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An open trial of aripiprazole for the treatment of delirium in hospitalized cancer patients

Published online by Cambridge University Press:  22 November 2011

Soenke Boettger  and
William Breitbart
Soenke Boettger
Affiliation:
Department of Consultation Liaison Psychiatry and Medical Psychiatry, Bellevue Hospital Center, New York University Langone Medical Center, New York, New York
William Breitbart*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
*
Address correspondence and reprint requests to: William Breitbart, Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, 641 Lexington Avenue, New York, NY 10022. E-mail: breitbaw@mskcc.org
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Abstract

Objective:

The purpose of this study was to examine the efficacy and safety of aripiprazole in the treatment of delirium in hospitalized cancer patients, and to examine differential responses based on delirium subtypes.

Method:

We conducted an analysis of 21 hospitalized cancer patients at Memorial Sloan-Kettering Cancer Center (MSKCC) who had been evaluated and treated for delirium with aripiprazole, using an MSKCC Institutional Review Board (IRB) approved Clinical Delirium Database. Measures used were the Memorial Delirium Assessment Scale (MDAS), the Karnofsky Scale of Performance Status (KPS), and side effect rating at baseline (T1), 2–3 days (T2), and 4–7 days (T3). All measurements were integrated into the routine clinical care of patients. Doses of aripiprazole were adjusted based on clinical response.

Results:

Patients treated for delirium with aripiprazole experienced significant improvement and resolution of delirium, with MDAS scores declining from a mean of 18.0 at baseline (T1) to mean of 10.8 at T2 and a mean of 8.3 at T3. KPS scores improved from 28.1 at baseline (T1) to 35.2 at T2 and 41 at T3. Delirium resolved (based on MDAS < 10) in 52.4% of cases at T2 and in 76.2% at T3. The mean dosage of aripiprazole required was 18.3 mg (range of 5–30) daily at T3. In our cohort of patients with hypoactive delirium, we observed a delirium resolution rate of 100% compared to the cohort of patients with hyperactive delirium (58.3% rate of delirium resolution). MDAS scores improved from 15.6 at T1 to 5.7 at T3 in hypoactive delirium and from 19.9 at T1 to 10.2 at T3 in hyperactive delirium. In patients with pre-morbid cognitive deficits and the hyperactive subtype of delirium, we observed a more limited treatment response to aripiprazole treatment for delirium. There were no clinically significant side effects noted.

Significance of results:

Aripiprazole is effective and safe in the treatment of delirium in hospitalized cancer patients. These preliminary finding suggest that aripiprazole may be most effective in resolving delirium of the hypoactive subtype.

Keywords

DeliriumAripiprazoleAntipsychotic treatmentDelirium subtypesCancer
Type
Original Articles
Information
Palliative & Supportive Care , Volume 9 , Issue 4 , December 2011 , pp. 351 - 357
Copyright
Copyright © Cambridge University Press 2011

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