せん妄に対する非定型抗精神病薬の有用性

The Usefulness of Atypical Antipsychotics in the Medication of Delirium

抄録

　近年，せん妄の薬物療法として非定型抗精神病薬の使用頻度が増加している。今回我々は，perospirone(38例)，risperidone内用液(30例)，olanzapine(5例)についてせん妄に対する有用性を検討し，いずれも8割以上の有効率が得られた。ただし，コンサルテーション・リエゾン活動の現場では糖尿病患者は少なくなく，せん妄の第一選択薬はserotonin-dopamine antagonist(SDA)になると考えられた。SDAで効果が不十分な場合はmulti-acting receptor targeted antipsychotics(MARTA)への変薬もしくは追加，糖尿病患者では定型抗精神病薬やmianserin，trazodoneへの変薬もしくは追加が望まれた。

　Although atypical antipsychotics have been widely used for the treatment of delirium in recent years, the exact differences among their therapeutic efficacies have not yet been fully evaluated. To further elucidate this issue, we examined and compared the effects of perospirone, risperidone and olanzapine on 38, 30 and 5 patients with delirium, respectively. The present results indicate that these three drugs are highly and almost equally effective in ameliorating the delirium symptoms such as excitement, hallucination and delusional state but have different side effects and pharmacodynamics. A substantial population of patients with diabetes under a delirious condition were recommended to be administered serotonin-dopamine antagonists (SDAs), perospirone and risperidone, because of their minimal influence on blood glucose metabolism. It is proposed that, for the treatment of the SDA-resistant delirium, we use olanzapine for those without diabetes and one of the agents including typical antipsychotics, mianserin and trazodone for those with diabetes.