Psychosomatics 43:175-182, June 2002
© 2002 The Academy of Psychosomatic Medicine
An Open Trial of Olanzapine for the Treatment of Delirium in Hospitalized Cancer Patients
William Breitbart, M.D.,
Annie Tremblay, M.D., and
Christopher Gibson, Ph.D.
Received September 7, 2001; accepted December 7, 2001. From the Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York; and Department of Psychiatry, Hotel Dieu Quebec, Quebec City, Canada. Address for correspondence and reprints: Dr. William Breitbart, Chief, Psychiatry Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1242 Second Avenue, Box 421, New York, New York 10021. E-mail; Breitbaw{at}mskcc.org
We conducted an open, prospective trial of olanzapine for the treatment of delirium in a sample of 79 hospitalized cancer patients. Patients all met DSM-IV criteria for a diagnosis of delirium and were rated systematically with the Memorial Delirium Assessment Scale (MDAS) as a measure of delirium severity, phenomenology, and resolution, over the course of a 7-day treatment period. Sociodemographic and medical variables and measures of physical performance status and drug-related side effects were collected. Fifty-seven patients (76%) had complete resolution of their delirium on olanzapine therapy. No patients experienced extrapyramidal side effects; however, 30% experienced sedation (usually not severe enough to interrupt treatment). Several factors were found to be significantly associated with poorer response to olanzapine treatment for delirium, including age >70 years, history of dementia, central nervous system spread of cancer and hypoxia as delirium etiologies, "hypoactive" delirium, and delirium of "severe" intensity (i.e., MDAS >23). A logistic-regression model suggests that age >70 years is the most powerful predictor of poorer response to olanzapine treatment for delirium (odds ratio, 171.5). Olanzapine appears to be a clinically efficacious and safe drug for the treatment of the symptoms of delirium in the hospitalized medically ill.
Key Words: Olanzapine • Delirium
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