A randomized controlled trial of quetiapine versus placebo in the treatment of
delirium.
Author(s): Tahir TA, Eeles E, Karapareddy V, Muthuvelu P, Chapple S, Phillips B, Adyemo T,
Farewell D, Bisson JI.
Affiliation(s): Department of Liaison Psychiatry, University Hospital of Wales, Cardiff and Vale
University Health Board, Heath Park, Cardiff, UK. tayyeb.tahir@wales.nhs.uk
Publication date & source: 2010, J Psychosom Res. , 69(5):485-90
BACKGROUND: Delirium is a commonly occurring complex neuropsychiatric disorder.
Evidence for its treatment based on randomized controlled trials (RCTs) is poor.
AIMS: To determine the efficacy and acceptability of quetiapine in the treatment
of delirium.
METHOD: A double-blind, RCT was conducted. A total of 42 patients were randomized
to quetiapine or a placebo group. The primary outcome measure was the Delirium
Rating Scale Revised 98. Other scales used were the Brief Psychiatric Rating
Scale, Mini-Mental State Examination and Clinical Global Improvement. In order to
account for missing data, a nonlinear mixed-effects model was used to estimate
the difference between the two groups.
RESULTS: The quetiapine group improved more rapidly than the placebo group.
Specifically, the quetiapine group recovered 82.7% faster (S.E. 37.1%, P=.026)
than the placebo group in terms of DRS-R-98 severity score. In terms of the
DRS-R-98 noncognitive subscale, the quetiapine group improved 57.7% faster (S.E.
29.2%, P=.048) than the placebo group.
CONCLUSIONS: Quetiapine has the potential to more quickly reduce the severity of
noncognitive aspects of delirium. This study was underpowered for treatment
comparisons at specific points in time but nonetheless detected significant
differences when analyzing the whole study period. While it is not possible to
draw definitive conclusions, further larger studies exploring the use of
quetiapine in other delirium populations seem justified. Larger increments in the
dose of quetiapine may yield even stronger results.
|