Treatment of Delirium in Older Adults with Quetiapine

Abstract

Delirium is a neuropsychiatric syndrome characterized by impairment of consciousness, changes in cognition, or perceptual disturbances. In addition, delirium is often accompanied by delusions, hallucinations, and agitation. In this study, 12 older patients with delirium were treated for neuropsychiatric symptoms with quetiapine. The mean duration for stabilization was 5.91 +/- 2.22 days, and the mean dose was 93.75 +/- 23.31 mg/day. None of the 12 patients developed extrapyramidal symptoms. There were significant improvements on all measures used in this study. Interestingly, the Delirium Rating Scale scores along with scores of the Mini-Mental State Examination and Clock Drawing Test continued to improve throughout the 3-month study period. In our study, we found that quetiapine was a safe and effective treatment in hospitalized older patients with delirium.

A randomized controlled trial of quetiapine versus placebo in the treatment of delirium

“…This study had a larger sample size than any of the RCTs in delirium reviewed by Boettger and Breitbart [14]. Even with a low dose, these results are consistent with the findings of previous RCTs of atypical antipsychotic medication [5,6,8] for delirium and non-RCT work with quetiapine [7,9]. The results of previous studies also suggest that low-dose antipsychotic medication effects improvement in the initial phase of treatment [14][15][16].…”

“…In two RCTs, olanzapine was recommended as a safe alternative to haloperidol in intensive care for managing delirium [5,6]. In a case series of 12 patients, quetiapine was found to be beneficial with improvement shown on Delirium Rating Scale scores along with improvement in scores of the Mini-Mental State Examination (MMSE) and Clock Drawing Test [7]. An open-labeled randomized prospective flexible dosing study found similar responses for amisulpride and quetiapine [8].…”

Drug treatment of delirium: Past, present and future

“…Similarly, further guidance on dosing of atypical antipsychotics is warranted. For example, mean daily quetiapine doses used in the studies identified were approximately 50 [45], 100 [28,30], and 200 mg [54]. These are lower than doses normally employed to treat schizophrenia.…”

“…Quetiapine has been reported to be a safe and effective treatment of delirium in a retrospective study [54], case series [28], and open prospective study [45]. A preliminary report of a small randomized placebo-controlled trial found significant improvement by the third day in noncognitive aspects of delirium, i.e., restlessness, agitation, thought, and perceptual disturbance with quetiapine [55].…”

The utility of the clock drawing test in detection of delirium in elderly hospitalised patients

“…Adamis, Morrison, Treloar, Macdonald, & Martin, 2005;Bryson et Aging & Mental Health, 2015http://dx.doi.org/10.1080/13607863.2015.1050996 et al, 2013Rolfson, McElhaney, Jhangri, & Rockwood, 1999) conclude that the CDT is not a suitable test to detect delirium. In addition, other studies have used the CDT to monitor response to treatment in delirium (Gamberini et al, 2009;Kim, Bader, Kotlyar, & Gropper, 2003;Zama, Maynard, & Davis, 2008). These studies to date have not clarified if performance on the CDT is related predominantly to the severity of cognitive impairment or to the broader spectrum of psychopathology that composes the delirium syndrome.…”