Evidence-Based Reviews

Antipsychotics for nonpsychotic illness

Current Psychiatry. 2013 February;12(2):22-30

References

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The most extensively studied SGA for treating delirium, risperidone often is used as an alternative to haloperidol. Case reports describe its potential efficacy.³² In a head-to-head study, risperidone was as effective as low-dose haloperidol for acute delirium treatment.³³

Clinical Point

In a head-to-head study, risperidone was as effective as low-dose haloperidol for acute delirium treatment

Olanzapine was effective in managing delirium in several case studies.³⁴ Also, in a 7-day, randomized, placebo-controlled study, olanzapine and haloperidol showed significantly greater and relatively equivalent improvement compared with placebo; patients treated with olanzapine experienced more rapid improvement in 1 study.³⁵

Case reports and prospective studies also have described quetiapine as effective for treating delirium.^36,37 In a prospective, double-blind, placebo-controlled study, patients taking quetiapine had a faster resolution of delirium with reduced overall duration and less agitation than those taking placebo.³⁷ Mortality, intensive care unit length of stay, and incidence of QTc prolongation did not differ, but patients treated with quetiapine were more likely to have increased somnolence and were more frequently discharged to home or rehabilitation centers. One limitation of the study is that concomitant haloperidol use on an “as needed” basis was permitted.³⁸

Evidence supporting the efficacy of ziprasidone for delirium is limited to case reports.³⁹ In 1 case report, a patient with chronic HIV infection and acute cryptococcal meningitis experienced significant improvement of delirium symptoms but could not continue ziprasidone because of fluctuating QTc intervals.⁴⁰

In 2 patients with delirium, aripiprazole, 15 and 30 mg/d, improved confusion, disorientation, and agitation within 7 days.⁴¹ In another study of delirium, 13 of 14 patients on flexibly dosed aripiprazole (5 to 15 mg/d) showed improvement in Clinical Global Impressions Scale scores, although 3 patients developed prolonged QTc intervals.⁴²

Stuttering or stammering

Stuttering or stammering are age-inappropriate disturbances in normal fluency and time patterning of speech. The evidence for antipsychotics to treat stuttering or stammering speech mainly consists of case reports and does not include disfluency frequency data, which makes it difficult to accept claims of efficacy. Disfluency frequency data describe how often a patient has specific disfluencies (blocks, prolongations, interjection, and repetition of syllables, words, or phrases).

Two FGAs (chlorpromazine and haloperidol) and 2 SGAs (risperidone and olanzapine) have been evaluated for treating stuttering. Children were 2.5 times more likely to demonstrate significant improvement when taking chlorpromazine vs placebo.⁴³ An open-label study of haloperidol lacked disfluency frequency data, therefore casting doubts on haloperidol’s reported efficacy in the study.⁴⁴

Clinical Point

Children were 2.5 times more likely to show improvement in stuttering when taking chlorpromazine vs placebo

In a case report, a 4-year-old boy with severe behavioral dyscontrol showed complete remission of stammering after 1 day of risperidone, 0.25 mg/d.⁴⁵ The patient’s symptoms reappeared several days after the drug was stopped. In a case series of 2 patients with developmental stuttering, 1 patient reported significant improvement in fluency with olanzapine, 2.5 mg/d, and the other showed marked improvement in fluency with 5 mg/d.⁴⁶

Related Resources

Sipahimalani A, Masand PS. Use of risperidone in delirium: case reports. Ann Clin Psychiatry. 1997;9(2):105-107.
Shapiro AK, Shapiro E, Wayne HL. Treatment of Tourette’s syndrome with haloperidol: review of 34 cases. Arch Gen Psychiatry. 1973;28(1):92-96.
Sipahimalani A, Masand PS. Olanzapine in the treatment of delirium. Psychosomatics. 1998;39(5):422-430.

Drug Brand Names

Aripiprazole • Abilify
Chlorpromazine • Thorazine
Clozapine • Clozaril
Fluphenazine • Permitil, Prolixin
Haloperidol • Haldol
Olanzapine • Zyprexa
Perphenazine • Trilafon
Pimozide • Orap
Prochlorperazine • Compazine
Quetiapine • Seroquel
Risperidone • Risperdal
Thioridazine • Mellaril
Trifluoperazine • Stelazine
Ziprasidone • Geodon

Disclosure

Dr. Macaluso has received grant or research support from EnVivo Pharmaceuticals, Janssen, L.P., and Pfizer, Inc.

Dr. Tripathi reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.