An open trial of aripiprazole for the treatment of delirium in hospitalized cancer patients
An open trial of aripiprazole for the treatment of delirium in hospitalized cancer patients
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DOI：
10.1017/s1478951511000368
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发表时间：
2011-12-01
影响因子：
2.2
通讯作者：
Breitbart, William
中科院分区：
文献类型：
--
作者：
Boettger, Soenke;Breitbart, William
目的：本研究的目的是检验阿立哌唑治疗住院癌症患者谵妄的有效性和安全性，并检查基于谵妄亚型的差异反应。方法：我们使用 MSKCC 机构审查委员会 (IRB) 批准的临床谵妄数据库，对纪念斯隆-凯特琳癌症中心 (MSKCC) 接受过阿立哌唑谵妄评估和治疗的 21 名住院癌症患者进行了分析。使用的测量方法包括纪念谵妄评估量表 (MDAS)、卡诺夫斯基体能状态量表 (KPS) 以及基线 (T1)、2-3 天 (T2) 和 4-7 天 (T3) 时的副作用评级。所有测量都被纳入患者的常规临床护理中。根据临床反应调整阿立哌唑的剂量。 结果：接受阿立哌唑治疗的谵妄患者的谵妄得到显着改善和缓解，MDAS 评分从基线 (T1) 的平均 18.0 下降至 T2 的平均 10.8 和 T3 的平均 8.3。 KPS 分数从基线 (T1) 的 28.1 提高到 T2 的 35.2 和 T3 的 41。 T2 时谵妄缓解率为 52.4%（基于 MDAS < 10），T3 时谵妄缓解率为 76.2%。 T3 时所需的阿立哌唑平均剂量为每天 18.3 mg（范围为 5-30）。在我们的低活跃性谵妄患者队列中，我们观察到与多动性谵妄患者队列相比，谵妄缓解率为 100%（谵妄缓解率为 58.3%）。活动性谵妄的 MDAS 评分从 T1 的 15.6 提高到 T3 的 5.7，活动性谵妄的 MDAS 评分从 T1 的 19.9 提高到 T3 的 10.2。在患有病前认知缺陷和谵妄多动亚型的患者中，我们观察到阿立哌唑治疗谵妄的治疗反应更为有限。没有发现临床上显着的副作用。结果的意义：阿立哌唑对于治疗住院癌症患者的谵妄是有效且安全的。这些初步发现表明阿立哌唑可能对解决活动减退亚型的谵妄最有效。
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.