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An open trial of aripiprazole for the treatment of delirium in hospitalized cancer patients

Published online by Cambridge University Press:  22 November 2011

Soenke Boettger  and
William Breitbart
Soenke Boettger
Affiliation:
Department of Consultation Liaison Psychiatry and Medical Psychiatry, Bellevue Hospital Center, New York University Langone Medical Center, New York, New York
William Breitbart*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
*
Address correspondence and reprint requests to: William Breitbart, Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, 641 Lexington Avenue, New York, NY 10022. E-mail: [email protected]
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Abstract

Objective:

The purpose of this study was to examine the efficacy and safety of aripiprazole in the treatment of delirium in hospitalized cancer patients, and to examine differential responses based on delirium subtypes.

Method:

We conducted an analysis of 21 hospitalized cancer patients at Memorial Sloan-Kettering Cancer Center (MSKCC) who had been evaluated and treated for delirium with aripiprazole, using an MSKCC Institutional Review Board (IRB) approved Clinical Delirium Database. Measures used were the Memorial Delirium Assessment Scale (MDAS), the Karnofsky Scale of Performance Status (KPS), and side effect rating at baseline (T1), 2–3 days (T2), and 4–7 days (T3). All measurements were integrated into the routine clinical care of patients. Doses of aripiprazole were adjusted based on clinical response.

Results:

Patients treated for delirium with aripiprazole experienced significant improvement and resolution of delirium, with MDAS scores declining from a mean of 18.0 at baseline (T1) to mean of 10.8 at T2 and a mean of 8.3 at T3. KPS scores improved from 28.1 at baseline (T1) to 35.2 at T2 and 41 at T3. Delirium resolved (based on MDAS < 10) in 52.4% of cases at T2 and in 76.2% at T3. The mean dosage of aripiprazole required was 18.3 mg (range of 5–30) daily at T3. In our cohort of patients with hypoactive delirium, we observed a delirium resolution rate of 100% compared to the cohort of patients with hyperactive delirium (58.3% rate of delirium resolution). MDAS scores improved from 15.6 at T1 to 5.7 at T3 in hypoactive delirium and from 19.9 at T1 to 10.2 at T3 in hyperactive delirium. In patients with pre-morbid cognitive deficits and the hyperactive subtype of delirium, we observed a more limited treatment response to aripiprazole treatment for delirium. There were no clinically significant side effects noted.

Significance of results:

Aripiprazole is effective and safe in the treatment of delirium in hospitalized cancer patients. These preliminary finding suggest that aripiprazole may be most effective in resolving delirium of the hypoactive subtype.

Keywords

DeliriumAripiprazoleAntipsychotic treatmentDelirium subtypesCancer
Type
Original Articles
Information
Palliative & Supportive Care , Volume 9 , Issue 4 , December 2011 , pp. 351 - 357
Copyright
Copyright © Cambridge University Press 2011

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References

REFERENCES

Alao, A.O. & Moskowitz, L. (2006). Aripiprazole and delirium. Annals of Clinical Psychiatry, 18, 267–269.CrossRefGoogle ScholarPubMed
Alao, A.O., Soderberg, M., Pohl, E.L., et al. (2005). Aripiprazole in the treatment of delirium. International Journal of Psychiatry in Medicine, 35, 429–433.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association. 124–127.Google Scholar
Arnt, J. (1998). Pharmacological differentiation of classical and novel antipsychotics. International Clinical Psychopharmacology, 13, Suppl. 3, S7–14.CrossRefGoogle ScholarPubMed
Boettger, S. & Breitbart, W. (2005). Atypical antipsychotics in the management of delirium: a review of the empirical literature. Palliative & Supportive Care, 3, 227–237.CrossRefGoogle ScholarPubMed
Bond, S.M., Neelon, V.J. & Belyea, M.J. (2006). Delirium in hospitalized older patients with cancer. Oncology Nursing Forum, 33, 1075–1083.CrossRefGoogle ScholarPubMed
Breitbart, W., Marotta, R., Platt, M.M., et al. (1996). A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. American Journal of Psychiatry, 153, 231–237.Google ScholarPubMed
Breitbart, W., Rosenfeld, B., Roth, A., et al. (1997). The memorial delirium assessment scale. Journal of Pain and Symptom Management, 13, 128–137.CrossRefGoogle ScholarPubMed
Breitbart, W. & Strout, D. (2000). Delirium in the terminally ill. Clinics in Geriatric Medicine, 16, 357–372.CrossRefGoogle ScholarPubMed
Breitbart, W., Tremblay, A. & Gibson, C. (2002). An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients. Psychosomatics, 43, 175–182.CrossRefGoogle ScholarPubMed
Bucht, G., Gustafson, Y. & Sandberg, O. (1999). Epidemiology of delirium. Dementia and Geriatric Cognitive Disorders, 10, 315–318.CrossRefGoogle ScholarPubMed
DeLeon, A., Patel, N.C. & Crismon, M.L. (2004). Aripiprazole: A comprehensive review of its pharmacology, clinical efficacy, and tolerability. Clinical Therapeutics, 26, 649–666.CrossRefGoogle ScholarPubMed
Factor, S.A. (2002). Pharmacology of atypical antipsychotics. Clinical Neuropharmacology, 25, 153–157.CrossRefGoogle ScholarPubMed
Gagnon, B., Low, G. & Schreier, G. (2005). Methylphenidate hydrochloride improves cognitive function in patients with advanced cancer and hypoactive delirium: A prospective clinical study. Journal of Psychiatry & Neuroscience, 30, 100–107.Google ScholarPubMed
Inouye, S.K. (1998). Delirium in hospitalized older patients. Clinics in Geriatric Medicine, 14, 745–764.CrossRefGoogle ScholarPubMed
Kane, J.M. (2001). Extrapyramidal side effects are unacceptable. European Neuropsychopharmacology 11, Suppl. 4, S397–S403.CrossRefGoogle ScholarPubMed
Karnofsky, D.A.Burchenal, J.H. (1949). The Clinical Evaluation of Chemotherapeutic Agents in Cancer. Evaluation of Chemotherapeutic Agents. New York: Columbia University Press. 191–205.Google Scholar
Lawlor, P.G., Nekolaichuk, C., Gagnon, B., et al. (2000). Clinical utility, factor analysis, and further validation of the memorial delirium assessment scale in patients with advanced cancer: Assessing delirium in advanced cancer. Cancer, 88, 2859–2867.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
Lingjaerde, O., Ahlfors, U.G., Bech, P., et al. (1987). The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatrica Scandinavica Supplementum, 334, 1–100.CrossRefGoogle Scholar
Lipowski, Z.J. (1989). Delirium in the elderly patient. New England Journal of Medicine, 320, 578–582.Google ScholarPubMed
Lonergan, E., Britton, A.M., Luxenberg, J., et al. (2007). Antipsychotics for delirium. Cochrane Database of Systematic Reviews, CD005594.CrossRefGoogle ScholarPubMed
Massie, M.J., Holland, J. & Glass, E. (1983). Delirium in terminally ill cancer patients. American Journal of Psychiatry, 140, 1048–1050.Google ScholarPubMed
Meagher, D., Moran, M., Raju, B., et al. (2008a). A new data-based motor subtype schema for delirium. The Journal of Neuropsychiatry and Clinical Neurosciences, 20, 185–193.CrossRefGoogle ScholarPubMed
Meagher, D.J., Moran, M., Raju, B., et al. (2008b). Motor symptoms in 100 patients with delirium versus control subjects: Comparison of subtyping methods. Psychosomatics, 49, 300–308.CrossRefGoogle ScholarPubMed
Meagher, D.J., O'Hanlon, D., O'Mahony, E., et al. (2000). Relationship between symptoms and motoric subtype of delirium. The Journal of Neuropsychiatry and Clinical Neurosciences, 12, 51–56.CrossRefGoogle ScholarPubMed
Miyamoto, S., Duncan, G.E., Marx, C.E., et al. (2004). Treatments for schizophrenia: A critical review of pharmacology and mechanisms of action of antipsychotic drugs. Molecular Psychiatry, 10, 79–104.CrossRefGoogle Scholar
Platt, M.M., Breitbart, W., Smith, M., et al. (1994). Efficacy of neuroleptics for hypoactive delirium. The Journal of Neuropsychiatry and Clinical Neurosciences, 6, 66–67.Google ScholarPubMed
Sommer, B.R., Wise, L.C. & Kraemer, H.C. (2002). Is dopamine administration possibly a risk factor for delirium? Critical Care Medicine, 30, 1508–1511.CrossRefGoogle ScholarPubMed
Straker, D.A., Shapiro, P.A. & Muskin, P.R. (2006). Aripiprazole in the treatment of delirium. Psychosomatics, 47, 385–391.CrossRefGoogle ScholarPubMed
Taylor, D.M. (2003). Aripiprazole: A review of its pharmacology and clinical use. International Journal of Clinical Practice, 57, 49–54.CrossRefGoogle ScholarPubMed
Trzepacz, P.T. (1999). Update on the neuropathogenesis of delirium. Dementia and Geriatric Cognitive Disorders, 10, 330–334.CrossRefGoogle ScholarPubMed
Trzepacz, P.T., Breitbart, W., Franklin, J., et al. (1999). Practice guideline for the treatment of patients with delirium. American Psychiatric Association. American Journal of Psychiatry, 156, 1–20.Google Scholar