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Quetiapine bij delirium 19 oktober 2010 Cindey Sijlbing.

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Presentatie over: "Quetiapine bij delirium 19 oktober 2010 Cindey Sijlbing."— Transcript van de presentatie:

1 Quetiapine bij delirium 19 oktober 2010 Cindey Sijlbing

2 Vraag: Is quetiapine additie bij haloperidol in de behandeling van een delirium zinvol en is monotherapie een goed alternatief?

3 Studies effect quetiapine in delirium - alleen quetiapine (3) - haloperidol vs quetiapine (1) - haldol + quetiapine vs haldol + placebo(1) Case reports (2) Reviews (5) Overige (1)

4 Haloperidol Voordelen haloperidol -orale, iv en parentale toediening -Sterke affiniteit dopamine receptor -Beperkte sedatatie -Nauwelijks anticholinerge effect Nadelen -EPS -QTc int verlening -VT

5 Quetiapine Voordelen quetiapine: -Affiniteit meerdere receptoren oa dopamine, seretonine, histamine -Beperkt anticholinerge effect -Zelden EPS -Korte ½ waarde tijd Nadeel: -Sedatie -Alleen per os of via sonde

6 Treatment delirium with quetiapine Thomas L, 2000 Type studie: retrospectief N: 22 (neuro + interne) Meetinstrument: DRS Dosis quetiapine: variabel Uitkomsten: -dag peak-respons -behandelduur -tolerantie middel

7 A prospective, open-label, flexible dose study of quetiapine in treatment of delirium Yukiya Sasaki, 2003 Type studie: prospectief N: 12 Meetinstrument: DRS, MMSE, DIEPSS Dosis quetiapine: variabel Uitkomst: -tijd tot remissie (DRS < 12) -MMSE score -tolerantie middel

8 Treatment of delirium in older adults with quetiapine Kye Y Kim, 2003 Type studie: prospectief N: 12 (≥ 60jr, mannen) Meetinstrument: DRS, CGI, MMSE, CDT Dosis quetiapine: variabel Outcome: -tijd tot stabilisatie -MMSE score -tolerantie middel

9 A pilot trial of quetiapine for the treatment of patients with delirium Chi-Un Pae, 2004 Type studie: prospectief, open label N: 22 Meetinstrument: DRS, CGI Dosis quetiapine: variabel Outcome: -tijd tot remissie (DRS < 15) -behandelduur -tolerantie middel

10 Resultaten/Conclusies: Quetiapine wrsch effectief bij delirium Gemidd duur behandeling: 8.5 dgn Gemidd duur tot remissie: 4.8 – 7.1dgn Dosis: 25-200mg per dag Quetiapine even effectief als haloperidol Gemidd piekrespons op dag 6.5 vs 7.6dgn Gemidd duur behandeling 13 vs 10.4dgn Q geeft minder (ernstige) bijwerkingen Vrijwel geen EPS, QTc interval verlening Q geeft vaak sedatie Enkele keren leidde dit tot staken medicatie

11 Beperkingen: Kleine studies (max 22 ptn) Specifieke populatie Niet placebo gecontroleerd Geen onderscheid in type delirium Bepaling remissie bij fluctuerend beeld

12 Efficacy and safety of qeutiapine in critically ill patients with delirium JW Devlin, 2010 Type studie: RCT, placebo gecontroleerd N: 36 (IC ptn, academisch ZH) Meetinstrument: ICSDC, SAS Dosis quetiapine: variabel, max 2dd 200 Uitkomst: -time to resolution (ICSDC ≤ 3) -duur aggiatie -verandering QTc interval, EPS

13 Ruime exclusie criteria Randomisatie in 2 groepen Beide groepen á 2h as needed iv haldol Groep 1, á 12h 50-100-150-200mg quetiapine Groep 2, á 12h placebo Sedativa & analgetica toediening vrij Participatie in studie max 10dgn DRS score per dienst VPK

14 Resultaten/conclusies Quetiapine + haloperidol effectiever dan alleen haloperidol Gemiddelde duur delirium: 36 vs 120h Gemiddelde ‘time to resolution’: 1 vs 4,5 Gemiddelde duur agitatie: 6 vs 36h Gemiddeld aantal dgn ≥ 1 dosis haloperidol 3 vs 4 Quetiapine + variabele dosis haloperidol veilig Hypotensie, somnolentie, geen EPS QTc interval verlenging/verandering vergelijkbaar Geen Torsades des pointes

15 Beperkingen Selectieve populatie Kleine studie Geen AP vrije controlegroep Haldol dosis variabel Toevoeging sedativa mogelijk Eenmalig ICDSC ≤ 3  remissie

16 Beantwoording vraag: Slechts 5 publicaties, matige kwaliteit, Klein aantal ptn. Lijkt veilig, mogelijk effect.

17 Literatuurlijst 1.Why all the confusion about confusion?Joffe AM. Crit Care Med. 2010 FebWhy all the confusion about confusion? 2.Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study.Devlin JW.Crit Care Med. 2010 FebEfficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. 3.Quetiapine in the treatment of postoperative delirium. A report of three cases.Khouzam HR.Compr Ther. 2008 4.Delirium and its treatment.Attard A.CNS Drugs. 2008Quetiapine in the treatment of postoperative delirium. A report of three cases.Delirium and its treatment. 5.Atypical antipsychotics for the treatment of delirious elders.Ozbolt LB. Am Med Dir Assoc. 2008 JanAtypical antipsychotics for the treatment of delirious elders. 6.An open-label study of quetiapine for delirium.Maneeton B. J Med Assoc Thai. 2007 OctAn open-label study of quetiapine for delirium. 7.Quetiapine as treatment for delirium during weaning from ventilation: a case report.Seemüller F. Clin Psychopharmacol. 2007 OcQuetiapine as treatment for delirium during weaning from ventilation: a case report. 8.Atypical antipsychotics versus haloperidol for treatment of delirium in acutely ill patients.Rea RS.Pharmacotherapy. 2007 AprAtypical antipsychotics versus haloperidol for treatment of delirium in acutely ill patients. 9.Antipsychotics in the treatment of delirium: a systematic review.Seitz DP. J Clin Psychiatry. 2007 Jan 10.Systematic review of antipsychotics for the treatment of hospital-associated delirium in medically or surgically ill patients.Lacasse H. Pharmacother. 2006 NovAntipsychotics in the treatment of delirium: a systematic review.Systematic review of antipsychotics for the treatment of hospital-associated delirium in medically or surgically ill patients. 11.Atypical antipsychotics in the management of delirium: a review of the empirical literature.Boettger Palliat support Care. 2005 SepAtypical antipsychotics in the management of delirium: a review of the empirical literature. 12.Treatment of Delirium With Quetiapine.Schwartz TL. J Clin Psychiatry. 2000 FebTreatment of Delirium With Quetiapine. 13.A pilot trial of quetiapine for the treatment of patients with delirium.Pae CU. Hum Psychopharmacol. 2004 Mar 14.A prospective, open-label, flexible-dose study of quetiapine in the treatment of delirium.Sasaki Y. J Clin Psychiatry. 2003 NovA pilot trial of quetiapine for the treatment of patients with delirium.A prospective, open-label, flexible-dose study of quetiapine in the treatment of delirium. 15.Quetiapine for treatment-resistant delirium.Al-Samarrai S. Psychosomatics. 2003 Jul-AugQuetiapine for treatment-resistant delirium. 16.Treatment of delirium in older adults with quetiapine.Kim KY. J Geriatr Psychiatry Neurol. 2003 MarTreatment of delirium in older adults with quetiapine. 17.The role of atypical antipsychotics in the treatment of delirium.Schwartz TL. Psychosomatics. 2002 May-JunThe role of atypical antipsychotics in the treatment of delirium. 18.The role of antipsychotics in treating delirium.Tune L.Curr Psychiatry Rep. 2002 JunThe role of antipsychotics in treating delirium. 19.Use of quetiapine in delirium: case reports.Torres R. Psychosomatics. 2001 Jul-AugUse of quetiapine in delirium: case reports.


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