Efficacy Of Olanzapine V/S Haloperidol In Treating Delirium In Intensive Care Settings – A Comparative Study From Southern Rajasthan.
DOI:
https://doi.org/10.69980/ajpr.v28i5.548Keywords:
ICU psychosis, delirium, antipsychotics, haloperidol, olanzapine.Abstract
Background: Delirium is a common yet often under diagnosed entity in medical and surgical intensive care (ICU) settings. Being a preventable and potentially reversible condition, the early recognition and optimal treatment of delirium is of vital importance in preventing its potential mortality. The FDA has approved haloperidol as well as olanzapine for treating ICU psychosis (delirium). This study aims to compare the efficacy of both drugs in treating ICU psychosis, while exploring their comparative safety profiles.
Methodology: A total sample population of 100 ICU patients diagnosed with delirium was recruited in the study and randomly divided in two treatment groups – haloperidol and olanzapine, after excluding delirium due to alcohol withdrawal (delirium tremens). Maximum dose of haloperidol administered was 2.5 mg/day (oral or parenteral) and of olanzapine was 5 mg/day. After taking consent from patient’s family member, the Delirium Screening Checklist, Delirium Rating Scale and Richmond Agitation Sedation Scale were applied in suspected delirium cases to record delirium severity score at zero hour. After drug administration, the scoring was repeated at 72 hours. Patient demographics and relevant clinical variables, along with any adverse drug effects were also recorded for further analysis.
Results: Severity of delirium significantly reduced in both treatment groups, regardless of underlying cause or comorbidity. Adverse drug effect of extrapyramidal signs was more seen with the use of haloperidol as compared to olanzapine. The underlying illness and dose of medication did not have a significant correlation with the extent of treatment response in both groups.
Conclusion: Adding to existing literature, this study reiterates that efficacy of both antipsychotics (typical – haloperidol and atypical – olanzapine) does not significantly differ in the treatment of delirium in ICU settings. The use of olanzapine seems to be overall safer as compared to haloperidol.
References
1. Salluh, J. I. F., et al. (2015). "Delirium epidemiology in critical care (DECCA): an international study." Critical Care, 14(6), R210.
2. NICE. (2010). Delirium: prevention, diagnosis and management. NICE Clinical Guidelines.
3. Girard, T. D., et al. (2008). "Clinical phenotypes of delirium during critical illness and severity of subsequent long-term cognitive impairment: a prospective cohort study." Lancet Respir Med, 6(3), 213–222.
4. Devlin, J. W., et al. (2010). "Pharmacologic prevention and treatment of delirium in the intensive care unit: A systematic review." Critical Care Medicine, 38(6), 139-148.
5. Pandharipande, P. P., et al. (2007). "Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients." Anesthesiology, 104(1), 21–26.
6. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, Tesoro EP, Elswick R. The Richmond Agitation–Sedation Scale: validity and reliability in adult intensive care unit patients. American journal of respiratory and critical care medicine. 2002 Nov 15;166(10):1338-44.
7. Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive care medicine. 2001 May;27:859-64
8. Trzepacz PT. The Delirium Rating Scale: its use in consultation-liaison research. Psychosomatics. 1999 May 1;40(3):193-204.
9. Jain R, Arun P, Sidana A, Sachdev A. Comparison of efficacy of haloperidol and olanzapine in the treatment of delirium. Indian Journal of Psychiatry. 2017 Oct 1;59(4):451-6.
10. van der Vorst MJ, Neefjes EC, Boddaert MS, Verdegaal BA, Beeker A, Teunissen SC, Beekman AT, Wilschut JA, Berkhof J, Zuurmond WW, Verheul HM. Olanzapine versus haloperidol for treatment of delirium in patients with advanced cancer: a phase III randomized clinical trial. The oncologist. 2020 Mar 1;25(3):e570-7.
11. Grover S, Kumar V, Chakrabarti S. Comparative efficacy study of haloperidol, olanzapine and risperidone in delirium. Journal of psychosomatic research. 2011 Oct 1;71(4):277-81.
12. Garg R, Singh Vk, Singh G. Comparison of Haloperidol and Quetiapine for Treatment of Delirium in Critical Illness: A Prospective Randomised Double-blind Placebo-controlled Trial. Journal of Clinical & Diagnostic Research. 2022 Jul 1;16(7).
13. Malik AK, Baidya DK, Anand RK, Subramaniam R. A new ICU delirium prevention bundle to reduce the incidence of delirium: a randomized parallel group trial. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine. 2021 Jul;25(7):754.
14. Jacob A, Chacko B, Sathyendra S, Peter JV, Abraham OC. Low Dose Risperidone Prophylaxis for The Prevention of Delirium in The Intensive Care Unit: A Randomized, Placebo Controlled Trial. Delirium Communications. 2023 Nov 6.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 American Journal of Psychiatric Rehabilitation
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License permitting all use, distribution, and reproduction in any medium, provided the work is properly cited.
