title: A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients.
abstract: OBJECTIVE
  The 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.
  
  
  METHODS
  Nondelirious, 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.
  
  
  RESULTS
  Treatment 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.
  
  
  CONCLUSIONS
  Symptoms 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.
authors.affiliation: Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: W
authors.initials: W
authors.lastname: Breitbart
authors.forename: R
authors.initials: R
authors.lastname: Marotta
authors.forename: M M
authors.initials: MM
authors.lastname: Platt
authors.forename: H
authors.initials: H
authors.lastname: Weisman
authors.forename: M
authors.initials: M
authors.lastname: Derevenco
authors.forename: C
authors.initials: C
authors.lastname: Grau
authors.forename: K
authors.initials: K
authors.lastname: Corbera
authors.forename: S
authors.initials: S
authors.lastname: Raymond
authors.forename: S
authors.initials: S
authors.lastname: Lund
authors.forename: P
authors.initials: P
authors.lastname: Jacobson
mesh_terms: D015526:AIDS Dementia Complex / Q000175:diagnosis / Q000188:drug therapy*; D000328:Adult; D001480:Basal Ganglia Diseases / Q000139:chemically induced / Q000453:epidemiology; D002746:Chlorpromazine / Q000009:adverse effects / Q000627:therapeutic use*; D003693:Delirium / Q000175:diagnosis / Q000188:drug therapy*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006220:Haloperidol / Q000009:adverse effects / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D008140:Lorazepam / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D006220:Haloperidol; D008140:Lorazepam; D002746:Chlorpromazine