A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients.
A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients.
复制标题
氟哌啶醇、氯丙嗪和劳拉西泮治疗住院艾滋病患者谵妄的双盲试验。
DOI：
10.1176/ajp.153.2.231
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Jacobson,P
中科院分区：
文献类型：
--
作者：
Breitbart,W;Marotta,R;Platt,MM;Weisman,H;Derevenco,M;Grau,C;Corbera,K;Raymond,S;Lund,S;Jacobson,P
目的采用随机、双盲、对照的方法，观察氟哌啶醇、氯丙嗪和劳拉西潘治疗成人艾滋病患者妄想症状的疗效和不良反应。如果患者符合DSM-III-R的精神错乱标准，并在妄想评定量表上获得13分或更高分，则进入研究的治疗阶段。30例患者被随机分配到氟哌啶醇(N=11)、氯丙嗪(N=13)或劳拉西潘(N=6)治疗。采用妄想评定量表、简易精神状态评定量表和锥体外系症状评定量表对治疗相关的疗效和副作用进行重复评估。结果相对较小剂量的氟哌啶醇或氯丙嗪治疗后妄想评定量表评定的妄想症状明显改善。劳拉西吩组的妄想症状未见改善。接受氯丙嗪治疗的患者的认知功能从基线到第二天有显著改善，这是通过简易智力状态来衡量的。氟哌啶醇或氯丙嗪治疗锥体外系副作用的发生率极低。然而，所有接受劳拉西潘治疗的患者都出现了限制治疗的不良反应。虽然只有一小部分患者接受了劳拉西潘的治疗，但作者充分考虑到了副作用，及早终止了该方案。结论在内科住院的艾滋病患者中，使用小剂量的抗精神病药(氟哌啶醇或氯丙嗪)可以有效地治疗妄想症状，且副作用少。单靠劳拉西潘似乎是无效的，并与限制治疗的不良反应有关。
ObjectiveThe 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.MethodNondelirious, 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.ResultsTreatment 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.ConclusionsSymptoms 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.