Risperidone in the treatment of delirium: results from a prospective open-label trial.
BACKGROUND
Effective treatment is necessary to reverse delirium and prevent potentially serious consequences.


METHODS
Patients were identified for screening by initial chart review of all consecutive admissions to the general medical or surgical wards at the Department of Veterans Affairs hospital and the University of Mississippi Medical Center in Jackson, Mississippi, between November 2000 and April 2002. Medically ill patients with delirium defined by DSM-IV criteria and a Delirium Rating Scale (DRS) score of >or= 13 were given risperidone, 0.5 mg, twice daily, with additional doses permitted on day 1 for target symptoms. Total day 1 dosage was given daily until the DRS score was <or= 12; dosage was then decreased by 50% (maintenance dose) and continued until day 6. Daily assessment included DRS, Cognitive Test for Delirium (CTD), and modified Extrapy-ramidal Symptom Rating Scale. Functional status (Karnofsky Scale of Performance Status; KSPS) and medical burden (Cumulative Illness Rating Scale) were assessed at baseline and day 6.


RESULTS
Ten patients (mean age = 64.7 years) were enrolled. Mean daily maintenance risperidone dosage was 0.75 mg. Mean CTD scores improved from day 1 to the day maintenance dose was initiated (p <.0005) and remained improved at day 6 (7.1 +/- 2.0 and 16.9 +/- 3.0, days 1 and 6, respectively; p =.0078). Mean DRS scores improved from day 1 to the day maintenance dose was initiated (p <.0001) and remained improved at day 6 (25.2 +/- 0.9 and 11.3 +/- 1.5, days 1 and 6, respectively; p <.0001). Mean KSPS scores improved from 32.0 on day 1 to 45.5 on day 6 (p =.044). No patient developed movement disorders. One patient each discontinued because of sedation and hypotension.


CONCLUSIONS
Low-dose risperidone can improve cognitive and behavioral symptoms of delirium in medically ill patients.
Mittal
Dinesh
D
Department of Veterans Affairs Medical Center, Jackson, Mississippi 39216, USA. dinesh.mittal@med.va.gov
Jimerson
Nita A
NA
Neely
Emily P
EP
Johnson
William D
WD
Kennedy
Richard E
RE
Torres
Rafael A
RA
Nasrallah
Henry A
HA
D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003693:Delirium / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004334:Drug Administration Schedule; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D018967:Risperidone / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D018967:Risperidone