A DOUBLE-BLIND TRIAL OF HALOPERIDOL, CHLORPROMAZINE, AND LORAZEPAM INTHE TREATMENT OF DELIRIUM IN HOSPITALIZED AIDS PATIENTS

Objective: The purpose of this study was to examine the efficacy and s ide effects of haloperidol, chlorpromazine, and lorazepam for the trea tment of the symptoms of delirium in adult AIDS patients in a randomiz ed, double-blind, comparison trial. Method: Nondelirious, medically ho spitalized AIDS patients (N=244) consented to participate in the study and were monitored prospectively for the development of delirium. Pat ients entered the treatment phase of the study if they met DSM-III-R c riteria for delirium and scored 13 or greater on the Delirium Rating S cale. Thirty patients were randomly assigned to treatment with haloper idol (N=11), chlorpromazine (N=13), or lorazepam (N=6). Efficacy and s ide effects associated with the treatment were measured with repeated assessments using the Delirium Rating Scale, the Mini-Mental State, an d the Extrapyramidal Symptom Rating Scale. Results: Treatment with eit her haloperidol or chlorpromazine in relatively low doses resulted in significant improvement in the symptoms of delirium as measured by the Delirium Rating Scale. No improvement in the symptoms of delirium was found in the lorazepam group. Cognitive function, as measured by the Mini-Mental State, improved significantly from baseline to day 2 for p atients receiving chlorpromazine. Treatment with haloperidol or chlorp romazine was associated with an extremely low prevalence of extrapyram idal side effects. All patients receiving lorazepam, however, develope d treatment-limiting adverse effects. Although only a small number of patients had been treated with lorazepam, the authors became sufficien tly concerned with the adverse effects to terminate that arm of the pr otocol early. Conclusions: Symptoms of delirium in medically hospitali zed AIDS patients may be treated efficaciously with few side effects b y using low-dose neuroleptics (haloperidol or chlorpromazine). Lorazep am alone appears to be ineffective and associated with treatment-limit ing adverse effects.