섬망 환자의 치료에서 항정신병 약물의 진정효과에 따른 반응 비교

Comparison of Treatment Response of Antipsychotics According to Sedative Effect in the Treatment of Patients with Delirium

섬망의 약물치료에서 저수면유발성 항정신병약물이 고수면유발성 항정신병약물에 비하여 치료 초기 2일간의 반응에서 더 좋은 효과를 보임과 동시에 관해에 이르는 시간이 더 빠르며, 항정신병약물 사용기간 또한 단축시킨다는 사실을 보여주었다. 본 연구를 통해 섬망 환자에서의 적절한 약물치료가 섬망 증상 호전뿐 아니라 초기 반응 및 치료 결과를 향상시킬 수 있는 중요한 역할을 가지고 있음을 이해할 수 있다.

Objective The purpose of the study is to compare treatment responses and side effects of antipsychotic medications in hospitalized delirium patients. Methods Among delirium patients hospitalized 23 less-sedating agent group and 26 sedating agent group were included in the study. Less sedating agents are haloperidol and risperidone, and sedating agents are olanzapine and quetiapine. All candidates underwent Clinical Global Impression Scale (CGI), Delirium Rating Scale-Revised 98 (DRS-R 98), and Extrapyramidal Symptom Rating Scale during the treatment period. At baseline, 1st day, 2nd day, 3rd day, 4th day, 5th day, 6th day, 7th day, 10th day, and 14th day, we compared treatment responses and side effect profiles between two groups. Results The remission defined as below 16 score of DRS-R 98, and the remission rate of both group were 78.3% at less-sedating agent group, and 80.8% at sedating agent group. They showed no difference each other. Time to remission of less-sedating group was significantly shorter than sedating group, they were 2.89±1.41 days at less-sedating agent group, and 5.76±4.45 days at sedating agent group (p=0.015). After 2 days of treatment, less-sedating agent group showed greater decrement of CGI-S score than sedating agent group, the score were 3.22±1.20 at less-sedating agent, and 4.00±1.22 at sedating agent group (p=0.030). And DRS-R 98 score after 2 days of treatment showed difference between both group, less-sedating agent group was 17.00±8.88, and sedating group was 22.72±8.49, they were different statistically (p=0.044). The mean dosage of each drugs were haloperidol 1.93 mg, risperidone 0.71 mg, olanzapine 3.75 mg, and quetiapine 46.09 mg. But there were no significant differences of rate of adverse effects. Conclusion There were no differences of total remission rate and rate of adverse effects between two groups for 2 weeks. But less-sedating agent group showed shorter time to remission and shorter duration of medication than sedating agent group. This study suggests that less-sedating agents are more suitable for early days of delirium treatment.