섬망 치료에 있어서 지프라시돈(Ziprasidone)과 리스페리돈(Risperidone)의 효과 비교
Comparison between Effectiveness of Ziprasidone and Risperidone for Treatment of Delirium in Hospitalized Patients
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Objectives：It has been shown that risperidone, an atypical antipsychotics, has effectiveness for treatment of delirium as good as haloperidol and has less side effects than haloperidol. Ziprasidone also has less extrapyramidal and anticholinergic side effects, but there has been little information published on ziprasidone for the treatment of patients with delirium. Therefore, this study investigated whether ziprasidone had effectiveness for treatment of delirium and whether there was a differential effect between risperidone and ziprasidone. Methods：Sixteen patients with delirium were enrolled in this study. All subjects(16 patients) were randomized to receive either risperidone(7 patients) or ziprasidone(9 patients) with fixed dose at the first day of treatment. Risperidone group was given 1mg and ziprasidone group was given 20mg at the first day of treatment in the night. Then, all subjects received either medications with flexible doses according to judgement on clinical status of patients. The effectiveness was evaluated using Clinical Global Impression-Severity(CGI-S), Korean version of Delirium Rating Scale(K-DRS), Korean Mini Mental Status Examination(K-MMSE), and Korean version of Delirium Rating Scale- Revised-98. The side effects was evaluated using Extrapyramidal Symptom Rating Scale(ESRS) which was administered by a trained psychiatrist. Results：There was no significant difference between both groups in the baseline K-DRS, K-DRS-R-98, KMMSE and CGI scores. At the seventh day of the treatment, K-DRS, K-DRS-R-98 and CGI scores were significantly decreased from the baseline in the ziprasidone treatment group, but not in risperidone treatment group. Conclusion：These results suggest that ziprasidone appears to be more effective than risperidone for treatment of delirium.
Abstract
Objectives：It has been shown that risperidone, an atypical antipsychotics, has effectiveness for treatment of delirium as good as haloperidol and has less side effects than haloperidol. Ziprasidone also has less extrapyramidal and anticholinergic side effects, but there has been little information published on ziprasidone for the treatment of patients with delirium. Therefore, this study investigated whether ziprasidone had effectiveness for treatment of delirium and whether there was a differential effect between risperidone and ziprasidone. Methods：Sixteen patients with delirium were enrolled in this study. All subjects(16 patients) were randomized to receive either risperidone(7 patients) or ziprasidone(9 patients) with fixed dose at the first day of treatment. Risperidone group was given 1mg and ziprasidone group was given 20mg at the first day of treatment in the night. Then, all subjects received either medications with flexible doses according to judgement on clinical status of patients. The effectiveness was evaluated using Clinical Global Impression-Severity(CGI-S), Korean version of Delirium Rating Scale(K-DRS), Korean Mini Mental Status Examination(K-MMSE), and Korean version of Delirium Rating Scale- Revised-98. The side effects was evaluated using Extrapyramidal Symptom Rating Scale(ESRS) which was administered by a trained psychiatrist. Results：There was no significant difference between both groups in the baseline K-DRS, K-DRS-R-98, KMMSE and CGI scores. At the seventh day of the treatment, K-DRS, K-DRS-R-98 and CGI scores were significantly decreased from the baseline in the ziprasidone treatment group, but not in risperidone treatment group. Conclusion：These results suggest that ziprasidone appears to be more effective than risperidone for treatment of delirium.
참고문헌 (31)
- Brown TM, "Delirium", BMJ, 21, pp.644~647 (2002)
- Johnson JC, "Delirium in the elderly", Emerg Med Clin North Am, 8, pp.255~265 (1990)
- Lipowski ZJ, "Delirium(acute confusional states)", JAMA, 258, pp.1789~1792 (1987)
- McCusker J, "Delirium predicts 12-month mortality", Arch Intern Med, 162, pp.457~463 (2002)
- McCusker J, "Does delirium increase hospital stay?", J Am Geriatr Soc, 51, pp.1539~1546 (2003)
- Strain JJ, "Cost offset from a psychiatric consultation-liaison intervention with elderly hip fracture patients", Am J Psychiatry, 148, pp.1044~1049 (1991)
- van Zyl LT, "Delirium concisely condition is associated with increased morbidity, mortality, and length of hospitalization", Geriatrics, 61, pp.18~21 (2006)
- 김휘중, "섬망의 병태생리", 생물치료정신의학, 5(1), pp.65~77 (1999), 대한생물치료정신의학회
- Carnes M, "Physicians vary in approaches to the clinical management of delirium", J Am Geriatr Soc, 51, pp.234~239 (2003)
- Sipahimalani A, "Use of risperidone in delirium: case reports", Ann Clin Psychiatry, 9, pp.105~107 (1997)
- Breitbart W, "An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients", Psychosomatics, 43, pp.175~182 (2002)
- Torres R, "Use of quetiapine in delirium: case reports", Psychosomatics, 42, pp.347~349 (2001)
- Lee KU, "Amisulpride versus quetiapine for the treatment of delirium: a randomized, open prospective study", Int Clin Psychopharmacol, 20, pp.311~314 (2005)
- Straker DA, "Aripiprazole in the treatment of delirium", Psychosomatics, 47, pp.385~391 (2006)
- Leso L, "Ziprasidone treatment of delirium", Psychosomatics, 43, pp.61~62 (2002)
- Young CC, "Intravenous ziprasidone for treatment of delirium in the intensive care unit", Anesthesiology, 101, pp.794~795 (2004)
- Horikawa N, "Treatment for delirium with risperidone: results of a prospective open trial with 10 patients", Gen Hosp Psychiatry, 25, pp.289~292 (2003)
- Mittal D, "Risperidone in the treatment of delirium: results from a prospective open-label trial", J Clin Psychiatry, 65, pp.662~667 (2004)
- Han CS, "A double-blind trial of risperidone and haloperidol for the treatment of delirium", Psychosomatics, 45, pp.297~301 (2004)
- American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR 4th ed" (2000), American Psychiatric Association Press
- 이양현, "한국판 섬망 평가 척도의 표준화", 생물치료정신의학, 9(2), pp.181~190 (2003), 대한생물치료정신의학회
- 임경옥, "한국판 섬망 평가 척도-98(K-DRS-98)의 표준화 연구", 신경정신의학, 45(6), pp.518~526 (2006), 대한신경정신의학회
- 권용철, "노인용 한국판 간이 정신상태 검사 Mini-Mental State Examination(MMSE-K)의 표준화 연구", 대한신경정신의학회, 28, pp.125~135 (1989)
- Rush AJ, "Handbook of Psychiatric Measures. 1st ed", pp.100~102 (2000), American Psychiatric Association
- Chouinard G, "Manual for the Extrapyramidal Symptom Rating Scale(ESRS)", Schizophr Res, 76, pp.247~265 (2005)
- Trzepacz PT, "A symptom rating scale for delirium", Psychiatry Res, 23, pp.89~97 (1988)
- 임경옥, "한국판 섬망 평가 척도-98(K-DRS-98)의 표준화 연구", 신경정신의학, 45(6), pp.518~526 (2006), 대한신경정신의학회
- Miyaji S, "Comparison of the risk of adverse events between risperidone and haloperidol in delirium patients", Psychiatry Clin Neurosci, 61, pp.275~282 (2007)
- Taylor D, "Ziprasidone in the management of schizophrenia: the QT interval issue in context", CNS Drugs, 17, pp.423~430 (2003)
- Nasrallah HA, "The roles of efficacy, safety, and tolerability in antipsychotic effectiveness: practical implications of the CATIE schizophrenia trial", J Clin Psychiatry, 68(1), pp.5~11 (2007)
- 강연욱, "치매환자들을 대상으로한 K-MMSE의 타당도 연구", 대한신경과학회지, 15, pp.300~308 (1997)