Intensive Care Medicine

, Volume 30, Issue 3, pp 444–449 | Cite as

Olanzapine vs haloperidol: treating delirium in a critical care setting

  • Yoanna K. SkrobikEmail author
  • Nicolas Bergeron
  • Marc Dumont
  • Stewart B. Gottfried



To compare the safety and estimate the response profile of olanzapine, a second-generation antipsychotic, to haloperidol in the treatment of delirium in the critical care setting.


Prospective randomized trial


Tertiary care university affiliated critical care unit.


All admissions to a medical and surgical intensive care unit with a diagnosis of delirium.


Patients were randomized to receive either enteral olanzapine or haloperidol.


Patient’s delirium severity and benzodiazepine use were monitored over 5 days after the diagnosis of delirium.

Main results

Delirium Index decreased over time in both groups, as did the administered dose of benzodiazepines. Clinical improvement was similar in both treatment arms. No side effects were noted in the olanzapine group, whereas the use of haloperidol was associated with extrapyramidal side effects.


Olanzapine is a safe alternative to haloperidol in delirious critical care patients, and may be of particular interest in patients in whom haloperidol is contraindicated.


Delirium Therapy Critical care Olanzapine Haloperidol Parkinson’s disease 



Support for this study was generously provided by a (peer-reviewed) grant from the Zyprexa fund, Eli-Lilly, North America.


  1. 1.
    Dubois MJ, Bergeron N, Dumont M, Dial S, Skrobik Y (2001) Delirium in an intensive care unit: a study of risk factors. Intensive Care Med 27:1297–1304Google Scholar
  2. 2.
    Dial S, Payne J (2002) Managing delirium in the intensive care unit. Clin Pulm Med 9:260–266CrossRefGoogle Scholar
  3. 3.
    Kishi Y, Iwasaki Y, Takezawa K, Kurosawa H, Endo S (1995) Delirium in critical care unit patients admitted through an emergency room. Gen Hosp Psychiatry 17:371–379CrossRefPubMedGoogle Scholar
  4. 4.
    Aldemir M, Ôzen S, Hara IH, Sir A, Baç B (2001) Predisposing factors for delirium in the surgical intensive care unit. Crit Care 5:265–270CrossRefPubMedGoogle Scholar
  5. 5.
    Ely EW, Guatam S, Margolin R, Francis J, May L, Speroff T, Truman B, Dittus R, Bernard GR, Inouye SK (2001) The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 27:1892–1900CrossRefPubMedGoogle Scholar
  6. 6.
    McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E (2002) Delirium predicts 12-month mortality. Arch Intern Med 162:457–463CrossRefPubMedGoogle Scholar
  7. 7.
    McGuire BE, Basten CJ, Ryan CJ, Gallagher J (2000) Intensive care unit syndrome: a dangerous misnomer. Arch Intern Med 160:906–909PubMedGoogle Scholar
  8. 8.
    Armstrong SC, Cozza KL, Watanabe KS (1997) The misdiagnosis of delirium. Psychosomatics 38:433–439PubMedGoogle Scholar
  9. 9.
    Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y (2001) Intensive care delirium screening checklist: evaluation of a new screening tool. Intensive Care Med 27:859–864Google Scholar
  10. 10.
    Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). J Am Med Assoc 286:2703–2710CrossRefGoogle Scholar
  11. 11.
    American Psychiatric Association (1999) Practice guideline for the treatment of patients with delirium. Am J Psychiatry 156:1–20Google Scholar
  12. 12.
    Breitbart W, Gibson C, Tremblay A (2002) The delirium experience: delirium recall and delirium-related distress in hospitalized patients with cancer—their spouses/caregivers, and their nurses. Psychosomatics 43:183–194CrossRefPubMedGoogle Scholar
  13. 13.
    Menza MA, Murray GB, Holmes VF, Rafuls WA (1987) Decreased extrapyramidal symptoms with intravenous haldol. J Clin Psychiatry 48:278–280PubMedGoogle Scholar
  14. 14.
    Wise MG, Cassem NH (1998) Behavioural disturbances in the ICU. In: Civetta JM, Taylor RW, Kirby RR (eds) Critical care. Lippincott, Philadelphia, pp 1595–1604Google Scholar
  15. 15.
    Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, Chalfin DB, Masica MF, Bjerke S, Coplin WM, Crippen DW, Fuchs BD, Kelleher RM, Marik PE, Nasraway SA, Murray MJ, Peruzzi WT, Lumb PD (2002) Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30:119–141PubMedGoogle Scholar
  16. 16.
    King DJ, Burke M, Lucas RA (1995) Antipsychotic drug-induced dysphoria. Br J Psychiatry 167:480–482PubMedGoogle Scholar
  17. 17.
    Bashford G, Bradd P (1996) Drug-induced Parkinsonism associated with dysphagia and aspiration: a brief report. J Geriatr Psychiatry Neurol 9:133PubMedGoogle Scholar
  18. 18.
    Caroff SN, Mann SC, Campbell EC (2001) Neuroleptic malignant syndrome. Adverse drug reaction bulletin, no. 209. Lippincott, Williams and Wilkins, London, pp 799–802Google Scholar
  19. 19.
    Ilchef R (1997) Neuroleptic-induced laryngeal dystonia can mimic anaphylaxis. Aust N Z J Psychiatry 31:877–879PubMedGoogle Scholar
  20. 20.
    Perrault LP, Denault AY, Carrier M, Cartier R, Belisle S (2000) Torsades de pointes secondary to intravenous haloperidol after coronary bypass surgery. Can J Anesth 47:251–254Google Scholar
  21. 21.
    Kapur S, Remington G, Jones C, Wilson A, DaSilva J, Houle S, Zipursky R (1996) High levels of dopamine D2 receptor occupancy with low-dose haloperidol treatment: a PET study. Am J Psychiatry 153:948–950PubMedGoogle Scholar
  22. 22.
    Sipahimalani A, Masand PS (1997) Use of risperidone in delirium: case reports. Ann Clin Psychiatry 9:105–107CrossRefPubMedGoogle Scholar
  23. 23.
    Sipahimalani A, Sime RM, Masand PS (1997) Treatment of delirium with risperidone. Int J Geriatr Psychopharmacol 1:24–26Google Scholar
  24. 24.
    Sipahimalani A, Masand PS (1998) Olanzapine in the treatment of delirium. Psychosomatics 39:422–430PubMedGoogle Scholar
  25. 25.
    Kim K, Pae C, Chae J, Bahk W, Jun T (2001) An open pilot trial of olanzapine for delirium in the Korean population. Psychiatr Clin Neurosci 55:515–519CrossRefGoogle Scholar
  26. 26.
    Breitbart W, Tremblay A, Gibson C (2002) An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients. Psychosomatics 43:175–182CrossRefPubMedGoogle Scholar
  27. 27.
    Markowitz JS, Brown CS, Moore TR (1999) Atypical antipsychotics. Part I: Pharmacology, pharmacokinetics, and efficacy. Ann Pharmacother 33:73–85PubMedGoogle Scholar
  28. 28.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn (DSM-IV). American Psychiatric Association, Washington, DCGoogle Scholar
  29. 29.
    Cammarano WB, Drasner K, Katz J (1998) Pain control, sedation, and use of muscle relaxants. In: Hall JB, Schmidt GA, Wood LD, (eds) Principles of critical care medicine. McGraw Hill, New York, pp 90–97Google Scholar
  30. 30.
    McCusker J, Cole M, Bellavance F, Primeau F (1998) Delirium: reliability and validity of a new measure of severity of delirium. Int Psychogeriatr 10:421–433PubMedGoogle Scholar
  31. 31.
    Ramsay MA, Savege TM, Simpson BR, Goodwin R (1974) Controlled sedation with aphaxalonealphadolone. Br Med J 2:656–659PubMedGoogle Scholar
  32. 32.
    Chouinard G, Ross-Chouinard A, Annable L, Jones B (1980) Extrapyramidal symptom rating scale. Can J Neurol Sci 7:233Google Scholar
  33. 33.
    Simpson GM, Angus JW (1970) A rating scale for extrapyramidal side effects. Acta Psychiatr Scand Suppl 212:11–19PubMedGoogle Scholar
  34. 34.
    Skrobik Y (2002) Haloperidol should be used sparingly. Crit Care Med 30:2613–2614CrossRefPubMedGoogle Scholar
  35. 35.
    Caroff S, Rosenberg H, Mann S, Campbell E, Sullivan K (2002) Neuroleptic malignant syndrome in the critical care unit. Crit Care Med 30:2609–2610CrossRefPubMedGoogle Scholar
  36. 36.
    Trzepacz P (2000) Semin Clin Neuropsychiatry 5:132–148PubMedGoogle Scholar
  37. 37.
    Ross CA, Peyser CE, Shapiro I, Folstein MF (1991) Delirium: phenomenologic and etiologic subtypes. Int Psychogeriatr 3:135–147PubMedGoogle Scholar
  38. 38.
    Liptzin B, Levkoff SE (1992) An empirical study of delirium subtypes. Br J Psychiatry 161:843–845PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Yoanna K. Skrobik
    • 1
    Email author
  • Nicolas Bergeron
    • 2
  • Marc Dumont
    • 3
  • Stewart B. Gottfried
    • 4
  1. 1.Department of Critical CareMaisonneuve Rosemont Hospital, Université de MontrealMontrealCanada
  2. 2.Department of psychiatryCHUM (pavillon Notre Dame Université de Montréal)MontrealCanada
  3. 3.StatisticianCorev GroupMontrealCanada
  4. 4.Division of Respiratory and Critical Care, Department of MedicineMcGill University Health CentreMontrealCanada

Personalised recommendations