Abnormalities in Glucose Blood Level during Antipsychotic Treatment in Schizophrenia Patients

Background: Schizophrenia is one of the mental disorder with many problematic issues, in both psychologically and socially. This disease requires provision of long-term antipsychotic therapy, hence could rise other potential health problems. Antipsychotic treatment can cause serious glucometabolic side-effects, including type 2 diabetes and hyperglycemic emergency. Recent attention has also been focused on antipsychotic-induced hyperglycemic emergencies experienced by new users of typical and atypical antipsychotic. Patients treated with atypical APDs have ~10 times higher risk in developing hyperglycaemic emergencies. In our pre-eliminary study, hyperglycemia condition in new patients occurs in four in seven patients who received typical and atypical antipsychotics. This condition is often overlooked and is not routinely evaluated. Moreover, it can develop into diabetes and increase the risk of morbidity and mortality in schizophrenia patients. In this study, we would like to determine the acute effects of metabolic (hyperglycemia) in patients treated with antipsychotic (Risperidone and Haloperidol) Measurement of blood sugar levels was performed in groups treated with haloperidol (N = 15) and treated with risperidone (N = 15). Plasma samples were taken at the beginning of treatment, in week IV, and in week VIII. The measurement of glucose levels was performed after meal and in early morning before breakfast (fasting blood glucose level 8 hours). Results: The blood sugar level after meals was significantly higher in the Risperidone group compared to the Haloperidol group (p <0.001) after IV and VIII weeks. Meanwhile, the fasting blood sugar level was significantly higher in the Risperidone group compared to the Haloperidol group after VIII weeks of treatment ( p <0.001). Conclusions: Both antipsychotics can cause an increase in blood sugar levels. Treatment with Risperidone significantly increased the blood sugar levels compared to treatment with haloperidol. Measurement of blood sugar level is needed to monitor the metabolic effect of antipsychotic, especially in patients treated with Risperidone. It is necessary to have dietary regulation and physical activities to prevent undesired metabolic side effects.

Comparison of the Effects of Haloperidol and Dexmedetomidine on Delirium and Agitation in Patients with a Traumatic Brain Injury Admitted to the Intensive Care Unit

Background: Patients under mechanical ventilation in the Intensive Care Unit (ICU) have a higher risk of delirium. To date, the ideal sedative combination for delirium treatment in terms of cost and side effects has not been determined. Objectives: This study was designed to compare the effects of haloperidol and dexmedetomidine on delirium in trauma patients under mechanical ventilation in the ICU. Methods: Sixty patients with a moderate traumatic brain injury were randomly divided into two groups. Patients in the haloperidol group received 2.5 mg of haloperidol intravenously every eight hours for ten minutes daily, and the dexmedetomidine group received 0.5 µg/kg of dexmedetomidine via intravenous infusion every other day. Delirium, agitation, length of hospitalization, duration of mechanical ventilation, and need for sedation up to seven days were measured and recorded in both groups. The Richmond Agitation-Sedation scale (RASS) and Acute Physiology and Chronic Health evaluation (APACHE II) scales were used to determine the level of agitation in patients. The Confusion Assessment method (CAM)-ICU criteria were used to determine the incidence of delirium. Results: Based on the results of this study, age and sex of the two groups were not significantly different. The mean age of the patients was 36.83 years in the haloperidol group and 40.1 years in the dexmedetomidine group. After the intervention, there was no significant difference in terms of the level of consciousness, number of days required for ventilation (P = 0.17), and number of days in the ICU (P = 0.49); however, there was a significant difference between the two groups three to seven days after the intervention. Besides, there was a significant difference between the two groups regarding the incidence of delirium five to seven days after the intervention (P < 0.05). Conclusions: There was a significant difference between the two groups in terms of the incidence of delirium and the level of agitation; the patients in the dexmedetomidine group were calmer and experienced less delirium.

Total Cholesterol Levels in Men with Schizophrenia Receiving Risperidone and Haloperidol Treatment

AIM: The objectives of the study were to compare total cholesterol levels in men with schizophrenia receiving risperidone and haloperidol treatment. METHODS: We conducted on treatment analysis experiment study involving 30 subjects who received risperidone and 30 subjects who received haloperidol. Total cholesterol levels were examined at week 0 and week 8. RESULTS: There were no statistically significant differences in baseline characteristics. At week 8, mean of total cholesterol level in the risperidone group was 207.23 ± 21.49 compared to 188.17 ± 17.00 in the haloperidol group. A difference of 19.06 ± 5.00 (95% CI 9.05–29.08) was observed, which is statistically significant (p < 0.001). CONCLUSIONS: There was a statistically significant increase in total cholesterol levels in men with schizophrenia receiving risperidone compared to haloperidol.

A Retrospective Comparison of the Effectiveness and Safety of Intravenous Olanzapine Versus Intravenous Haloperidol for Agitation in Adult Intensive Care Unit Patients

Objective: Intravenous (IV) olanzapine could be an alternative to first-generation antipsychotics for the management of agitation in intensive care unit (ICU) patients. We compared the effectiveness and safety of IV olanzapine to IV haloperidol for agitation management in adult patients in the ICU at a tertiary academic medical center. Methods: A retrospective cohort study was conducted. The primary outcome was the proportion of patients who achieved a Richmond Agitation Sedation Scale (RASS) score of < +1 within 4 hours of IV olanzapine or IV haloperidol administration. Secondary outcomes included the proportion of patients who required rescue medications for agitation within 4 hours of initial IV olanzapine or IV haloperidol administration, incidence of adverse events and ICU length of stay. Results: In the 192 patient analytic cohort, there was no difference in the proportion of patients who achieved a RASS score of < +1 within 4 hours of receiving IV olanzapine or IV haloperidol (49% vs. 42%, p = 0.31). Patients in the IV haloperidol group were more likely to receive rescue medications (28% vs 55%, p < 0.01). There was no difference in the incidence of respiratory events or hypotension between IV olanzapine and IV haloperidol. Patients in the IV olanzapine group experienced more bradycardia (11% vs. 3%, p = 0.04) and somnolence (9% vs. 1%, p = 0.02) compared to the IV haloperidol group. Patients in the IV olanzapine group had a longer median ICU length of stay (7.5 days vs. 5 days, p = 0.04). Conclusion: In this retrospective cohort study, there was no difference in the effectiveness of IV olanzapine compared to IV haloperidol for the management of agitation. IV olanzapine was associated with an increased incidence of bradycardia and somnolence.

Should we still monitor QTc duration in frail older patients on low-dose haloperidol? A prospective observational cohort study

Background Haloperidol at high dosage is associated with QTc prolongation and polymorphic ventricular arrhythmia but the effects of low-dose haloperidol remain unknown. Objective To evaluate the effects of low-dose haloperidol on QTc-duration in frail hospitalized elderly patients with delirium. Methods A prospective observational study including hospitalized patients aged ≥70 years with Groningen Frailty Index-score &gt; 3. We included 150 patients who received haloperidol and 150 age- and frailty-matched control patients. Serial ECG recordings were performed at hospital admission and during hospitalization. QT-interval was corrected according to Framingham (QTc). Patients were grouped according to baseline QTc in normal (nQTc), borderline (bQTc) or abnormal (aQTc). Primary outcome was change in QTc-duration between first and second ECG. Potentially dangerous QTc was defined as QTc &gt;500 ms or an increase of &gt;50 ms. Results Patients in the haloperidol group (48% male, mean age 85y, nQT n = 98, bQT n = 31, aQT n = 20) received an average dose of 1.5 mg haloperidol per 24 hours. QTc decreased in patients with borderline (mean − 15 ± 29 ms, P &lt; 0.05) or abnormal (−19 ± 27 ms, P &lt; 0.05) QTc at baseline, no patients developed dangerous QTc-duration. In the control group (41% male, mean age 84y, nQT n = 99 bQT n = 29, aQT n = 22) QTc decreased to a similar extent (bQT −7 ± 16 ms, aQTc −23 ± 20 ms). Conclusion A trend to QTc shortening was seen, especially in patients with borderline or abnormal QTc at baseline, regardless of haloperidol use. These findings suggest that ECG monitoring of frail elderly patients who receive low-dose haloperidol, may not be necessary.

The Difference Scores of Positive and Negative Syndrome Scale Exited Components in Psychotic Agitation Patients of Haloperidol Injection and those Prescribed with the Injection of Haloperidol and Diazepam

BACKGROUND: The availability of psychotic medications in primary health care in Indonesia is in a limited number. The center of psychiatric health-care provides varied types of medications. However, the quantities are limited, in which the second generation of psychotic drugs is relatively expensive. Common available drug medications are haloperidol and diazepam. AIM: This study aims to investigate the difference scores of Positive and Negative Syndrome Scale (PANSS-EC) in psychotic agitation patients of haloperidol prescription and those who have been prescribed with haloperidol and diazepam injections at Prof. Dr. M. Ildrem Mental Hospital, Medan North Sumatera, Indonesia. METHODS: This study involved 64 psychotic agitation patients who were divided into two groups. The first group was 32 patients who have been prescribed by 5 mg of haloperidol injections and the second group was 32 patients who have been injected by 5 mg of haloperidol and 10 mg of diazepam. The PANSS-EC score assessment was performed for 1 h due to the side effects of medication consumption. RESULTS: A significant comparison in terms of the decreasing of PANSS-EC scores in psychotic agitation patients who have been injected by the combination of haloperidol and diazepam was confirmed during the assessment of 30 and 60 min (p < 0.001). The extrapyramidal side effects in haloperidol group were found in two subjects, and the reinjections of combination therapy of haloperidol and diazepam were lower than those with one type of drugs medication, which, respectively, were accounted for 56.25% and 84.37%. CONCLUSIONS: Combination therapy of haloperidol and diazepam had more accelerating effects in reducing agitation compared to those prescribed by only haloperidol.

LO69: Haloperidol versus ondansetron for hyperemesis due to cannabis (HaVOC): a randomized, controlled clinical trial

Introduction: One of the most common adverse effects of habitual cannabis use is hyperemesis—recurrent bouts of protracted vomiting, retching and abdominal pain superimposed on a baseline of daily nausea and anorexia. Largely anecdotal evidence supports the use of haloperidol, benzodiazepines or topical capsaicin over traditional antiemetics, yet little is known about the cause or optimal treatment of this newly recognized disorder. We report the results of one of the first clinical trials on so-called cannabis hyperemesis syndrome (NCT03056482). Methods: We approached adults with a working diagnosis of hyperemesis due to cannabis, provided they had ongoing emesis for >2 hours, a cyclic pattern of 3+ episodes in the last 2 years, and near daily use of cannabis by inhalation. We excluded those who were pregnant, deemed unreliable, or using opioids. Subjects provided written consent to be randomized during the index or any subsequent visit to either haloperidol (with a nested randomization to either 0.05 mg/kg or 0.1 mg/kg) or ondansetron 8 mg intravenously in a quadruple-blind fashion, and to be followed for 7 days. The primary outcome was the average reduction from baseline in abdominal pain and nausea (each measured on a 10-cm VAS) at 2 hours. While the original trial design allowed for crossover, the primary analysis used only the first treatment period since fewer than the prespecified threshold of 20% of subjects crossed over. Results: We enrolled 33 subjects, of whom 30 (16 men, 29+/-11 years old, using 1.5+/-0.9 g/day since age 19+/-2 years) were treated at least once (haloperidol 13, ondansetron 17). Haloperidol at either dose was superior to ondansetron (difference 2.3 cm [95%CI 0.6, 4.0]; p = 0.01), with similar improvements in both pain and nausea, as well as less rescue antiemetics (27% vs 61%; p = 0.04), and shorter time to ED departure (3.1+/-1.7 vs 5.6+/-4.5 hours; p = 0.03 Wilcoxon rank sum). There were two (haloperidol) vs six (ondansetron) return visits for ongoing nausea/vomiting, as well as two return visits for acute dystonia, both in the higher dose haloperidol group. Conclusion: Haloperidol is superior to ondansetron for the acute symptomatic treatment of patients with ongoing hyperemesis attributed to habitual cannabis use. The efficacy of this agent over ondansetron provides insight into the mechanism of this new disorder, now almost a daily diagnosis in many Canadian emergency departments.

Sedation and Non-Invasive Mask Ventilation in Patients with Delirium and Acute Respiratory Failure

Aim: To compare the safety and efficacy of dexmedetomidine and haloperidol in patients with delirium and acute respiratory failure in non-invasive mask lung ventilation.Materials and methods. We carried out a retrospective analysis of data on patients with somatogenic delirium and acute respiratory failure (57 men, 4 women) experienced noninvasive ventilation (NIV) in the intensive care unit of the Botkin State Clinical Hospital in 2017–2018. Depending on the type of sedation the patients were divided into two groups: those on dexmedetomidine (n=31) and those receiving haloperidol (n=30). Dexmedetomidine was administered as a continuous infusion at a rate of 0.2–1.4 µg/kg/h while controlling the level of consciousness; haloperidol was administered by intravenous bolus injections until a sufficient level of sedation was reached in a dose of 2.5 mg 2–3 times a day.Results. The efficiency of sedation to achieve the required level of cooperation and possibility of NIV was 87.1% (27 patients) and 66.6% (20 patients) in dexmedetomidine and haloperidol groups. When estimating sedation in patients of both groups according to the RASS scale the scores did not differ significantly and were equal on the average to 1.7±0.3 (eye contact to voice). In haloperidol group in 10 out of 30 (33.3%) patients a sufficient level of sedation was not achieved, which required immediate tracheal intubation and invasive lung ventilation. Mortality in this group was 20% (6 patients), while in dexmedetomidine group it was 6.4% (2 patients).Conclusion. The use of dexmedetomidine, despite greater variability of hemodynamic parameters, allows to perform NIV with sufficient cooperation with the patient, reduces the frequency of tracheal intubation, risk of complications and mortality.

IATROGENIC MALE INFERTILITY WITH PSYCHOTROPIC DRUGS IN RATS: CASE OF HALOPERIDOLAND CLOMIPRAMINE.

Objective:To study the effects of haloperidol and clomipramine on fertility in male rats. Material And Method: This is an analytical experimental study. Three lots of 5 rats were formed: distilled water lot at 0.5 ml/100g; Clomipramine lot at 2 mg/kg/day; haloperidol lot 2.5 mg/kg/day. The diferent product were daily oraly administrated during 45 days. The study variables were: testicular weights, spermogram and hormonal biomarkers (testosterone, FSH, LH). Results: On the average testicular weight (in grams): control 1.3±0.05; haloperidol 1.2±0.20; clomipramine 1.19±0.009 and on the pH: control 6.8 ±0.12; haloperidol 6.9±0.18; Clomipramine 6.8 ±0.2. There is no significant change in testicular weight and sperm pH compared to controls. Concerning the vitality, number, and morphological abnormalities of sperm cells, there are no significant changes. Vitality in % : control 55.4±3.15, haloperidol 44.9±6.20, Clomipramine 45.2±5.11 and sperm count (x106 / ml): (control 269.6±40.54, haloperidol 145.6±39.77, clomipramine 317.6±98.58). Sperm morphological abnormalities (% of normal morphology): (control 91.2; haloperidol 87.7; Clomipramine 81.8). Clomipramine caused a very significant increase (p=0.0036) in the serum concentration of FSH and LH (in IU/l) (P=0.0001): for control LH 0.46; clomipramine 3.46; for FSH: control 0.87; Clomipramine; however, there is an insignificant increase in testosterone (in ng/ml) with these two psychotropic drugs (control 1.56; haloperidol 2.66; Clomipramine 2.9). However, no significant difference of reproductive hormons were observed with haloperidol group (testosterone 2, 66; FSH 0, 72; LH 0, 26). Conclusion: Haloperidol and Clomipramine affect male fertility: Clomipramine at the peripheral level and haloperidol at the central level.

The Side Effect of Haloperidol in Schizophrenic Patients: Analysis of Red Blood Cell Distribution Width (RDW) and Mean Platelet Volume (MPV) Values

INTRODUCTION: Like the increase of pro-inflammatory cytokines and oxidative stress as schizophrenia pathophysiology, haloperidol also increases RDW and MPV values. Both of these values ​​have been clinicians concern because they are a risk factor for the various type of vascular disease. OBJECTIVE: This study aims to determine the side effect of haloperidol on RDW and MPV values in schizophrenic patients. METHODS: This research method uses observational analytic design with a prospective cohort approach with pre and posts analysis conducted at the Regional Special Hospital of South Sulawesi Province during May - July 2018 in 30 schizophrenic subjects. The subjects were diagnosed as first episode schizophrenia based on ICD 10, blood samples were taken, for RDW and MPV values ​​before and after haloperidol was given at the 4th and 8th weeks. RESULTS: The results showed that the mean RDW value at the 4th week was higher in 15 mg/day haloperidol group (15.8) compared to 7.5 mg/day haloperidol group (15.3) with p&lt;0.05. Mean RDW value taken at 8th week was higher in 15 mg/day haloperidol group (16.4) compared to 7.5 mg/day haloperidol group (15.6) with p&lt;0.001. Mean MPV value taken at 8th week was higher in 15 mg/day haloperidol group (13.3) compared to 7.5 mg/day haloperidol group (11.6) with p&lt;0.001. CONCLUSION: This study showed an increase in the RDW value in schizophrenia subjects prior to the haloperidol administration. RDW ​​and MPV values were higher after haloperidol treatment compares to before haloperidol treatment. The increase of RDW and MPV values tend to be influenced by haloperidol dosage and administration duration.