names including organic brain syndrome, intensive care psychosis and acute confusional state.

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Effect of haloperidol dosing frequencies on the duration and severity of delirium in elderly hip fracture patients. A prospective randomized trial

Cited by 2 publications

References 0 publications

Efficacy and safety of haloperidol prophylaxis for delirium prevention in older medical and surgical at-risk patients acutely admitted to hospital through the emergency department: study protocol of a multicenter, randomised, double-blind, placebo-controlled clinical trial

Efficacy and safety of haloperidol prophylaxis for delirium prevention in older medical and surgical at-risk patients acutely admitted to hospital through the emergency department: study protocol of a multicenter, randomised, double-blind, placebo-controlled clinical trial

Drug Treatment of Other Psychiatric Conditions

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